Abstract
We assessed efficacy and effectiveness of pharmacological and non-pharmacological interventions in improving symptom control, functional exercise capacity and quality of life (Qol) in people living with fibrotic interstitial lung disease (ILD).
We summarised evidence from three previous reviews (to June 2014) and conducted an updated search of nine databases and grey literature (2011–19) (registration: CRD42017065933) for prospective studies of interventions aimed to alleviate symptoms, improve Qol or functional exercise capacity in fibrotic ILD. Data were synthesised through narrative synthesis or meta-analysed as appropriate.
Forty-seven studies with 2527 participants were included. From 22 pharmacological studies of eleven different interventions (n=1683) the most tested interventions were bosentan and sildenafil. From 25 non-pharmacological studies, the most tested intervention was for pulmonary rehabilitation / exercise training (PR) (22 studies, n=748). An improvement in 6-min walk distance (6MWD) immediately following PR (6 studies; n=200, MD [95%CI] 39.9 m [18.2 to 61.5]) but not longer-term (3 or 6 months, 4 studies; n=147, MD 5.3 m [−12.9 to 23.4]. Multiple, varied outcome measures were used, e.g. 37 studies assessing dyspnoea used 10 different scales with lack of reporting of rate of deterioration in outcomes. Evidence gap mapping highlighted the most and least researched symptoms were dyspnoea and cough respectively.
This evidence synthesis highlights overwhelmingly that the most researched symptom is dyspnoea and the strongest evidence base is for short-term PR. The least researched symptom was cough. Research going forward must focus on prioritising and standardising meaningful outcomes and focusing interventions on neglected symptoms.
Footnotes
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Conflict of interest: Dr. Bajwah has nothing to disclose.
Conflict of interest: Dr. Colquitt has nothing to disclose.
Conflict of interest: Dr. Lovemen has nothing to disclose.
Conflict of interest: Dr. Bausewein has nothing to disclose.
Conflict of interest: Dr. Almond has nothing to disclose.
Conflict of interest: Dr. Oluyase has nothing to disclose.
Conflict of interest: Dr. Dzingina has nothing to disclose.
Conflict of interest: Dr. Maddocks has nothing to disclose.
Conflict of interest: Dr. Higginson has nothing to disclose.
Conflict of interest: Dr. Wells has nothing to disclose.
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- Received February 28, 2020.
- Accepted September 12, 2020.
- Copyright ©ERS 2020
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