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Targeting treatable traits in severe chronic obstructive pulmonary disease: a nonpharmacological approach

SUMMARY: Pulmonary rehabilitation should be tailor made to improve physical and mental conditions to cope with COPD. It improves exercise tolerance, reduces dyspnea and improves quality of life. Despite the association between dyspnea and hyperinflation, patients with severe hyperinflation are also rewarded with health benefits from pulmonary rehabilitation.

At the Sunday session “Targeting treatable traits in severe chronic obstructive pulmonary disease: a nonpharmacological approach”, we got an update on ‘treatable traits’ for advanced COPD patients beyond ‘regular care’. There was a consensus throughout the session that we should regard the COPD patients as more than the diseased lung. Evidence evolved during the past decade shows that severe COPD patients benefit a lot from pulmonary rehabilitation programs. Frits M.E. Franssen from the Netherlands provided us with up-to-date insights on how to rehabilitate a severe COPD patient.

Franssen presented the definition of pulmonary rehabilitation as a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies. The aim of pulmonary rehabilitation is to improve the physical and psychological condition of patients, not only with COPD but also with other chronic respiratory diseases, as well as to promote a healthy lifestyle. There is an ongoing international debate about the core components of pulmonary rehabilitation. It is important to remember, says Franssen, that pulmonary rehabilitation is more than exercise training and education. If we look at the needs of individual patients, interventions like nutritional support, psychological support, lifestyle interventions, optimization of pharmacotherapies and adherence to medication and advanced care planning are also components with potentially large benefits. Looking closer at the benefits, most evidence is on improvement of exercise tolerance, reduction in shortness of breath and improvement in quality of life1

However, studies also show that other important outcomes of pulmonary rehabilitation include improvement in body composition, reduction in psychological symptoms and reduction in mortality and re-admissions. Looking further into patient groups, hyperinflation is associated with dyspnoea, therefore patients with severe hyperinflation could be prevented from exercising to a sufficient level. Interestingly, when targeting specifically at this group of patients, Vanfleteren and colleagues (Vanfleteren et al., Arch Phys Med Rehabil 2018) demonstrated that static lung hyperinflation does not prevent patients from benefiting from pulmonary rehabilitation.  

Ingvild Bjellmo Johnsen
Medical Advisor Respiratory, Chiesi Nordic

Reference:

  1. McCarthy et al., Cochrane Syst Rev. 2015, Maltais et al., Am J Respir Crit Care Med 1996, Lindenauer et al., JAMA 2020, Schois et al., A J Respir Crit Care Med 1998, Maddocks et al., Thorax 2016, Coventry et al. J Psycsom Res 2007, Stoilkova et al., Respir Med 2013, vivodlzev et al., CHEST 2010, Moore et al., CHEST 2017, Stefan et al., Am J Respir Crit Care Med 2021, Pitta et al, CHEST, 200

ID 410-2023-MARK