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Randomized Controlled Trial
. 2024 Aug;29(8):694-703.
doi: 10.1111/resp.14734. Epub 2024 May 8.

Impact and timing of pulmonary rehabilitation in patients undergoing bronchoscopic lung volume reduction with endobronchial valves: A multicentre randomized controlled trial in patients with severe emphysema

Marieke C van der Molen  1   2 , Rein Posthuma  3   4   5 , Jorine E Hartman  1   2 , Hester van der Vaart  1   2   6 , Eline Bij de Vaate  7 , Anouk W Vaes  4 , Bram van den Borst  8 , Dirk van Ranst  9 , Martijn A Spruit  3   4   5 , Lowie E G W Vanfleteren  10   11 , Dirk-Jan Slebos  1   2 ; SoLVE consortium group
Collaborators, Affiliations
Free article
Randomized Controlled Trial

Impact and timing of pulmonary rehabilitation in patients undergoing bronchoscopic lung volume reduction with endobronchial valves: A multicentre randomized controlled trial in patients with severe emphysema

Marieke C van der Molen et al. Respirology. 2024 Aug.
Free article

Abstract

Background and objective: Both bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) and pulmonary rehabilitation (PR) are effective treatments for improving exercise capacity and patient-reported outcomes in patients with severe Chronic Obstructive Pulmonary Disease (COPD). According to current recommendations, all BLVR-EBV patients should have undergone PR first. Our aim was to study the effects of PR both before and after BLVR-EBV compared to BLVR-EBV alone.

Methods: We included patients with severe COPD who were eligible for BLVR-EBV and PR. Participants were randomized into three groups: PR before BLVR-EBV, PR after BLVR-EBV or BLVR-EBV without PR. The primary outcome was change in constant work rate cycle test (CWRT) endurance time at 6-month follow-up of the PR groups compared to BLVR-EBV alone. Secondary endpoints included changes in 6-minute walking test, daily step count, dyspnoea and health-related quality of life.

Results: Ninety-seven participants were included. At 6-month follow-up, there was no difference in change in CWRT endurance time between the PR before BLVR-EBV and BLVR-EBV alone groups (median: 421 [IQR: 44; 1304] vs. 787 [123; 1024] seconds, p = 0.82) or in any of the secondary endpoints, but the PR after BLVR-EBV group exhibited a smaller improvement in CWRT endurance time (median: 107 [IQR: 2; 573], p = 0.04) and health-related quality of life compared to BLVR-EBV alone.

Conclusion: The addition of PR to BLVR-EBV did not result in increased exercise capacity, daily step count or improved patient-reported outcomes compared to BLVR-EBV alone, neither when PR was administered before BLVR-EBV nor when PR was administered after BLVR-EBV.

Keywords: Bronchoscopic lung volume reduction; COPD; chronic obstructive pulmonary disease; endobronchial valves; pulmonary rehabilitation.

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References

REFERENCES

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