Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: a systematic review

Early pulmonary rehabilitation in ARDS patients: Effects on respiratory function and long-term outcomes: A retrospective study

This retrospective cohort study, conducted at People's Hospital of Wenjiang Chengdu (January 2018 to January 2022), aimed to evaluate the effects of early pulmonary rehabilitation (PR) on respiratory function in acute respiratory distress syndrome patients after discontinuing invasive mechanical ventilation in the intensive care unit. Patients were divided into PR and control groups based on an offline training protocol. Outcome measures included short physical performance battery scores, respiratory muscle strength, and pulmonary function indicators at discharge and 3 months post-discharge, including peak expiratory flow, forced expiratory volume in 1 second/forced vital capacity, and vital capacity. Kaplan-Meier analysis assessed 6-month survival rates. Among the 240 patients, 120 received traditional training and 120 received early PR. Both groups had no significant differences in baseline characteristics. Short physical performance battery scores and respiratory muscle strength showed gradual improvements in both groups, with the PR group achieving significantly higher scores at 5 and 7 days (P < .05). At 3 months post-discharge, pulmonary function indicators such as peak expiratory flow, forced expiratory volume in 1 second/forced vital capacity, and vital capacity in the PR group were significantly improved compared to discharge and were higher than those in the control group (P < .05). The number of sputum aspirations in the PR group significantly decreased (P < .05), and intensive care unit stays after weaning were significantly shorter (P < .05). Kaplan-Meier survival analysis revealed that the cumulative survival rate at 6 months post-discharge was significantly higher in the PR group compared to the control group (hazard ratio = 0.660, 95% CI: 0.472-0.922, P = .014). These findings suggest that early PR significantly enhances respiratory function recovery, reduces complications, and improves survival outcomes in acute respiratory distress syndrome patients after invasive ventilation.

Evidence gaps in conservative non-pharmacological interventions and guideline implementation for high-burden non-communicable diseases: protocol for an overview of reviews

Non-communicable diseases (NCDs) represent a high burden for the society and affected individuals. Conservative non-pharmacological interventions play a first-line role in the treatment and management of most NCDs. Systematic reviews (SRs) provide the highest level of evidence and significantly influence clinical decision-making. The primary aim of this study is to provide an overview of the evidence on the effectiveness of recommended conservative non-pharmacological interventions for highly burdensome NCDs. The secondary aim is to provide an overview of the evidence for guideline implementation. A literature search was performed in Medline (PubMed), EMBASE and Cochrane CENTRAL. Six reviewers will, in duplicate, independently screen and select studies following eligibility criteria. The population will include individuals with NCDs from disease categories chosen based on WHO burden of disease data and the importance of conservative rehabilitation for their management. Eligible interventions will encompass conservative non-pharmacological approaches recommended by clinical practice guidelines (ie, physical, psychological and education/advice). Eligible comparator will include no or minimal intervention and other competitive interventions. Outcomes will comprise proposed core outcomes for the respective diseases, including patient-reported (eg, pain) and performance-based (eg, physical functioning) outcomes. SRs published in the last 5 years as peer-reviewed journal article in the English language will be eligible. The overview will be reported in accordance with the Preferred Reporting Items for Overviews of reviews.

[Outcomes of respiratory rehabilitation program in lung transplant recipients: a quasi experimental study]

INTRODUCTION

Lung transplant (LT) is the ultimate option for end-stage lung diseases. Malnutrition and sarcopenia, common in LT recipients, can be reversible with adequate exercise and nutrition. This study aims to assess changes in physical performance and aerobic capacity after a 10-week rehabilitation program (RP) in LT recipients, as well as to describe the prevalence of sarcopenia and malnutrition before and after RP and their influence on clinically relevant outcomes.

MATERIALS AND METHODS

Quasi-experimental study, before and after a 10-week PR in first-time TP recipients, aged over 18 years, from January 2022 to September 2023. Aerobic exercise capacity was assessed through the 6-minute walking test (6MWT) and peak oxygen consumption (VO2peak); and physical performance was measured using the Short Physical Performance Battery (SPPB). Additionally, the prevalence of sarcopenia was described according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2) and malnutrition according to the criteria of the Global Leadership Initiative on Malnutrition (GLIM).

