Nam Jung Hyun, Kim Kyung Joo, Rhee Chin Kook, Choi Joon Young, Jo Yong Suk
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Thorac Dis. 2024 Dec 31;16(12):8379-8388. doi: 10.21037/jtd-24-1165. Epub 2024 Dec 11.
The benefits of pulmonary rehabilitation (PR) for patients with idiopathic pulmonary fibrosis (IPF) have been limited to improving dyspnea, exercise capacity, and quality of life (QoL). This study aimed to assess the current status of PR and its effect on prognosis.
The Nationwide Korean Health Insurance Review and Assessment Service (HIRA) database was used in this study. Annual PR implementation rate since 2016 following its coverage in the health insurance was analyzed. IPF cases were defined using the International Classification of Diseases 10 Revision (ICD-10) codes and rare intractable diseases (RID) codes. Risk of acute exacerbation (AE) and mortality of IPF patients with or without PR were analyzed.
Of the 4,228 patients with IPF, only 205 (4.85%) received PR. Patients in the PR group were more frequently treated with pirfenidone and systemic steroids than non-PR group. In patients treated with steroids, mortality risk increased regardless of PR application, with hazard ratio (HR) of 1.63 [95% confidence interval (CI): 1.26-2.10, P<0.001] in the PR group and 1.38 (95% CI: 1.21-1.57, P<0.001) in the non-PR group, compared to those not treated with steroids. Additionally, PR did not significant affect mortality risk in patients not receiving steroids (HR, 1.49, 95% CI: 0.87-2.54, P=0.15). Similar patterns were seen for the risk of AE.
PR was applied in only a minority of patients with IPF. It did not succeed in reducing the risk of AE or mortality. A prospective study targeting early-stage patients is needed to evaluate the impact of PR considering the progressive nature of IPF disease itself.
肺康复（PR）对特发性肺纤维化（IPF）患者的益处仅限于改善呼吸困难、运动能力和生活质量（QoL）。本研究旨在评估PR的现状及其对预后的影响。
本研究使用了韩国全国健康保险审查和评估服务（HIRA）数据库。分析了自2016年健康保险覆盖后每年的PR实施率。IPF病例使用国际疾病分类第10版（ICD-10）编码和罕见难治性疾病（RID）编码进行定义。分析了接受或未接受PR的IPF患者的急性加重（AE）风险和死亡率。
在4228例IPF患者中，只有205例（4.85%）接受了PR。PR组患者比非PR组更频繁地接受吡非尼酮和全身性激素治疗。在接受激素治疗的患者中，无论是否应用PR，死亡风险均增加，与未接受激素治疗的患者相比，PR组的风险比（HR）为1.63[95%置信区间（CI）：1.26-2.10，P<0.001]，非PR组为1.38（95%CI：1.21-1.57，P<0.001）。此外，PR对未接受激素治疗的患者的死亡风险没有显著影响（HR，1.49，95%CI：0.87-2.54，P=0.15）。AE风险也呈现类似模式。
PR仅应用于少数IPF患者。它未能成功降低AE风险或死亡率。鉴于IPF疾病本身的进展性，需要针对早期患者进行前瞻性研究以评估PR的影响。
