Skip to main content
The Egyptian Journal of Bronchology
Download PDF

Impact of pulmonary rehabilitation on patients with interstitial lung diseases: an Egyptian experience

Egyptian Journal of Bronchology volume 13, pages 219–225 (2019)Cite this article

Abstract

Background

Dyspnea, cough, fatigue, functional limitation, and low quality of life (QOL) are manifestations of almost all interstitial lung diseases (ILDs), with little effective and may be well-tolerated pharmacotherapy in most of its subtypes. The application of pulmonary rehabilitation (PR) may have some benefits in patients with ILDs.

Aim

The aim of this study was to evaluate the effect of PR program on ILD patients’ QOL, exercise capacity, dyspnea, and spirometry.

Settings and design This was a single-center experimental randomized controlled study.

Patients and material

This study initially enrolled 62 patients previously diagnosed as having ILD at the Chest Department according to American Thoracic Society (ATS)/ European Respiratory Society (ERS) diagnostic criteria; however, 12 patients were excluded, and only 50 patients were included and completed the study, and they were classified randomly into the control group (n=25, received conventional treatment only) and the PR group (n=25, received conventional treatment and PR). Pre-PR and post-PR program assessment of QOL by the 36-item short-form health survey (SF36) questionnaire, exercise capacity by the 6-min walk test, dyspnea by the modified Medical Research Council and spirometry were carried out.

Statistical analysis used

All data were collected, tabulated and statistically analyzed using SPSS 16.0 for Windows.

Results

This study showed a statistically significant difference for the PR group over the control group at the end of the PR program, wherein all components of the SF36Q score had a P value less than 0.05, dyspnea score by modified Medical Research Council (P=0.02) and exercise tolerance by 6 min walking distance test (P=0.005). Moreover, the maximum voluntary ventilation (MVV%) showed a statistically significant improvement (P=0.003) in contrast to the other measured spirometric parameters measured in this study (forced vital capacity, forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity %, forced expiratory flow25–75) wherein P value was more than 0.05. A negative correlation was found between the baseline physical functioning item of SF36Q and the change (Δ) in 6 min walk distance test.

Conclusion

PR could be considered as an adjuvant method in the treatment of patients with stable ILDs and could provide improvement in their dyspnea perception, exercise tolerance, and health-related QOL.

References

  1. Dowman LM, McDonald CF, Hill CJ, Lee AL, Barker K, Boote CD, et al. The evidence of benefits of exercise training in interstitial lung disease:a randomized controlled trial. Thorax 2017; 72:610–619.

    Article  Google Scholar 

  2. Garvey C. Interstitial lung disease and pulmonary rehabilitation. J Cardiopulm Rehab Prev 2010; 30:141–146.

    Article  Google Scholar 

  3. Mendes P, Wickerson L, Helm D, Janaudis-Ferreira T, Brooks D, Singer LG, et al. Skeletal muscle atrophy in advanced interstitial lung disease. Respirology 2015; 20:953–959.

    Article  Google Scholar 

  4. Shehata SM, Refky MM, Al Gabry MM, Nafae RM. Outcome of pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease at Chest Department, Zagazig University Hospitals (2014–2016). Egypt J Bronchol 2018; 12:279–287.

    Article  Google Scholar 

  5. Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ ALAT statement:idiopathic pulmonary fibrosis:evidence based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011; 183:788e824.

  6. De Vries J, Seebregts A, Drent M. Assessing health status and quality of life in idiopathic pulmonary fibrosis:which measure should be used? Respir Med 2000; 94:273–278.

    Article  Google Scholar 

  7. De Vries J, Drent M. Quality of life and health status in interstitial lung diseases. Curr Opin Pulm Med 2006; 12:354–358.

    Article  Google Scholar 

  8. Curtis JR, Patrick DL. The assessment of health status among patients with COPD. Eur Respir J 2003; 41:36–45.

    Article  Google Scholar 

  9. Christopher JR, Chris G, Harold RC. Pulmonary rehabilitation for interstitial lung disease. Chest 2010; 138:240–241.

    Article  Google Scholar 

  10. Wells AU. The revised ATS/ERS/JRS/ALAT diagnostic criteria for idiopathic pulmonary fibrosis (IPF) – practical implications. Respir Res 2013; 14 (Suppl 1):S2.