RESULTS

Of the 41 patients, 56% had sarcopenia and 80% had malnutrition. After RP, the distance walked in the 6MWT increased by 66.3m (p=0.004) in men and 61m (p=0.001) in women. VO2peak increased in men by a mean of 3.1ml/min/kg (p=0.024). Physical performance improved significantly in both men and women according to the Short Physical Performance Battery (SPPB), with clinically relevant differences of 1.6 pts (p<0.001) and 1.2 pts (p=0.012), respectively. The prevalence of sarcopenia decreased to 24% and malnutrition to 61%.

CONCLUSIONS

RP proved to be an effective and safe intervention for LT recipients. In addition to improvements in skeletal muscle strength and exercise capacity, a reduction in the prevalence of sarcopenia and malnutrition was also observed.

Pulmonary rehabilitation and family/friend caregivers: the hidden reciprocal relationship improving outcomes in chronic respiratory diseases

INTRODUCTION

The experiences and needs of living with chronic respiratory diseases (CRD) can be overwhelming. Individuals often rely on informal care for daily assistance and having a family/friend caregiver has been associated with better health outcomes. Nevertheless, family/friend caregivers frequently feel alone and unsupported. Pulmonary rehabilitation (PR) leads to multidimensional benefits across CRD and individuals have suggested improvements for PR. Family/friend caregivers highly support PR in practical and psychosocial ways and have identified this intervention as an opportunity to be supported. This reciprocal relationship between PR and the family/friend caregivers has been scarcely explored and its importance for the management of CRD is poorly understood.

AREAS COVERED

This perspective synthesizes the experiences and needs of living with CRD from the perspective of people with CRD and their family/friend caregivers; and proposes a vision of a reciprocal/symbiotic relationship, through PR, for optimizing care for people with CRD and their caregivers.

EXPERT OPINION

A deeper understanding/recognition of the extensiveness and somewhat overlap of the experiences and unmet needs of individuals with CRD and their family/friend caregivers; and of the reciprocal/symbiotic relationship between PR and the family/friend caregivers might be important to optimizing management and, ultimately, individuals and caregivers' outcomes in CRD.

Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease: Meeting Report and Literature Review

TOPIC IMPORTANCE

Cognitive and physical limitations are common in individuals with chronic lung diseases, but their interactions with physical function and activities of daily living are not well characterized. Understanding these interactions and potential contributors may provide insights on disability and enable more tailored rehabilitation strategies.

REVIEW FINDINGS

This review summarizes a 2-day meeting of patient partners, clinicians, researchers, and lung associations to discuss the interplay between cognitive and physical function in people with chronic lung diseases. This report covers four areas: (1) cognitive-physical limitations in patients with chronic lung diseases; (2) cognitive assessments; (3) strategies to optimize cognition and motor control; and (4) future research directions. Cognitive and physical impairments have multiple effects on quality of life and daily function. Meeting participants acknowledged the need for a standardized cognitive assessment to complement physical assessments in patients with chronic lung diseases. Dyspnea, fatigue, and age were recognized as important contributors to cognition that can affect motor control and daily physical function. Pulmonary rehabilitation was highlighted as a multidisciplinary strategy that may improve respiratory and limb motor control through neuroplasticity and has the potential to improve physical function and quality of life.

SUMMARY

There was consensus that cognitive function and the cognitive interference of dyspnea in people with chronic lung diseases contribute to motor control impairments that can negatively affect daily function, which may be improved with pulmonary rehabilitation. The meeting generated several key research questions related to cognitive-physical interactions in individuals with chronic lung diseases.

Long-term self-reported attendance in exercise training or lung choir and status of quality of life following initial pulmonary rehabilitation for COPD

Background

Both adherence rates to pulmonary rehabilitation (PR) programmes and long-term attendance in exercise training after PR remain a challenge. In our previous randomised controlled trial (RCT), effects were positively associated with a dose-response pattern, regardless of whether PR contained conventional physical exercise training (PExT) or Singing for Lung Health (SLH) as a training modality within a 10 weeks' PR programme for chronic obstructive pulmonary disease (COPD). However, long-term status of this RCT cohort remains unknown. In this study, we investigated whether current status (=attendance in supervised exercise training or a lung choir and scoring in quality of life (QoL)) was related to initial PR completion, randomisation, or adherence.

Methods

We collected data via telephone, using a researcher-developed questionnaire on current self-reported attendance in supervised exercise training or a lung choir and on perceived benefits of the initial RCT intervention. Additionally, we used COPD-validated questionnaires (primarily: QoL (measure: St George's Respiratory Questionnaire; SGRQ).

