ERS 2022: Best Abstracts in Pulmonary Rehabilitation and Chronic Care
In this session, experts highlighted the best abstracts in pulmonary rehabilitation and chronic care in patients with chronic respiratory diseases.
Peak oxygen uptake (VO2peak) is the gold standard measure of aerobic fitness and improves with exercise training for people with COPD. However, the optimal mode of training for improvement in cardiorespiratory fitness in COPD is unclear. A study was conducted to determine the effect of different aerobic exercise training (AExT) modalities on change in VO2peak in COPD. High-intensity training modalities resulted in the greatest increase in V?O2peak, but the differences were insignificant compared to the moderate-intensity modalities. Combination programmes like high-intensity continuous cycling and walking (P-score = 0.96) or high-intensity interval cycling and walking (P-score = 0.91) were more effective than usual care. The optimal mode of AExT to improve VO2peak in COPD remains unclear; however, high-intensity AExT may be preferable over moderate-intensity AExT.
Exercise tolerance, a strong predictor of morbidity and mortality, is reduced 2-3 months post-COVID-19 hospitalization. However, the long-term effects of COVID-19 on exercise tolerance in this population remain largely unknown. A study aimed to measure exercise tolerance 5 and 12 months after hospital discharge for COVID-19 and compared groups according to the limiting symptom. Exercise tolerance remained unchanged between 5- and 12 months post-discharge. Incremental shuttle walk test (ISWT) % predicted was <80% in 75% patients 12 months post-discharge. Patients terminated the test due to breathlessness (28%), leg fatigue (10%), breathlessness and leg fatigue (23%) or other reasons (39%). There was no difference in exercise tolerance 12 months post-discharge between patients who reported different limiting symptoms. The study concluded that between 5- and 12 months post-discharge, exercise tolerance did not increase, regardless of patient-reported exercise limitations, emphasizing the need for effective rehabilitation strategies in this population.
Pulmonary rehabilitation (PR) improves breathlessness, exercise capacity and quality of life in patients with interstitial lung disease (ILD), including idiopathic pulmonary fibrosis (IPF). However, limited data exist for anxiety and depression. The study aimed to determine the prevalence of anxiety and depression in patients with IPF referred for PR and the response to PR and to estimate the minimal significant difference (MID) of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) in IPF. The study showed that the symptoms of anxiety and depression were present in a significant proportion of patients. In patients with a probable mood disorder, significant improvements in HADS-A and HADS-D were observed with PR. Mean MID estimates for HADS-A and HADS-D in response to PR were -2 and -1.2, respectively.
A retrospective study was conducted to evaluate the effects of an 8-week home-based PR program on anxiety and depressive symptoms, general fatigue, and burden in informal caregivers of patients with COPD. About 40%, 40% and 45% of the caregivers showed high baseline burden, anxiety symptoms, and abnormal fatigue, respectively. Burden, anxiety and depressive symptoms, and general fatigue of caregivers were all improved post PR. A more significant improvement in anxiety symptoms and general fatigue was seen in patients who reported with a caregiver than those who reported without one. The study concluded that integrating the caregivers of patients with COPD into PR has effectively improved the burden, anxiety and depressive symptoms, and general fatigue of the caregivers as well as the physical and psychological well-being of patients with COPD.
