Pulmonary rehabilitation has a positive effect on survival in patients with interstitial lung disease at five years, strengthening the rationale for such programs to be embedded in standard and holistic care, Australian respiratory researchers say.
Their study, published in Chest [link here], compared the survival outcomes of 182 patients (60% male, mean age 69) with interstitial lung disease (ILD) who were allocated to either pulmonary rehabilitation or a control group by combining data from two randomised controlled trials, previously published in 2008 and 2017.
Of the included participants, 87 had idiopathic pulmonary fibrosis (IPF). At 10 years follow-up, 62% had died, 6% had transplants, 20% were alive and 12% were lost.
Findings showed the median survival for those who completed pulmonary rehabilitation was 6.1 years compared to 4.7 years for those in the control group, however this was not significantly different, the researchers noted.
Patients with IPF had consistently worse survival rates than patients with non-IPF ILD at five years (41% vs 66% respectively) and 10 years (31% and 68%), with a significantly worse median survival of 4.4 years versus eight years, respectively.
However, the overall pulmonary rehabilitation survival pattern did not differ between those with IPF and those with non-IPF ILD, “suggesting the impact… [was] consistent across ILD subtypes despite disease heterogeneity and in line with current evidence for pulmonary rehabilitation with comparable benefits in exercise capacity, symptoms and quality of life across the entire spectrum of disease”.
Completion of pulmonary rehabilitation was associated with a 44% lower risk of mortality or lung transplant (HR 0.56) at five years after adjusting for baseline variables, but there was no difference in survival with the control group at 10 years.
Among the other findings, less exertional desaturation, preserved lung function and better functional capacity were all strongly associated with better survival among patients at 10 years after adjusting for pulmonary rehabilitation participation.
“This suggests that engaging in pulmonary rehabilitation when ILD disease is milder may facilitate a stronger survival benefit. In similar sense that an early referral to pulmonary rehabilitation when the impact of the disease is milder, is favourable to promote longer lasting benefits in exercise capacity and symptoms,” said the Melbourne respiratory researchers, from Alfred Health and Austin Health.
They added that their findings, taken together with other published research, complemented the American Thoracic Society clinical guidelines and suggested that pulmonary rehabilitation might play a role in prolonging survival.
However, they also acknowledged areas of uncertainty, including wide confidence intervals and the loss of a survival gap at 10 years. Potential confounders included whether the control group had engaged in rehabilitation at another timepoint over follow-up, while one of the study’s limitations was the study sample being potentially underpowered.
“Our findings suggest that the participation in pulmonary rehabilitation may provide some protective effect on survival at five years, although a large amount of uncertainty around this effect remains,” the authors said.
“Nonetheless our findings provide support for the ongoing recommended inclusion of pulmonary rehabilitation in the holistic care of people with ILD.”