Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Thorax. 2022 Jun;77(6):589-595. doi: 10.1136/thoraxjnl-2021-217361. Epub 2021 Aug 30.
The impact of pulmonary rehabilitation (PR) on survival in patients with fibrotic interstitial lung disease (ILD) is unknown. Given the challenges conducting a large randomised controlled trial, we aimed to determine whether improvement in 6-minute walk distance (6MWD) was associated with better survival.
This retrospective, international cohort study included patients with fibrotic ILD participating in either inpatient or outpatient PR at 12 sites in 5 countries. Multivariable models were used to estimate the association between change in 6MWD and time to death or lung transplantation accounting for clustering by centre and other confounders.
701 participants (445 men and 256 women) with fibrotic ILD were included. The mean±SD ages of the 196 inpatients and 505 outpatients were 70±11 and 69±12 years, respectively. Baseline/changes in 6MWD were 262±128/55±83 m for inpatients and 358±125/34±65 m for outpatients. Improvement in 6MWD during PR was associated with lower hazard rates for death or lung transplant on adjusted analysis for both inpatient (HR per 10 m 0.94, 95% CI 0.91 to 0.97, p<0.001) and outpatient PR (HR 0.97, 95% CI 0.95 to 1.00, p=0.042). Participation in ≥80% of planned outpatient PR sessions was associated with a 33% lower risk of death (95% CI 0.49% to 0.92%).
Patients with fibrotic ILD who improved physical performance during PR had better survival compared with those who did not improve performance. Confirmation of these hypothesis-generating findings in a randomised controlled trial would be required to definitely change clinical practice, and would further support efforts to improve availability of PR for patients with fibrotic ILD.
肺康复（PR）对纤维化间质性肺疾病（ILD）患者的生存影响尚不清楚。鉴于进行大型随机对照试验的挑战，我们旨在确定 6 分钟步行距离（6MWD）的改善是否与更好的生存相关。
这是一项回顾性、国际性队列研究，纳入了来自 5 个国家 12 个地点的纤维化 ILD 患者，他们接受了住院或门诊 PR 治疗。使用多变量模型来估计 6MWD 变化与死亡或肺移植时间之间的关联，同时考虑到中心聚类和其他混杂因素。
纳入了 701 名纤维化 ILD 患者（445 名男性和 256 名女性）。196 名住院患者和 505 名门诊患者的平均年龄±标准差分别为 70±11 岁和 69±12 岁。住院患者的基线/6MWD 变化分别为 262±128/55±83m，门诊患者分别为 358±125/34±65m。在调整了住院（每 10m HR 0.94，95%CI 0.91 至 0.97，p<0.001）和门诊 PR（HR 0.97，95%CI 0.95 至 1.00，p=0.042）的混杂因素后，PR 期间 6MWD 的改善与较低的死亡或肺移植风险相关。参加≥80%计划门诊 PR 疗程与死亡风险降低 33%相关（95%CI 0.49% 至 0.92%）。
与未改善运动表现的患者相比，纤维化 ILD 患者在 PR 期间改善身体表现者的生存率更高。需要在随机对照试验中证实这些产生假说的发现，才能确定改变临床实践，并且进一步支持努力提高纤维化 ILD 患者获得 PR 的机会。
