Department of Internal Medicine, University of Toronto, Toronto, ON, Canada.
Department of Internal Medicine, University of Calgary, Calgary, AB, Canada; College of Public Health, Kent State University, Kent, OH, United States.
Respir Med. 2023 Nov-Dec;219:107433. doi: 10.1016/j.rmed.2023.107433. Epub 2023 Oct 19.
Interstitial lung diseases (ILDs) cause fibrosis of lung parenchyma, leading to impaired quality of life, dyspnea, and functional decline. Individuals with ILD experience a high prevalence of anxiety and depression. Recent research has demonstrated pulmonary rehabilitation (PR) alleviates symptoms of anxiety and depression in those with COPD.
What is the influence of PR on symptoms of anxiety and depression in individuals with ILD?
We conducted a PRISMA-2020-compliant systematic review of randomized controlled trials (RCTs) investigating PR's effect on anxiety and depression in patients with ILD. We searched MEDLINE, EMBASE, Cochrane, and PsycINFO from inception until April 3, 2023. A narrative synthesis was conducted where a quantitative approach was not feasible.
Five RCTs (n = 281) were included. Idiopathic pulmonary fibrosis (IPF) was the most common type of ILD (k = 3). One study reported clinically-significant improvements in symptoms of anxiety among patients with IPF, and two studies for symptoms of depression among patients with sarcoidosis. Dropout rates were similar between intervention and control groups. All studies were at a high risk of bias.
Pulmonary rehabilitation is not detrimental to anxiety or depression for patients with ILD, and may improve symptoms of anxiety in IPF and depression in sarcoidosis. However, no conclusion can be drawn from available evidence, which is limited by heterogeneous populations/interventions, sample sizes and unexpectedly low prevalences of clinically-significant anxiety or depression. Further adequately powered RCTs that focus on anxiety and depressive symptoms as primary outcomes are needed.
间质性肺疾病（ILDs）导致肺实质纤维化，导致生活质量下降、呼吸困难和功能下降。ILD 患者普遍存在焦虑和抑郁。最近的研究表明，肺康复（PR）可缓解 COPD 患者的焦虑和抑郁症状。
PR 对 ILD 患者的焦虑和抑郁症状有何影响？
我们对 PR 对 ILD 患者焦虑和抑郁影响的随机对照试验（RCTs）进行了 PRISMA-2020 一致的系统评价。我们从成立开始到 2023 年 4 月 3 日，在 MEDLINE、EMBASE、Cochrane 和 PsycINFO 上进行了搜索。进行了叙述性综合，而不是采用定量方法。
纳入了 5 项 RCT（n=281）。特发性肺纤维化（IPF）是最常见的 ILD 类型（k=3）。一项研究报告称，IPF 患者的焦虑症状有临床显著改善，两项研究报告称，结节病患者的抑郁症状有临床显著改善。干预组和对照组的辍学率相似。所有研究均存在高偏倚风险。
肺康复对 ILD 患者的焦虑或抑郁没有不良影响，并且可能改善 IPF 患者的焦虑症状和结节病患者的抑郁症状。然而，由于人群/干预措施、样本量和焦虑或抑郁的临床显著程度的预期低患病率存在异质性，因此无法从现有证据中得出结论。需要进一步进行适当的、有足够样本量的 RCT，将焦虑和抑郁症状作为主要结局。
