Shibuya Manaka, Yamamoto Shuhei, Kobayashi Shuken, Nishie Kenichi, Yamaga Takayoshi, Kawachi Shohei, Matsunaga Atsuhiko
Department of Rehabilitation, Kitasato University Hospital, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan.
Department of Rehabilitation, Shinshu University Hospital, 3-1-1, Asahi, Matsumoto, Nagano, Japan.
Respir Care. 2022 Mar;67(3):360-369. doi: 10.4187/respcare.09066. Epub 2021 Dec 7.
The aim of this study was to clarify the effectiveness of pulmonary rehabilitation in patients after exacerbations of COPD and to explore the initiation timing of pulmonary rehabilitation.
Systematic review and meta-analysis were performed to assess the effects of pulmonary rehabilitation in subjects with exacerbations of COPD on mortality and readmission compared with usual care. We searched for studies published up to October 2020 in MEDLINE, Embase, Cochrane Library, and other sources. Risk of bias was assessed for the randomization process, deviations from intended interventions, missing outcome data, outcome measurements, and selection of the reported result using the Risk of Bias 2 tool. We pooled mortality and readmission data and performed comparisons between pulmonary rehabilitation and usual care. The subgroup analysis compared pulmonary rehabilitation at different start times (early: ≤ 1 week from admission; and late: > 1 week from admission).
We identified 10 randomized trials (1,056 participants). Our meta-analysis showed a clinically relevant reduction in readmission up to 3-6 months after pulmonary rehabilitation in both early group (4 trials, 190 subjects; risk ratio [RR] 0.58, [95% CI 0.34-0.99]) and late group (3 trials, 281 subjects; RR 0.48, [95% CI 0.32-0.71]). However, pulmonary rehabilitation had no significant effect on mortality 1 y later compared with usual care (4 trials, 765 subjects; RR 1.27, [95% CI 0.91-1.79]).
Pulmonary rehabilitation showed short-term effects for subjects with exacerbations of COPD even if initiated within 1 week; however, further study is required to determine its long-term effects.
本研究旨在阐明慢性阻塞性肺疾病（COPD）急性加重期患者进行肺康复的有效性，并探讨肺康复的起始时机。
进行系统评价和荟萃分析，以评估与常规治疗相比，COPD急性加重期患者进行肺康复对死亡率和再入院率的影响。我们检索了截至2020年10月在MEDLINE、Embase、Cochrane图书馆及其他来源发表的研究。使用偏倚风险2工具对随机化过程、与预期干预的偏差、缺失结局数据、结局测量以及报告结果的选择进行偏倚风险评估。我们汇总了死亡率和再入院率数据，并对肺康复和常规治疗进行了比较。亚组分析比较了不同起始时间（早期：入院后≤1周；晚期：入院后>1周）的肺康复情况。
我们纳入了10项随机试验（1056名参与者）。我们的荟萃分析显示，在早期组（4项试验，190名受试者；风险比[RR]0.58，[95%置信区间0.34 - 0.99]）和晚期组（3项试验，281名受试者；RR 0.48，[95%置信区间0.32 - 0.71]）中，肺康复后3至6个月内再入院率均有临床意义的降低。然而，与常规治疗相比，1年后肺康复对死亡率无显著影响（4项试验，765名受试者；RR 1.27，[95%置信区间0.91 - 1.79]）。
即使在1周内开始，肺康复对COPD急性加重期患者也显示出短期效果；然而，需要进一步研究以确定其长期效果。
