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Published on: November 8, 2013
Impact of Pulmonary Rehabilitation on Survival in People With Interstitial Lung Disease
Leona M Dowman1, Baruch Vainshelboim2, Anne E Holland3
1Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia; Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia.
Background:
Pulmonary rehabilitation (PR) is a beneficial intervention for people with interstitial lung disease (ILD); however, the effect of PR on survival is unclear. This study compared the survival outcomes in people with ILD who were allocated to PR vs those who were allocated to control in 2 published randomized controlled trials.
Research Question:
Does participation in PR impact survival among people with ILD?
Study Design And Methods:
The combined data from the 2 previous randomized controlled trials of PR in ILD were included. Time from start of PR until date of death, lung transplantation, or censoring was calculated. Kaplan-Meir and Cox proportional hazard regression analysis were used to assess the impact of PR on survival. Baseline variables of age at time of PR, sex, FVC, 6-minute walk distance, exertional nadir oxyhemoglobin desaturation, and diagnosis of idiopathic pulmonary fibrosis were included as covariates.
Results:
Of the 182 participants with ILD (idiopathic pulmonary fibrosis: n = 87; male: n = 109; mean age ± SD, 69 ± 10; FVC % predicted ± SD, 76 ± 19; carbon monoxide transfer factor % predicted ± SD, 48 ± 16), death occurred in 62%, 6% were transplanted, 20% were alive, and 12% were lost to follow-up. Median survival for those who completed PR was 6.1 years (95% CI, 4.4-7.9) compared with 4.7 years (95% CI, 3.4-6.0) for those in the control group; however, this was not significantly different (log rank P = .70). After adjusting for baseline variables at 5 years, completion of PR was associated with a 44% lower risk of mortality (hazard ratio, 0.56; 95% CI, 0.36-0.88; P = .01). At 10 years, no difference in survival was observed between the PR and control group.
Interpretation:
Participation in PR among people with ILD may impact survival at 5 years. Along with clinical improvements after PR, the potential for a survival benefit further strengthens the importance of PR in the standard care of people with ILD.
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