Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan.
Respiration. 2011;81(3):196-205. doi: 10.1159/000315475. Epub 2010 May 27.
The benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) are well recognized. However, whether individuals with idiopathic pulmonary fibrosis (IPF) benefit is less clear.
To evaluate the effects of pulmonary rehabilitation in subjects with IPF and compare their responses with a group of COPD subjects who underwent an identical program.
For- ty-five subjects with IPF and 45 age- and Medical Research Council grade-matched COPD subjects were recruited. Subjects completed an 8-week outpatient pulmonary rehabilitation program. Dyspnea, peripheral muscle force, exercise capacity (6-min walk distance, 6MWD), activities of daily living, and health status (36-item short-form survey, SF-36) were assessed at baseline, immediately following and at 6 months following completion of the program.
Adherence to the program was similar in both groups. Significant improvements in dyspnea, muscle force, exercise capacity and ADL were observed in both groups (all p < 0.05); however, the magnitude of improvement in all outcomes was less in the IPF group [mean (95% CI) improvement in 6MWD, IPF 16.2 (7.1-25.4); COPD 53.1 (44.9-61.2)]. All domains of SF-36, with the exception of social function, improved (all p < 0.05) in the COPD group; however, there were no changes in SF-36 scores in the IPF group. The benefits were well maintained in the COPD group at 6 months, but, with the exception of the ADL score, the benefits were no longer present in the IPF group.
Pulmonary rehabilitation in IPF produces only modest short-term gains in dyspnea, exercise capacity and ADL, but does not improve health status.
慢性阻塞性肺疾病（COPD）患者进行肺康复治疗的益处已得到广泛认可。然而，特发性肺纤维化（IPF）患者是否从中获益尚不清楚。
评估肺康复治疗对 IPF 患者的效果，并将其与接受相同方案的 COPD 患者进行比较。
共招募了 45 例 IPF 患者和 45 例年龄和英国医学研究理事会呼吸困难量表（Medical Research Council Dyspnea Scale，MRC）分级匹配的 COPD 患者。所有患者均完成了 8 周的门诊肺康复治疗。在基线、治疗结束后即刻以及 6 个月时评估呼吸困难、外周肌肉力量、运动能力（6 分钟步行距离，6MWD）、日常生活活动能力和健康状况（36 项简短健康调查问卷，36-item short-form survey，SF-36）。
两组患者对方案的依从性相似。两组患者的呼吸困难、肌肉力量、运动能力和日常生活活动能力均显著改善（所有 p < 0.05）；然而，IPF 组的所有改善结果的幅度均较小[6MWD 改善程度，IPF 组 16.2（7.1-25.4）；COPD 组 53.1（44.9-61.2）]。除社会功能外，COPD 组所有 SF-36 维度的评分均有所改善（所有 p < 0.05）；而 IPF 组的 SF-36 评分则无变化。COPD 组在 6 个月时的获益得以维持，但除日常生活活动能力评分外，IPF 组的获益已不再存在。
肺康复治疗在 IPF 患者中仅能带来短期、适度的呼吸困难、运动能力和日常生活活动能力改善，但不能改善健康状况。
