March 2015 Pulmonary Rehabilitation as a non-pharmacological intervention in patients COPD reinforced

Research published in Cochrane Review

Pulmonary Rehabilitation is a non- pharmacological intervention for patients with Chronic Obstructive Airways Disease (COPD) and its effectiveness was confirmed in a Cochrane Review which has generated major interest across the world.

The review was led by a team from the School of Nursing and Midwifery at the National University of Ireland Galway. The team consisted of Bernard McCarthy, Dr Dympna Casey, Professor Declan Devane, Professor Kathy Murphy, Edel Murphy and the internationally renowned Canadian pulmonologist Dr Yves Lacasse. The two-year project brought together the findings of 65 randomised control trials involving 3822 participants for inclusion in the analysis.

COPD is a chronic lung disease that causes obstruction in breathing. This results in persistent and progressive breathlessness, productive coughing, fatigue and recurrent chest infection. Worldwide, COPD is a major cause of long term health issues. The World Health Organisation projects that by the year 2030 it will be the third most frequent cause of death globally.

There are around 110,000 people in Ireland diagnosed with COPD, but it is estimated that a further 200,000 people living with the disease who have not been diagnosed. COPD affects the quality of peoples’ life but pulmonary rehabilitation can make a difference.

Bernard McCarthy, NUI Galway, the lead author explains: “At this time, COPD is an incurable, life-limiting condition that is associated with significant economic costs due to progressive disease severity and frequent hospital admissions and readmissions. Our findings from pooling all the international research demonstrate that pulmonary rehabilitation has a significant positive effect. Pulmonary rehabilitation which includes exercise as a key component and may also include assessment, education, psychological support and dietary advice, has been shown to relieve breathing difficulty and fatigue and improves individuals’ sense of control over their condition. These all lead to a better quality of life for individuals with COPD, facilitating them to re-engage with their normal lives.”

The authors concluded that these improvements from Pulmonary Rehabilitation are clinically significant. In addition the volume of evidence is now so convincing that “additional randomised controlled trials are no longer warranted.” What we now need, according to the team, is to investigate the components of pulmonary rehabilitation essential for best outcomes. “It would be good to investigate the ideal programme length and location, the degree of supervision and intensity of training required, or how long treatment effects persist.” The team also found some tentative evidence that “there is a difference between hospital-based and community-based programmes, which now requires further study.”

Some authors of the report were previously involved in the PRINCE study which was completed in 2012 in conjunction with Irish general practices. The PRINCE (Pulmonary Rehabilitation in Nurse-led Community Environment) study was funded by the HRB, and consisted of a two-armed randomised cluster trial. In one arm (intervention group), persons with COPD received a structured education pulmonary rehabilitation programme, while the other arm (control group) received usual care. At the time, the study was one of the largest pulmonary rehabilitation trials conducted in primary care.

This recent Cochrane Review informs the global community of professionals working in this field about the potential for helping patients with this debilitating illness. Bernard McCarthy added “We must reinforce that prevention is the priority, focusing on measures, such as smoking cessation. Our findings gives hope to those suffering from COPD worldwide who are currently housebound and reluctant to engage in routine activities of living due to the limiting natures of this condition. For them Pulmonary Rehabilitation might be a light at the end of a very dark tunnel.”

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