Results

In 2023 (i.e., mean/median 4.7 years after initial PR), surviving participants were contacted (n = 196; 73% of 270), and 160 (82% of 196) were included. Out of the included participants, 30 (19%) had not completed initial PR. Compared to the initial PR-completers, non-completers reported less current attendance in exercise training or lung choir (24% vs. 46%, p = 0.03) but SGRQ scores were comparable. Yet, those who attended exercise training or lung choir at present (n = 66/160; 41% out of 160) reported better QoL score than those with no current attendance (SGRQ; Attending: 39.9 ± 15.4; Not attending: 43.1 ± 16.7; p = 0.02). Neither having had SLH instead of PExT, nor adherence level during initial PR, was related to current attendance or to QoL scores.

Conclusion

This study indicates that long-term self-reported attendance and current QoL scores are positively related to initial completion of a PR programme. Surprisingly, neither initial PR content (PExT or SLH) nor initial PR adherence was related to long-term outcomes. We suggest that future PR programmes include special attention to those who do not complete PR to support long-term attendance and QoL status.

Effects of using wearable devices to monitoring physical activity in pulmonary rehabilitation programs for chronic respiratory diseases: A systematic review protocol

INTRODUCTION

Pulmonary rehabilitation (PR) is an intervention aimed at the comprehensive care of individuals with chronic respiratory diseases. Patients with chronic obstructive pulmonary disease (COPD) and asthma present low levels of physical fitness because they avoid physical exercises due to the fear of triggering recurrent symptoms. Wearable devices have been integrated into behavioral modification interventions for physical activity in PR protocols. Therefore, this review aims to identify how wearable devices are being utilized for monitoring chronic respiratory diseases in pulmonary rehabilitation programs.

METHODS AND ANALYSIS

Searches will be conducted on Medline, Cochrane Central Register of Controlled Trials, Embase (CENTRAL), CINAHL and PEDro electronic databases, as well as a search in the grey literature. We will include baseline data from randomized clinical trials reporting the use of wearable devices for monitoring physical activity in protocols for pulmonary rehabilitation programs for chronic respiratory diseases. Studies that discuss only the development of algorithms or applications for the assessment of diseases or unavailable full texts will be excluded. The main reviewer will conduct the initial search and exclusion of duplicates, while two independent reviewers will select studies, extract data, and assess the methodological quality using the PEDro tool.

PROSPERO REGISTRATION NUMBER

CRD42024504137.

Baseline dependent minimally important differences for clinical outcomes of pulmonary rehabilitation in people with COPD

INTRODUCTION

Minimally important differences (MIDs) for common outcomes of pulmonary rehabilitation are well documented for people with chronic obstructive pulmonary disease (COPD). It is not known whether MIDs differ based on COPD disease characteristics. This study aimed to estimate MIDs for clinical outcomes of pulmonary rehabilitation dependent upon baseline characteristics.

METHODS

A database containing 2791 people with COPD was split into derivation (n=2245; age 66±9 years; 50% males; FEV1 47±20% predicted) and comparator (n=546; age 66±9 years; 47% males; FEV1 46±21% predicted) cohorts. MIDs were estimated using 0.5 x SD (symmetrically distributed) or 0.5 x IQR (non-symmetrically distributed) for: 6-minute walk test (6MWT), constant work rate test (CWRT), COPD assessment test (CAT), St. George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), and fat-free mass index (FFMI). MIDs were estimated based on baseline outcome scores, lung function, modified medical research council (mMRC) grade and FFMI.

RESULTS

MID estimates were comparable to previously reported values. MIDs for SGRQ domains (Symptom=8.7 points, Activity=7.1 points, Impact=8.1 points) and FFMI were produced (0.36kg/m2). There was greater variation of change in 6MWT, SGRQ-activity, SGRQ-impact, HADS and FFMI on which the MIDs were determined when categorising for baseline values (all, p<0.05). Greater variation of change in 6MWT on which the MIDs were determined was evident with COPD disease severity grouping (p<0.05). The magnitude of change in 6MWT, CAT, CWRT, SGRQ-activity, and FFMI with baseline mMRC score categorisation resulted in greater variation on which the MIDs were determined (all, p<0.05). Baseline stratification for FFMI resulted in greater variation of change in CWRT (p<0.001) and HADS-depression (p = 0.043) on which MIDs were determined.

DISCUSSION

Findings suggest that baseline presentation should be considered for people with COPD when assessing the efficacy of pulmonary rehabilitation. However, clinical significance of the variation underpinning MIDs is yet to be determined.