In 2018, a national telemonitoring programme (ETAPES) was launched in France for four chronic diseases, including the respiratory failure on home non-invasive ventilation (NIV). It consisted of therapeutic education and daily transmitted ventilator data analysis to determine low compliance, unintentional leaks, or the onset of a COPD exacerbation. The main objective of the study was to determine the quality of ventilation. Quality of ventilation (good quality Q+) is defined by composite criteria: compliance ≥4hours/day, non-intentional leaks < 24L/min and apnea-hypopnea index (AHI) <10/hour. At ETAPES entry, 72% of the 83 patients newly started on NIV and 77% of those on NIV for more than a month were Q+. After one year, 12 patients had died, and 39 had discontinued ETAPES. 87% of the patients still in ETAPES after a year were Q+. The main cause of Q- was persistent leaks. The DIsability RElated to COPD Tool (DIRECT) median score was nine initially and significantly improved at 3 and 12 months. NIV telemonitoring may improve the quality of ventilation even in patients with NIV for several years
ENO Breathe is an online breathing and well-being programme for people with long COVID that focuses on breathing re-training using singing techniques. The study aimed to evaluate whether ENO Breathe improves health-related quality of life (HRQoL) in people with persistent breathlessness after COVID-19. The study's primary outcome included a change in HRQoL using the RAND SF-36 Mental (MHC) and Physical (PHC) Health Composite Scores. ENO Breathe was associated with a 2.42 point improvement in MHC but not PHC. Three participant experience themes were identified: improvements in symptoms, feeling that the programme was complementary to standard healthcare, and the suitability of singing and music to address their needs. In people with persistent symptoms after COVID-19, an online breathing and well-being programme can improve the mental component of HRQoL and elements of breathlessness. Mind-body and music-based approaches, as well as practical, enjoyable symptom-management techniques, may help with recovery.
Pulmonary hyperinflation in COPD is related to smaller chamber sizes and impaired cardiac function. Bronchoscopic lung volume reduction with endobronchial valves (BLVR) is a treatment option for reducing hyperinflation in patients with severe emphysema. The study investigated whether BLVR improves cardiac preload in this patient group. Furthermore, whether the treatment results in elevated pulmonary artery pressures due to pulmonary vascular bed reduction was also investigated. The right ventricle end-diastolic volume index (RVEDVI) significantly improved (+7.9 ml/m2, p = 0.001) at the 8-week follow-up. In addition to increased stroke volumes of the left atrium (+6.2 ml, p < 0.001) and the left ventricle (+12.5 ml, p = 0.01), a significantly higher ejection fraction of the left atrium ( +5.6%, p = 0.01) and the left ventricle (+3.6%, p = 0.03) and strain measurements were also observed. The cardiac output was significantly increased by up to 900 ml, but there were no changes in pulmonary artery pressures. The increase in cardiac output of the left and the right ventricle was + 0.93 (p = 0.01) and +0.62 (p = 0.02), respectively. The study concluded that reduction of hyperinflation using BLVR with endobronchial valves significantly improved cardiac preload, myocardial contractility, and cardiac output, with no changes in pulmonary artery pressures.
Dysfunction of limb muscles is a systemic manifestation of COPD that requires specific exercise training interventions. Exercise interventions have long-term benefits for patients. A randomized controlled pilot trial aimed to evaluate the feasibility and effectiveness of a low-load eccentric training (LLET) program on limb muscle function and functional performance in patients with COPD. No changes were seen in quadriceps peak torque (QPT). The LLET group improved the 5 sit-to-stand (5STS) time and BODE index. Both groups showed improvements in Barthel index dyspnea (BID), 5STS power, and 5STS relative activation. Preliminary results of the study suggested that LLET is safe, feasible, and may have beneficial effects on functional performance in patients with COPD.
A study aimed to estimate the role of surfactant protein-A (SP-A) in patients discharged after COVID-19 pneumonia. The main group included 75 patients. Patients were divided into 3 subgroups: 27 patients after moderate COVID-19 pneumonia, 30 patients after severe COVID-19 pneumonia, and 18 patients after critical COVID-19 pneumonia. After 1.5 months of the onset of COVID-19, 98.7% of patients had dyspnea, but the level of SpO2 was normal. The level of SP-A did not differ between subgroup 1 and the control group, but it was significantly higher in patients in subgroup 2 and 3 as compared to the control group and subgroup 1. At the same time, a strong direct correlation was observed between the level of SP-A and the severity of dyspnea by the Modified Medical Research Council (mMRC) Dyspnea Scale. The study concluded that the level of SP-A is an independent predictor of lung lesions in the early post-COVID-19 period in patients after severe and critical COVID-19 pneumonia. It also demonstrated that the damage to the surfactant system of the lungs could be the reason for dyspnea in the early period after COVID-19. Therefore, the determination of SP-A is essential in customizing the most appropriate therapeutic strategies for patients following severe and critical COVID-19.
European Respiratory Society (ERS) International Congress 2022, 3rd-6th Sept. 2022, Barcelona
