Pulmonary Rehabilitation and Noninvasive Ventilation in Patients with Hypercapnic Interstitial Lung Disease

Abstract

Background: Pulmonary rehabilitation (PR) has a positive impact on functional status and quality of life in patients with interstitial lung disease (ILD). Objectives: This study investigated the effects of PR in hypercapnic ILD patients receiving nighttime noninvasive positive pressure ventilation (NPPV). Methods: Consecutive ILD patients referred to a specialized inpatient PR center were included. All participated in a PR program. Those with hypercapnia received NPPV (NPPV group; n = 29); the remaining patients served as comparison group (n = 319). Results: PR improved the 6-min walk distance by 64.4 ± 67.1 m versus baseline (p < 0.0001) in NPPV patients and by 43.2 ± 55.1 m (p < 0.0001) in the comparison group (difference 21.1 m, 95% confidence interval 0.5-41.8; p = 0.045). There was no change in total lung capacity during PR in NPPV recipients or the comparison group. Forced vital capacity significantly increased from baseline in the comparison, but not the NPPV group. NPPV recipients were significantly more likely than the comparison group to have improved dyspnea during PR (p = 0.049). There was no improvement in the 36-item Short Form (SF-36) physical component score in the NPPV group after PR, but there was in the comparison group. PR improved the SF-36 mental component score versus baseline in both groups. Conclusion: An individually tailored PR plus nighttime NPPV appears feasible in hypercapnic ILD patients and significantly improves exercise capacity and quality of life.

Short-Term Effects of a Multimodal 3-Week Inpatient Pulmonary Rehabilitation Programme for Patients with Sarcoidosis: The ProKaSaRe Study

“…Additionally, ProKaSaRe provides initial evidence that PR leads to significant and clinically relevant improvements that can be measured directly after the rehabilitation. Our results support the recommendations of other studies and highlight the importance of individualised multimodal PR concepts [4, 7, 52], while suggesting that training and rehabilitation are important and effective complementary therapies for the management of all degrees of burden of sarcoidosis. The extent of the positive effects of PR should be investigated further.…”

Non‐invasive ventilation during cycle exercise training in patients with chronic respiratory failure on long‐term ventilatory support: A randomized controlled trial

“…5,6 Severe stable chronic obstructive pulmonary disease (COPD) patients undergoing home nocturnal NIV and daytime ET show a significant improvement in exercise capacity and health-related quality of life (HRQL) as compared with patients undergoing ET alone. [7][8][9] Similar results have been reported in patients with interstitial lung 10 and restrictive thoracic diseases (RTD). 11,12 Furthermore, in chronic hypercapnic COPD patients under long-term ventilatory support, NIV can be administered during walking, resulting in improved oxygenation, 13 decreased dyspnoea and increased walking distance.…”

Non-Invasive Ventilation as an Adjunct to Exercise Training in Chronic Ventilatory Failure: A Narrative Review

“…In a RCT on a small sample size of patients with restrictive thoracic disease, home-based exercise training with NIV was effective and feasible [26], confirming an old physiological small study [27]. A non-randomised study showed that an individually tailored pulmonary rehabilitation programme plus night-time NIV was feasible in hypercapnic patients with interstitial lung disease and significantly improved exercise capacity and HRQL [28]. …”