Core outcome set for pulmonary rehabilitation of patients with COPD: results of a modified Delphi survey

INTRODUCTION

There is high heterogeneity of outcomes and measures reported in pulmonary rehabilitation (PR) trials of people with chronic obstructive pulmonary disease (COPD). This hinders study comparability and benchmarking of PR. We have developed a core outcome set (COS) to overcome these challenges.

METHODS

This study was informed by a systematic review and two qualitative studies and had patient involvement since its inception. A two-round Delphi survey was available in seven languages. Outcomes (n=63) scored 7-9 (crucial) by ≥70% of the participants and 1-3 (not that important) by ≤15% of participants from both groups in the Likert scale were automatically included in the COS, while outcomes that were considered crucial by only one of the groups were further discussed by the authors in a meeting.

RESULTS

A total of 299 people (n=229 healthcare professionals/researchers/policy-makers; n=70 people with COPD and informal caregivers) participated in the survey (83% retention), which covered 29 countries/five continents. After the second round, six outcomes were included and three were added in the meeting. The final COS contains dyspnoea, fatigue, functional exercise capacity, health-related quality of life, health behaviours/lifestyle, knowledge about the disease, lower limb muscle function, personal goals and problematic activities of daily living.

CONCLUSION

A COS for PR of people with COPD is now available and can be used by different stakeholders to improve consistency and comparability of studies, benchmark PR and improve the quality of care provided. Future research should establish the core measures and investigate the uptake of this COS.

Pulmonary rehabilitation in sarcoidosis: A systematic review and meta-analysis

BACKGROUND

Exercise intolerance, muscle weakness, dyspnoea, and fatigue are frequent complications in symptomatic sarcoidosis patients. Pulmonary rehabilitation improves exercise capacity, symptoms, and quality of life in patients with chronic respiratory diseases. Our objective was to systematically determine the effects of pulmonary rehabilitation in patients with sarcoidosis.

METHODS

A systematic review was conducted in seven databases. Studies that applied pulmonary rehabilitation in patients with sarcoidosis were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence.

RESULTS

Of the 406 reports returned by the initial search, five articles reporting on 184 patients were included in the data synthesis. Two studies included multi-component exercise, one inspiratory muscle training, one a physical activity incentivisation programme, and one a telerehabilitation program. In the intervention group (IG), we found significant improvement in exercise capacity (SMD 1.65, 95%CI 0.45, 2.86 points, p = 0.006). If we only analyse the studies that performed the 6-min walking test, the IG walked 40.3 (CI95% 20.3, 60.2) m higher than the control group (CG) (p < 0.001). Additionally, dyspnoea score was reduced (MD -0.42 95%CI -0.75, -0.10, p = 0.002). However, fatigue, quality of life and pulmonary function did not show any change.

CONCLUSION

Pulmonary rehabilitation could improve exercise capacity and dyspnoea perception in patients with sarcoidosis.

Social determinants of advanced chronic respiratory interventions: a scoping review

INTRODUCTION

Income, education, occupation, social class, sex and race/ethnicity are essential social determinants of health (SDH). Reporting of SDH when testing complex interventions for people with advanced chronic respiratory diseases or how they impact accessibility, engagement and effectiveness within sub-populations is unclear.

AIMS AND METHODS

This scoping review examined reporting of SDH in pulmonary rehabilitation (PR), singing for lung health (SLH) and multicomponent palliative care interventions (MPCI). Reporting of SDH was assessed from studies from PubMed and three systematic reviews.

RESULTS

Eight SLH, 35 MPCI and 351 PR studies were included. Sex was most reported (PR: n=331, 94.3%; SLH: n=6, 75.0%; MPCI: n=31, 88.6%), while social class was only mentioned in one PR study (n=1, 0.3%). 18 PR studies (5.1%), two SLH studies (25.0%) and three MPCI studies (8.6%) reported no SDH. Included studies were predominantly from high-income countries (304 PR studies from 26 countries, six SLH studies from two countries and all the MPCI studies from 12 countries), published from 2000 to 2022 with reporting in PR progressively increasing.

CONCLUSION

Reporting of SDH is limited. Consequently, impacts of these social barriers on engagement in clinical trials or whether the complex interventions are effective universally or within certain sub-populations is unclear.

