What are the functions and conditions of the lungs?

From the Guidelines

Pulmonary rehabilitation is a crucial component in the management of patients with interstitial lung disease (ILD), as it has been shown to result in meaningful short-term benefits in functional exercise tolerance, dyspnea, and quality of life 1.

Key Concepts

• Interstitial lung disease (ILD) is characterized by exercise intolerance, marked dyspnea on exertion, and poor quality of life 1.
• Pulmonary rehabilitation has been demonstrated to improve functional exercise tolerance, dyspnea, and quality of life in patients with ILD, although the magnitude of these benefits may be smaller compared to those seen in chronic obstructive pulmonary disease (COPD) 1.
• The mechanisms of respiratory limitation in ILD differ from those in COPD, but the similarities in clinical problems, such as exercise intolerance and muscle dysfunction, suggest that pulmonary rehabilitation may also benefit patients with ILD 1.

Recommendations

• Pulmonary rehabilitation should be considered for patients with ILD who have dyspnea or other respiratory symptoms, reduced exercise tolerance, or impaired health status 1.
• A multidisciplinary program of care, including exercise training, education, nutritional intervention, and psychosocial support, is essential for optimizing physical and social performance and autonomy in patients with ILD 1.
• The interdisciplinary team of healthcare professionals in pulmonary rehabilitation should include physicians, nurses, respiratory therapists, and other experts with appropriate expertise to provide comprehensive care 1.

Clinical Implications

• Pulmonary rehabilitation has a positive impact on functional status and quality of life in patients with ILD, as demonstrated by studies such as the one conducted by Huppmann and colleagues, which included 402 individuals with ILD over an 11-year period 1.
• The benefits of pulmonary rehabilitation in ILD may be limited by the rapid progression of the disease, highlighting the need for early intervention and ongoing support 1.
• Further research is needed to fully understand the effects of pulmonary rehabilitation on morbidity, mortality, and quality of life in patients with ILD, and to develop more effective treatment strategies 1.

From the Research

Lungs and Respiratory Diseases

• Chronic obstructive pulmonary disease (COPD) and asthma are common airway disorders characterized by chronic airway inflammation and airflow obstruction 2.
• The diagnosis of COPD is often delayed due to inaccessibility to spirometry, and the prevalence of the asthma COPD overlap phenotype is rather high given the exposure to biomass smoke 3.
• Patients with COPD and asthma overlap phenotype have twice the rate of exacerbations compared to patients with either disease alone 3.

Treatment Options

• A treatment strategy that reduces the risk of exacerbations would contribute immensely to the management of patients with COPD and asthma overlap phenotype 3.
• Evidence of eosinophilia should prompt treatment with a combination of inhaled corticosteroids (ICS) and long-acting β-agonists (LABA) 3.
• Salmeterol-fluticasone combination (SFC) has been shown to improve airflow limitation and reduce the rate of exacerbations in patients with COPD and asthma 3, 4, 5.
• Azithromycin combined with SFC has been shown to have good effects in treating COPD patients with acute exacerbation of chronic bronchitis in the stable stage 4.

Safety and Efficacy

• The cardiovascular safety of LABA in patients with COPD is critical, and salmeterol has been shown to have no increased risk of new cardiovascular adverse events 3.
• Low-dose fluticasone propionate in combination with salmeterol has been shown to be effective in patients with COPD, with a lower incidence of pneumonia compared to higher doses 6.
• The fixed combination of fluticasone and salmeterol has been shown to be effective in adult Chinese patients with asthma and COPD, improving symptoms, health status, and reducing exacerbations 2.