Differences in Response to Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis and Chronic Obstructive Pulmonary Disease

Abstract

Background: The benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) are well recognized. However, whether individuals with idiopathic pulmonary fibrosis (IPF) benefit is less clear. Objectives: To evaluate the effects of pulmonary rehabilitation in subjects with IPF and compare their responses with a group of COPD subjects who underwent an identical program. Methods: For- ty-five subjects with IPF and 45 age- and Medical Research Council grade-matched COPD subjects were recruited. Subjects completed an 8-week outpatient pulmonary rehabilitation program. Dyspnea, peripheral muscle force, exercise capacity (6-min walk distance, 6MWD), activities of daily living, and health status (36-item short-form survey, SF-36) were assessed at baseline, immediately following and at 6 months following completion of the program. Results: Adherence to the program was similar in both groups. Significant improvements in dyspnea, muscle force, exercise capacity and ADL were observed in both groups (all p < 0.05); however, the magnitude of improvement in all outcomes was less in the IPF group [mean (95% CI) improvement in 6MWD, IPF 16.2 (7.1–25.4); COPD 53.1 (44.9–61.2)]. All domains of SF-36, with the exception of social function, improved (all p < 0.05) in the COPD group; however, there were no changes in SF-36 scores in the IPF group. The benefits were well maintained in the COPD group at 6 months, but, with the exception of the ADL score, the benefits were no longer present in the IPF group. Conclusions: Pulmonary rehabilitation in IPF produces only modest short-term gains in dyspnea, exercise capacity and ADL, but does not improve health status.

Effects of inpatient pulmonary rehabilitation in patients with interstitial lung disease

“…Therefore, our data show a significant and clinically important improvement in all sub-and summary-scores of SF-36. Our observation is in concordance with some published studies [8,23,31,33], while others did not detect any influence of PR in HRQL [10,24,25]. NAJI et al [31] demonstrated in their group of ILD patients a significant reduction in anxiety and depression after completing PR.…”

“…We observed a small, statistically significant improvement of blood gas analysis and lung function parameters, which is in line with other published studies [10,23]. Although these improvements are statistically significant, their clinical relevance is probably negligible.…”

“…FERREIRA et al [22] measured an average increase of 56 m in their study with 113 ILD patients and SWIGRIS et al [25] documented an improvement of 61 m in 6MWD in their study of 21 IPF patients. In contrast, KOZU et al [10] found only an increase of 16 m in 6MWD in 36 IPF patients. Based on lung function parameters, patients included in all of these studies showed less advanced ILD with a lower proportion of LTOT when compared with our study population (table 4).…”

“…We speculate that ILD patients walking at their highest possible capacities achieve their dyspnoea maximum more rapidly, in contrast to COPD patients, independent of the distance walked. However, due to conflicting data from different studies, dyspnoea rating is still under debate in IPF patients [10,[22][23][24][25].…”

“…However, data supporting PR in patients with ILD are scarce and the effects of PR in patients with ILD are largely unknown. While ventilatory limitation and skeletal muscle dysfunction are present in both COPD and ILD, impaired pulmonary gas exchange and circulatory factors may be more important in ILD patients [10][11][12].…”