High-intensity interval training improves the outcomes of patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials

BACKGROUND

Pulmonary exercise is an important part in the treatment of chronic obstructive pulmonary disease (COPD). We aimed to evaluate the effects and safety of high-intensity interval training (HIIT) in patients with COPD, to provide insights to the COPD treatment and care.

METHODS

Two investigators searched PubMed, Medline, Embase, web of Science, Cochrane library, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases up to Sept 15, 2022 for randomized controlled trials (RCTs) on the effects and safety of HIIT for COPD patients. RevMan5.3 software was used for statistical analysis.

RESULTS

A total of 20 RCTs involving 962 COPD patients were finally included. 514 patients underwent HIIT interventions. Meta-analysis showed that HIIT increased the peak oxygen consumption (SMD = 0.30, 95%CI:0.14-0.46), peak minute ventilation (SMD = 0.26, 95%CI: 0.05-0.47), peak work rate (SMD = 0.34, 95%CI: 0.17-0.51), 6-min walking distance (SMD = 0.39, 95%CI: 0.23-0.55) in COPD patients (all P < 0.05). HIIT improved the quality of life (SMD = 0.30, 95%CI: 0.06-0.54) and reduced the dyspnea (SMD = -0.27, 95%CI: -0.51∼-0.03) in COPD patients (all P < 0.05). There were no significant differences in the forced expiratory volume in 1 s/forced vital capacity (SMD = 0.28, 95%CI: -0.01-0.56) and St. George's Respiratory Questionnaire score (SMD = -0.35, 95%CI: -0.73-0.03) between HIIT and control group (all P > 0.05). There was no publication bias analyzed by the Egger test and funnel plots (all P > 0.05).

CONCLUSIONS

HIIT may be beneficial to improve the pulmonary function, exercise capacity and quality of life of patients with COPD, which is worthy of clinical promotion for COPD treatment and care.

The presence of extra-pulmonary treatable traits increases the likelihood of responding to pulmonary rehabilitation

INTRODUCTION

Studies suggest that people with chronic obstructive pulmonary disease (COPD) who are worse at baseline respond better to pulmonary rehabilitation (PR). Identifying treatable traits (TTs) may help to distinguish responders from non-responders. We explored the impact of PR on extra-pulmonary traits of people with COPD and whether the presence of TT influences the type of response to PR.

METHODS

A comprehensive assessment of 9 TT including symptoms (dyspnoea, fatigue, anxiety and depression), functional capacity, deconditioning, balance, impact of the disease and health-related quality of life was conducted before and after a 12-week community-based PR programme. Pre-post differences between people with or without each TT at baseline were compared with independent samples t-tests or Mann-Whitney U tests. Proportion of responders between groups were explored with chi-square tests and odds ratio.

RESULTS

102 people with COPD were included (70 [65; 75] years old, 78% male, FEV₁ 47 [36; 60] %predicted). They had a median of 3 (out of 9) TTs per person and each patient responded on average to 5 (out of 9) outcomes of PR. People with TT were more responsive than those without them in all outcomes (p < 0.05) except for the 1-min sit-to-stand test. The presence of TT increased 4 to 20 times the likelihood of being a good responder.

CONCLUSIONS

Identification of baseline extra-pulmonary TT in people with COPD showed the potential to inform on PR responsiveness and might therefore be an important strategy for patient prioritization, treatment personalisation (i.e., activation of the most suitable components) and optimisation.

Differential Impact of Low Fat-Free Mass in People With COPD Based on BMI Classifications: Results From the COPD and Systemic Consequences-Comorbidities Network

BACKGROUND

Alterations in body composition, including a low fat-free mass index (FFMI), are common in patients with COPD and occur regardless of body weight.

RESEARCH QUESTION

Is the impact of low FFMI on exercise capacity, health-related quality of life (HRQL), and systemic inflammation different among patients with COPD stratified in different BMI classifications?

STUDY DESIGN AND METHODS

We analyzed baseline data of patients with COPD from the COPD and Systemic Consequences-Comorbidities Network cohort. Assessments included lung function, bioelectrical impedance analysis, 6-min walk distance (6MWD), HRQL, and inflammatory markers. Patients were stratified in underweight, normal weight (NW), preobese, and obese according to BMI and as presenting low, normal, or high FFMI using 25th and 75th percentiles of reference values. Linear mixed models were used to investigate the associations between fat-free mass (FFM) and fat mass with secondary outcomes in each BMI group.

