Pulmonary Rehabilitation in Individuals With Non-Cystic Fibrosis Bronchiectasis: A Systematic Review.

Abstract

To examine the effect of pulmonary rehabilitation (PR) (exercise and education) or exercise training (ET) on exercise capacity, health-related quality of life (HRQOL), symptoms, frequency of exacerbations, and mortality compared with no treatment in adults with bronchiectasis. Computer-based databases were searched from their inception to February 2016. Randomized controlled trials of PR or ET versus no treatment in adults with bronchiectasis were included. Two reviewers independently extracted data and assessed methodologic quality using the Cochrane risk-of-bias tool. Four trials with 164 participants were included, with variable study quality. Supervised outpatient PR or ET of 8 weeks improved incremental shuttle walk distance (weighted mean difference [WMD]=67m; 95% confidence interval [CI], 52-82m) and disease-specific HRQOL (WMD=-4.65; 95% CI, -6.7 to -2.6 units) immediately after intervention, but these benefits were not sustained at 6 months. There was no effect on cough-related quality of life (WMD=1.3; 95% CI, -0.9 to 3.4 units) or psychological symptoms. PR commenced during an acute exacerbation and continued beyond discharge had no effect on exercise capacity or HRQOL. The frequency of exacerbations over 12 months was reduced with outpatient ET (median, 2 vs 1; P=.013), but PR initiated during an exacerbation had no impact on exacerbation frequency or mortality. Short-term improvements in exercise capacity and HRQOL were achieved with supervised PR and ET programs, but sustaining these benefits is challenging in people with bronchiectasis. The frequency of exacerbations over 12 months was reduced with ET only.