Abstract
Background and objective Rehabilitation programs are a valuable treatment modality for patients with chronic-obstructive pulmonary disease (COPD) to increase exercise capacity and quality of life. The utility of pulmonary rehabilitation (PR) prior to bronchoscopic lung volume reduction (BLVR) is unclear.
Methods We performed a post-hoc analysis of the VENT trial, the first multicenter randomized trial comparing the safety and efficacy of BLVR. Patients completed a PR program prior to BLVR over 6–10 weeks and maintained by daily practice, consisting of endurance training, strength training and upper/lower limb exercise. Lung function and exercise parameters (six-minute-walking testing; 6-MWT) were assessed before and after rehabilitation and we tried to identify predictors for PR benefit.
Results Lung function and exercise capacity of 403 patients (mean age 63.3±7.4 years, 37.5% female, mean FEV1 30.1±7.6 l) were analyzed. Exercise capacity significantly improved from 331.6±98.8 to 345.6±95.3 m (p<0.001) in 6-MWT with 40.3% showing clinically meaningful improvements. Patients also experienced less dyspnea after 6-MWT, while pulmonary function parameters did not change significantly overall. Patients with lower exercise capacity at screening (6-MWT <250 m) benefited more from PR. The indication and prerequisites for BLVR were still present in all patients after PR.
Conclusion The national mandatory requirements for rehabilitation prior to BLVR, which apply to all COPD patients, should be reconsidered and specified for COPD patients who really benefit.
Footnotes
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Conflicts of interest: Judith Brock has received honoraria and consultation fees from Boehringer Ingelheim, Astra Zeneca, streamed up!, Intuitive Surgical Inc, Berlin Chemie, Olympus. There is no conflict of interest regarding this manuscript.
Conflicts of interest: Konstantina Kontogianni has received honoraria for teaching courses from Olympus, for lectures from Berlin-Chemie and Boston Scientific, for attending meetings from Astra Zeneca. She has no conflicts of interest regarding this manuscript.
Conflicts of interest: Frank Sciurba reports institutional grant supports from Sanofi/Regeneron, Astra Zeneca, Verona Pharma, Nuvaira, Gala Therapeutics and personal payments for advisory boards of Sanofi/Regeneron, Astra Zeneca, Verona Pharma, Galxo Smith Kline, Boehringer Ingelheim.
Conflicts of interest: Gerard Criner reports grants from Pulmonx and honorarium for teaching activities. All activities are outside the submitted work.
Conflicts of interest: Felix Herth reports consulting fees from Pulmonx outside the submitted work.
Conflicts of interest: All authors confirm no conflicts of interest regarding this manuscript.
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- Received October 3, 2023.
- Copyright ©The authors 2023
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