Pulmonary Rehabilitation in Interstitial Lung Disease: Benefits and Predictors of Response

Alicia Ferreira, MD; Chris Garvey, FNP; Gerilynn L. Connors, RRT; Lana Hilling, RCP; Julia Rigler, RRT; Susan Farrell, RRT; Cindy Cayou, RCP; Cyrus Shariat, MD; Harold R. Collard, MD, FCCP


CHEST. 2009;135(2):442-447. 

In This Article

Abstract and Introduction


Background: Data examining the role of pulmonary rehabilitation (PR) in interstitial lung disease (ILD) are limited. We tested the hypothesis that PR can improve functional status and dyspnea in a large group of patients with ILD, and that certain baseline patient variables can predict this improvement.
Methods: Data from patients who were referred to PR with a diagnosis of ILD were included. Baseline and post-PR variables were recorded, and changes in 6-min walk test (6MWT) distance and dyspnea were evaluated. The impact of baseline variables on change in 6MWT distance and dyspnea were analyzed.
Results: A statistically significant difference was seen in both the change in Borg score and 6MWT distance after PR (p < 0.0001). These changes were consistent with previously established clinically significant differences. Baseline 6MWT distance was a significant predictor of change in 6MWT distance (p < 0.0001), with increasing baseline 6MWT distance predicting a smaller improvement after PR.
Conclusions: These results suggest that PR should be considered as a standard of care for patients with ILD.

Pulmonary rehabilitation (PR) has been defined as an "evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory disease who are symptomatic and often have decreased daily life activities."[1] Although the American Thoracic Society/European Respiratory Society consensus statement on PR supports the use of PR in the management of chronic respiratory disease regardless of cause, the data supporting its use come largely from the study of COPD, in which PR has been shown to increase exercise endurance, decrease dyspnea, improve health related quality of life, and reduce health-care cost.[1,2,3,4,5,6] Data examining the role of PR in other forms of chronic lung disease such as interstitial lung disease (ILD) are emerging.

ILD is a diverse group of pulmonary disorders characterized by involvement of the lung parenchyma by inflammation and fibrosis, leading to restrictive physiology and common clinical, radiographic, physiologic, and pathologic manifestations. Patients with ILD frequently present with exertional dyspnea, which has been shown to be closely related to quality of life.[7,8,9] The mechanisms through which ILD produces dyspnea differ in some aspects from those in COPD and include neuromechanical dissociation, physiologic restriction (due to reduced compliance and increased elastic recoil), ventilation-perfusion derangements, diffusion impairment, circulatory and cardiovascular limitations, anxiety, and depression, as well as skeletal and ventilatory muscle weakness.[7,10,11]

PR is likely to improve several of these factors, particularly cardiovascular performance, muscle strength, and mood disorders, and there have been several studies[12,13,14,15,16,17] that support this contention. Unfortunately, none of these studies is sufficiently large to conclusively demonstrate clinically meaningful benefits of PR in this population, and none have looked at possible predictors of response. We tested the hypothesis that PR can improve functional status and dyspnea in a large group of patients with ILD, and that certain baseline patient variables can predict this improvement.


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