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. 2019 Apr 8;5(2):00045-2019.
doi: 10.1183/23120541.00045-2019. eCollection 2019 Apr.

Long-term evaluation of home-based pulmonary rehabilitation in patients with fibrotic idiopathic interstitial pneumonias

Benoit Wallaert  1   2 , Louise Duthoit  1   2 , Elodie Drumez  3 , Hélène Behal  3 , Lidwine Wemeau  1 , Cécile Chenivesse  1 , Jean-Marie Grosbois  4
Affiliations

Long-term evaluation of home-based pulmonary rehabilitation in patients with fibrotic idiopathic interstitial pneumonias

Benoit Wallaert et al. ERJ Open Res. .

Abstract

Background: Few studies have examined the benefits of pulmonary rehabilitation in patients with fibrotic idiopathic pulmonary pneumonia (f-IIP). Here, we report the results of an observational study in routine clinical practice of home-based pulmonary rehabilitation for f-IIP patients.

Methods: A total of 112 consecutive patients (61 with idiopathic pulmonary fibrosis and 51 with fibrotic nonspecific interstitial pneumonitis) were enrolled, of whom 65 had mild-to-moderate disease (forced vital capacity (FVC) ≥50% predicted and diffusing capacity of the lung for carbon monoxide (D LCO) ≥30% predicted) and 47 had severe disease (FVC <50% predicted and/or D LCO <30% predicted). The 2-month pulmonary rehabilitation programme consisted of a once-weekly visit with retraining, therapeutic education and psychosocial support. Patients were provided with an individualised action plan and were followed-up bimonthly for 12 months. Exercise tolerance (6-min stepper test (6MST)), mood (Hospital Anxiety and Depression Scale (HADS)) and quality of life (QoL) (Visual Simplified Respiratory Questionnaire (VSRQ)) were assessed before (T0), immediately after (T2), 6 months after (T8) and 12 months after (T14) the end of the pulmonary rehabilitation programme.

Results: 6MST strokes, HADS Anxiety score and VSRQ score were each significantly improved at T2 (n=101), T8 (n=76) and T14 (n=62) compared with T0 values. The improvements in outcomes were not influenced by disease severity or subtype. Patients who completed the study had significantly better baseline FVC and D LCO values than those who did not.

Conclusions: Home-based pulmonary rehabilitation provides long-term benefits in exercise tolerance, anxiety and QoL for patients with f-IIP. Pulmonary rehabilitation should be prescribed systematically as part of the therapeutic arsenal for these patients.

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Conflict of interest statement

Conflict of interest: B. Wallaert reports personal fees from Roche and Boehringer Ingelheim, outside the submitted work. Conflict of interest: L. Duthoit has nothing to disclose. Conflict of interest: E. Drumez has nothing to disclose. Conflict of interest: H. Behal has nothing to disclose. Conflict of interest: L. Wemeau reports personal fees from Roche and Boehringer Ingelheim, outside the submitted work. Conflict of interest: C. Chenivesse has nothing to disclose. Conflict of interest: J-M. Grosbois reports that FormAction Santé received financial support from Adair, France Oxygène, Homeperf, LVL Medical, Orkyn, Santélys, Santeo, SOS Oxygène, Sysmed, VitalAire and ARS Hauts de France, during the conduct of the study.

Figures

FIGURE 1
FIGURE 1
Flow diagram of patient disposition.
FIGURE 2
FIGURE 2
Evaluation of exercise tolerance (6-min stepper test (6MST)), quality of life (Visual Simplified Respiratory Questionnaire (VSRQ)) and mood (Hospital Anxiety and Depression Scale (HADS)) in the fibrosing idiopathic pulmonary pneumonia patient population and the subset who completed the study according to disease severity. a, b) Number of strokes performed in the 6MST, c, d) VSRQ score and e, f) HADS score were assessed for all patients (a, c and e) and the 62 patients who completed the study (b, d and f) before (T0), immediately after (T2), 6 months after (T8) and 12 months after (T14) the end of the pulmonary rehabilitation programme. Data are presented as mean±se. The p-value for the interaction between time and disease severity (i.e. change in the variable with time compared between the mild-to-moderate and severe disease groups) is indicated.
FIGURE 3
FIGURE 3
Evaluation of exercise tolerance (6-min stepper test (6MST)), quality of life (Visual Simplified Respiratory Questionnaire (VSRQ)) and mood (Hospital Anxiety and Depression Scale (HADS)) in the patients with idiopathic pulmonary fibrosis (IPF) and fibrotic nonspecific interstitial pneumonitis (f-NSIP). a, b) Number of strokes performed in the 6MST, c, d) VSRQ score and e, f) HADS score were assessed for the subsets of patients with IPF (n=61) (a, c and e) and NSIP (n=51) (b, d and f) before (T0), immediately after (T2), 6 months after (T8) and 12 months after (T14) the end of the pulmonary rehabilitation programme. Data are presented as mean±se. The p-value for the interaction between time and disease aetiology (i.e. change in the variable with time compared between the disease groups) is indicated.
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