A simple at-home program with daily exercise, airway clearance, and nurse support helps patients breathe easier, offering new hope for millions living with this chronic lung disease.
Study: Role of home-based pulmonary rehabilitation programs for disease progression and quality of life in patients with stable bronchiectasis: a single-center RCT. Image credit: Migma__Agency/Shutterstock.com
A single-center randomized controlled trial investigating the protective efficacy of the home-based pulmonary rehabilitation program in patients with stable bronchiectasis reported improved clinical outcomes and quality of life. The trial findings are published in Frontiers in Medicine.
Background
Bronchiectasis is a chronic respiratory disease characterized by irreversible widening and damage of the airways, airway inflammation, and recurrent infections. Because it is chronic and relapsing, patients with bronchiectasis often require long-term home management. However, a considerable proportion of patients lack effective home monitoring, leading to chronic airway inflammation, progressive structural damage, and a poor quality of life.
Home-based Pulmonary Rehabilitation (HBPR) is a personalized intervention delivered at home for patients with chronic lung diseases. This low-cost, easy-to-implement intervention includes breathing training, regular walking or light-intensity aerobic exercises, and airway clearance processes.
In this randomized controlled trial, researchers investigated the efficacy of HBPR in improving clinical outcomes and quality of life in patients with stable bronchiectasis.
Trial design
The trial enrolled 80 patients who were discharged from the Shanghai Pulmonary Hospital, China. In China, the estimated prevalence of bronchiectasis is 1.2% in individuals aged 40 years or above.
The patients were randomly assigned to the intervention group and the control group. The intervention group patients received the pre-designed HBPR program for bronchiectasis, which included an average of five weekly exercise sessions, with a median training duration of 45 minutes.
The program also included daily aerobic exercise (30 to 60 minutes), twice-daily inspiratory muscle training, and using Threshold IMT devices at 30% to 50% of maximal inspiratory pressure, individualized airway clearance techniques such as postural drainage and Active Cycle of Breathing Techniques, phased intensity progression, weekly remote or in-person nurse guidance, nutrition management and health education via e-health platforms, all monitored through electronic logs. The intervention was delivered by specially trained nursing staff. The control group patients received standard respiratory care.
The control group patients received a structured form of respiratory care, including educational manuals, weekly WeChat-based rehabilitation videos, scheduled follow-up assessments, and access to a respiratory chronic disease nursing clinic, but without individualized supervision, inspiratory muscle training, or progressive programming of HBPR.
The effect of intervention on the patient’s quality of life, lung function indicators, and the frequency of acute exacerbations was assessed over a 12-month period.
Key findings
The trial findings revealed a significant beneficial effect of the 12-month HBPR program on patients’ overall quality of life, including physical and emotional functioning, social functioning, treatment burden, health perceptions, and respiratory symptoms. These benefits became statistically significant starting at 3 months after intervention and strengthened at 6 and 12 months, with no significant differences at baseline or 1 month.
Significant improvements in lung function indicators, including forced expiratory volume, forced vital capacity, and peak expiratory flow, were observed during the follow-up period in patients receiving HBPR. At 12 months, mean FEV1 increased to 2.56 L in the HBPR group compared to 2.20 L in controls, while peak expiratory flow rose to 4.68 L/s versus 3.54 L/s, respectively (P <0.001). The benefits were more pronounced after 6 and 12 months of intervention.
A significant beneficial impact of HBPR was observed on chronic cough symptoms, the most common symptoms in bronchiectasis patients. These symptoms are significantly associated with increased disease burden and severity and increased frequency of acute exacerbations. Leicester Cough Questionnaire (LCQ) scores reached 18.3 in the HBPR group versus 13.4 in the control group at 12 months (P <0.001).
The frequency of acute exacerbations, which is substantially associated with disease worsening, showed a significant improvement following HBPR. This highlights the clinical significance of implementing HBPR.
Significance of findings
The trial findings highlight the efficacy of expert-supervised HBPR in improving respiration functions, frequency of acute exacerbations, and quality of life in hospital-discharged patients with stable bronchiectasis.
The HBPR program explored in the trial includes a phased training design, personalized intensity adjustment, and multimodal supervision-feedback mechanisms, which form a closed-loop intervention model. These features separate HBPR from standard respiratory care, which is mainly passive and lacks individualized supervision or progressive programming.
Exercise training in HBPR can help increase muscle oxidative capacity and endurance, improving patients’ physical functioning. Airway clearance processes can help reduce mucus retention, improve airway potency, prevent recurrent infections, alleviate dyspnea, coughing, and fatigue. These are possible mechanisms by which HBPR helps improve patients’ overall quality of life with stable bronchiectasis.
Respiratory muscle training and aerobic exercise included in HBPR synergistically help increase the strength and endurance of the respiratory muscles and reduce airway resistance. Airway clearance processes help reduce airway inflammation and improve pulmonary function by reducing the accumulation of mucus. HBPR also includes nutrition management education, providing adequate nutritional support to patients. All these features collectively contribute to the observed improvements in respiratory functions.
Mucus clearance and prevention of recurrent infections through airway clearance processes are the major factors associated with the observed reduction in the frequency of acute exacerbations. Furthermore, health education in HBPR improves patients’ ability to identify acute exacerbations and respond promptly.
The trial was conducted on a limited number of patients, which may restrict the generalizability of its findings. Future multicenter trials with larger sample sizes and longer follow-up periods are needed to validate these findings and capture the long-term sustainability and prognostic impact of the intervention.
All 80 patients completed the full 12-month follow-up period without dropouts, improving data integrity. The authors emphasize this as a preliminary exploratory trial designed to inform larger, multicenter studies. The trial did not stratify patients according to their disease severity and record disease etiology. These factors may influence the observed clinical outcomes associated with HBPR.
Overall, the trial highlights the significance of HBPR in improving patients’ adherence to the intervention through remote guidance and family support and reducing their dependency on medical institutions. Furthermore, HBPR as an e-health platform can effectively monitor patients’ rehabilitation progress in real time and optimize the intervention strategies as needed.
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