COPD pulmonary rehabilitation - good enough for ILD patients?

Introduction: Evidence supports the use of pulmonary rehabilitation (PR) as a primary intervention in interstitial lung disease (ILD). NICE guidance has challenged respiratory clinicians to define exercise prescription in ILD (1). We are developing a bespoke ILD PR but meanwhile report on our experiences with COPD-type PR in patients with ILD. Methods: 66 consecutive ILD patients with confirmed diagnosis of ILD (HRCT chest) who completed a PR programme at BreathingSpace (minimum 12 sessions) 2015-16 were reviewed against parameters used in the British Thoracic Society (BTS) audit of COPD. We focused on 3 main outcome measures- change in incremental shuttle walk distance, MRC and CAT test (2) Results: N=66 ILD patients (43 M, median age 71 range 41-84). Table 1 summarises PR outcome measures comparing results with our BTS PR COPD audit. 36 (55%) achieved a minimum of 48M improvement in ISWT (median 70M range 50-380M). The median reduction in CAT score was 0 (range -15 to +8). 25 of 60 patients with complete data (41%) achieved a reduction in CAT score of at least 2. The median post PR MRC score was 2 with 35 (54%) recording a lower MRC score than pre-PR. Conclusion: PR programmes derived from experience with COPD patients produce similar outcomes in conventional parameters and therefore appear to be effective management pending further research into exercise prescription and outcome measurement in ILD. References: 1. Ideopathic Pulmonary Fibrosis in adults. www.nice.org.uk CG163 May 2017 2. Someva F et al The COPD Assessment Test as a prognostic marker in ILD Clin Med insights 2016