It’s hard to improve on pulmonary rehabilitation for COPD when it is already so effective, the American Thoracic Society (ATS) 2018 International Conference was told.
Speaking in a Clinical Year in Review session, Dr William Man, a lung and sleep specialist at the Royal Brompton & Harefield NHS Foundation Trust in the UK, said neither the addition of pedometers or inspiratory muscle training were useful as adjuncts to pulmonary rehabilitation programs.
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Dr William Mann
He said a UK study, which he coauthored, found the addition of pedometers ‘blunted’ the usual improvements in quality of life seen with pulmonary rehab.
And inspiratory muscle training, which people either loved or hated, did not improve clinical outcomes from pulmonary rehab in another randomised controlled trial.
“I think pulmonary rehabilitation is a very good intervention and that’s why we have found it very difficult to find adjuncts to make it better. But we can always do better.
We are now in the era of personalised medicine and I think because it has been relatively effective in all sorts of patients, what we haven’t been so good at is identifying particular aspects of rehab that would benefit particular phenotypes of patients.”
He said there was some data now to show that frail patients were much more likely not to complete pulmonary rehabilitation.
“So are there other things we can do for these sorts of patients? For example, we could work with other specialties such as palliative care or geriatricians, and use the knowledge that other specialties have to manage these complex patients.”
Dr Man said different models of pulmonary rehabilitation typically came up short when compared to supervised, centre-based programs but there remained a real opportunity for something new to improve uptake.