Differences in response to pulmonary rehabilitation in idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease

BACKGROUND: The benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) are well recognized. However, whether individuals with idiopathic pulmonary fibrosis (IPF) benefit is less clear.

OBJECTIVES: To evaluate the effects of pulmonary rehabilitation in subjects with IPF and compare their responses with a group of COPD subjects who underwent an identical program.

METHODS: For- ty-five subjects with IPF and 45 age- and Medical Research Council grade-matched COPD subjects were recruited. Subjects completed an 8-week outpatient pulmonary rehabilitation program. Dyspnea, peripheral muscle force, exercise capacity (6-min walk distance, 6MWD), activities of daily living, and health status (36-item short-form survey, SF-36) were assessed at baseline, immediately following and at 6 months following completion of the program.

RESULTS: Adherence to the program was similar in both groups. Significant improvements in dyspnea, muscle force, exercise capacity and ADL were observed in both groups (all p < 0.05); however, the magnitude of improvement in all outcomes was less in the IPF group [mean (95% CI) improvement in 6MWD, IPF 16.2 (7.1-25.4); COPD 53.1 (44.9-61.2)]. All domains of SF-36, with the exception of social function, improved (all p < 0.05) in the COPD group; however, there were no changes in SF-36 scores in the IPF group. The benefits were well maintained in the COPD group at 6 months, but, with the exception of the ADL score, the benefits were no longer present in the IPF group.

CONCLUSIONS: Pulmonary rehabilitation in IPF produces only modest short-term gains in dyspnea, exercise capacity and ADL, but does not improve health status.