RESULTS

Two thousand one hundred thirty-seven patients with COPD (Global Initiative for Chronic Obstructive Lung Disease stages 1-4; 61% men; mean ± SD age, 65 ± 8 years; mean ± SD FEV₁, 52.5 ± 18.8% predicted) were included. The proportions of patients in underweight, NW, preobese, and obese groups were 12.3%, 31.3%, 39.6%, and 16.8%, respectively. The frequency of low FFMI decreased from lower to higher BMI groups (underweight, 81%; NW, 53%; preobese, 42%; and obese, 39%). FFM was associated with the 6MWD in the underweight group, even when adjusting for a broad set of covariates (P < .05). HRQL was not associated with FFM after adjustment for lung function or dyspnea (P > .32). Fat mass was associated with higher systemic inflammation in the NW and preobese groups (P < .05).

INTERPRETATION

In patients with COPD with lower weight, such as underweight patients, higher FFMI is associated independently with better exercise capacity. In contrast, in preobese and obese patients with COPD, a higher FFMI was not consistently associated with better outcomes.

Performance Score (T2D)-A New Perspective in the Assessment of Six-Minute Walking Tests in Pulmonary Rehabilitation

Because absolute changes in outcomes are difficult to interpret and the minimal clinically important difference (MCID) is not suitable to address this challenge, a novel method of classifying outcomes by relating changes to baseline values is warranted. We used the "performance score" (T2D), which reflects individual performance, enabling us to consider the functional status at the beginning of rehabilitation without dealing with the problems of mathematical coupling or regression effects, as encountered in ANCOVA. To illustrate the T2D, we retrospectively analyzed changes in the six-minute walking test (6MWT) in COPD patients undergoing outpatient pulmonary rehabilitation and compared the results with absolute differences related to a predetermined MCID. We evaluated a total of 575 COPD patients with a mean age of 61.4 ± 9.2 years. 6MWT improved significantly, with a mean change of 32.3 ± 71.2. A total of 105/311 participants who had reached the MCID were still classified as "below average" by the T2D. Conversely, 76/264 patients who had not reached the MCID were classified as "above average". This new performance measure accounts for the patient's current status and for changes over time, potentially representing a simple and user-friendly tool that can be used to quantify a patient's performance and response to rehabilitation.

Monthly Follow-Ups of Functional Status in People with COPD: A Longitudinal Study

Functional status is an important and meaningful outcome in people with chronic obstructive pulmonary disease (COPD), although its measurement is not embedded in routine clinical assessments. This study described the functional status of people with COPD using the 1-min sit-to-stand test (1minSTS) over a 6-month period and the examined sociodemographic and clinical characteristics associated with this outcome. Data from a prospective study including people with COPD were analyzed. Functional status was assessed monthly with the 1minSTS over 6 months. Linear-mixed effect models assessed the 1minSTS number of repetitions mean change. One-hundred and eight participants (82.4% men; 66.9 ± 9.5 years) were included. A significantly lower number of repetitions in the 1minSTS over the 6-month period was associated with being female (estimate: −4.69, 95%CI: −8.20; −1.18), being older (estimate: −0.56, 95%CI: −0.77; −0.34), having higher BMI (estimate: −0.55, 95%CI: −0.81; −0.28) and having higher activity-related dyspnea (estimate: −2.04, 95%CI: −3.25; −0.83). Half of the participants showed improvements above three repetitions in the 1minSTS over the 6-month period, independently of their baseline impairment (1minSTS < 70% predicted: 52.5%; ≥70% predicted: 54.4%). To conclude, monthly follow-up assessments were associated with clinically relevant benefits in the functional status of people with COPD. Age, body composition, and activity-related dyspnea were the main predictors of functional status over time. Further research is needed to corroborate our findings and to support the beneficial effects of regular COPD monitoring.

Access, access, access: the Three A's of pulmonary rehabilitation - perspectives of patients, loved ones and healthcare professionals

Improving access to pulmonary rehabilitation (PR) is a worldwide priority [1]. Evidence suggests that those who are more symptomatic, with frequent hospitalisations and whose health status and ability to exercise and perform activities of daily living is worse, are also the ones who respond better [2] and should be referred/prioritised to PR [3]. We explored whether these criteria are aligned with the perspectives of people with chronic respiratory diseases (CRDs), their loved ones (LOs) and healthcare professionals (HCPs).

Efforts need to be made to increase access to pulmonary rehabilitation as early as possible, prioritising those who are more symptomatic and have functional status limitations, and improving communication within and among healthcare serviceshttps://bit.ly/3LMcLcU