  11. Dowman L, Hill CJ, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev 2014; 10:CD006322.

  12. Collard HR, Ryerson CJ, Corte TJ, Jenkins G, Kondoh Y, Lederer DJ, et al. Acute exacerbation of idiopathic pulmonary fibrosis. An international working group report. Am J Respir Crit Care Med 2016; 194:265–275.

    Article  CAS  Google Scholar 

  13. Selim MA, Jason DC, Victor AF, Martin JS, David AZ, Nancy P, et al. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 2003; 167:735–740.

    Article  Google Scholar 

  14. Holland AE, Hill CJ, Conron M, Munro P, McDonald CF. Short-term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease. Thorax 2008; 63:549–5.

    Article  CAS  Google Scholar 

  15. Ryerson CJ, Cayou C, Topp F, Hilling L, Camp PG, Wilcox PG, et al. Pulmonary rehabilitation improves long-term outcomes in interstitial lung disease:a prospective cohort study. Respir Med 2014; 108:203–210.

    Article  Google Scholar 

  16. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006; 173:1390–1413.

    Article  Google Scholar 

  17. Panagiotou M, Polychronopoulos V, Strange C. Respiratory and lower limb muscle function in interstitial lung disease. Chron Respir Dis 2016; 13:162–172.

    Article  Google Scholar 

  18. Tonelli R, Cocconcelli E, Lanini B, Romagnoli I, Florini F, Castaniere I. Effectiveness of pulmonary rehabilitation in patients with interstitial lung disease of different etiology. BMC Pulm Med 2017; 17:130.

    Article  Google Scholar 

  19. Peña JB, Gutiérrez HH. Effects of pulmonary rehabilitation in patients with diffuse interstitial lung disease. Int J Phys Med Rehabil 2015; 3:308.

    Google Scholar 

  20. Holland AE, Dowman LM, Hill CJ. Principles of rehabilitation and reactivation:interstitial lung disease, sarcoidosis and rheumatoid disease with respiratory involvement. Respiration 2015; 89:89–99.

    Article  Google Scholar 

  21. Holland AE, Hill CJ, Glaspole I, Goh N, McDonald CF. Predictors of benefit following pulmonary rehabilitation for interstitial lung disease. Respir Med 2012; 106:429–435.

    Article  Google Scholar 

  22. Nishiyama O, Kondoh Y, Kimura T, Kato K, Kataoka A, Ogawa T, et al. Effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Respirology 2008; 13:394–399.

    Article  Google Scholar 

  23. Perez BS, Wuyts W, Barbier V, Langer D, Burtin C, Van RH, et al. Preliminary results of pulmonary rehabilitation in interstitial lung diseases:a randomised controlled trial. Eur Respir Soc Ann Cong 2011; 38:255.

    Google Scholar 

  24. Vainshelboim B, Oliveira L, Yohoshua L, Weis I, Fox B, Kramer M. The effect of pulmonary rehabilitation on exercise tolerance, pulmonary function, dyspnea and quality of life in patients with idiopathic pulmonary fibrosis. European Respiratory Society 23rd Annual Congress; September 7–11; Barcelona. 2013; 187, issue Meeting Abstracts:A1832.

  25. Collard HR, Anstrom KJ, Schwarz MI, Zisman DA. Sildenafil improves walk distance in idiopathic pulmonary fibrosis. Chest 2007; 131:897–899.

    Article  Google Scholar 

  26. Baradzina HL, Ponachevnaya NV. Pulmonary rehabilitation programme in sarcoidosis (abstract). Eur Respir J 2005; 26 (Suppl 49):333S.

  27. Huppmann P, Sczepanski B, Boensch M, Winterkamp S, Schönheit-Kenn U, Neurohr C, et al. Effects of inpatient pulmonary rehabilitation in patients with interstitial lung disease. Eur Respir J 2012; 42:444–453.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Chest, Faculty of Medicine, Zagazig University, 44519, Zagazig, Egypt

    Howida M. El-Komy, Mohammed Awad, Waleed Mansour MD & Enaam I. Elsayed

Authors
  1. Howida M. El-Komy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammed Awad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Waleed Mansour MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Enaam I. Elsayed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Waleed Mansour MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El-Komy, H.M., Awad, M., Mansour, W. et al. Impact of pulmonary rehabilitation on patients with interstitial lung diseases: an Egyptian experience. Egypt J Bronchol 13, 219–225 (2019). https://doi.org/10.4103/ejb.ejb_64_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_64_18

Keywords