The prognostic value of cardiopulmonary exercise testing in interstitial lung disease: a systematic review (original) (raw)
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Validity and repeatability of cardiopulmonary exercise testing in interstitial lung disease
BMC Pulmonary Medicine
Background Cardiopulmonary exercise testing (CPET), and its primary outcome of peak oxygen uptake (VO2peak), are acknowledged as biomarkers in the diagnostic and prognostic management of interstitial lung disease (ILD). However, the validity and repeatability of CPET in those with ILD has yet to be fully characterised, and this study fills this evidence gap. Methods Twenty-six people with ILD were recruited, and 21 successfully completed three CPETs. Of these, 17 completed two valid CPETs within a 3-month window, and 11 completed two valid CPETs within a 6-month window. Technical standards from the European Respiratory Society established validity, and repeatability was determined using mean change, intraclass correlation coefficient and typical error. Results Every participant (100%) who successfully exercised to volitional exhaustion produced a maximal, and therefore valid, CPET. Approximately 20% of participants presented with a plateau in VO2, the primary criteria for establishi...
Feasibility of cardiopulmonary exercise testing in interstitial lung disease: the PETFIB study
BMJ Open Respiratory Research, 2021
Introduction Cardiopulmonary exercise testing (CPET) provides a series of biomarkers, such as peak oxygen uptake, which could assess the development of disease status in interstitial lung disease (ILD). However, despite use in research and clinical settings, the feasibility of CPET in this patient group has yet to be established. Methods Twenty-six patients with ILD (19 male) were recruited to this study. Following screening for contraindications to maximal exercise, participants underwent an incremental CPET to volitional exhaustion. Feasibility of CPET was assessed by the implementation, practicality, acceptability and demand, thus providing clinical-driven and patient-driven information on this testing procedure. Results Of the 26 recruited participants, 24 successfully completed at least one CPET, with 67/78 prospective tests being completed. Contraindications included hypertension, low resting oxygen saturation and recent pulmonary embolism. Of the CPETs undertaken, 63% successfully reached volitional exhaustion, with 31% being terminated early by clinicians due to excessive desaturation. Quantitative and qualitative feedback from participants revealed a positive experience of CPET and desire for it to be included as a future monitoring tool. Conclusion CPET is feasible in patients with ILD. Identification of common clinical contraindications, and understanding of patient perspectives will allow for effective design of future studies utilising CPET as a monitoring procedure. METHODS Design and population This feasibility study examined practicalities and safety associated with performing CPET in individuals with ILD. The study was designed to have participants perform three Key messages ► Is cardiopulmonary exercise testing safe, practical and acceptable to patients with interstitial lung disease? ► This modality of exercise testing provides novel physiological data in addition to traditional spirometry and should be considered as a future biomarker for use in this clinical population. ► This study provides important clinical data on safety, and the valuable patient perspective on the acceptability, of exercise within the management of interstitial lung disease.
Does the severity of interstitial lung disease affect the gains from pulmonary rehabilitation?
The clinical respiratory journal, 2018
Reduced exercise capacity is a main feature of Interstitial Lung Diseases (ILDs) and it is related to closely prognosis of these patients. Pulmonary Rehabilitation (PR) results to improve in peak exercise capacity, dyspnea and quality of life in ILDs. We aimed to evaluate the benefits of PR in patients with ILDs and to determine whether there are similar gains in patients with severe ILD. We recruited ILD stable patients. All patients were evaluated with pulmonary function test, exercise capacity [6-minute walking test (6MWD)], quality of life [Short Form-36 (SF-36), St. George's Respiratory Questionnare (SGRQ), Hospital anxiety and Depression (HAD)] before and after PR (8 week). 57 patients who completed PR program, 30 women and 27 men, included in this study. It was determined a significant difference in terms of quality of life and exercise capacity (p <0,05) before and after PR. When these patients were divided into two groups (DLCO <40% predicted, severe: group-1, and...
BMC Pulmonary Medicine, 2013
Background: Interstitial lung disease encompasses a diverse group of chronic lung conditions characterised by distressing dyspnoea, fatigue, reduced exercise tolerance and poor health-related quality of life. Exercise training is one of the few treatments to induce positive changes in exercise tolerance and symptoms, however there is marked variability in response. The aetiology and severity of interstitial lung disease may influence the response to treatment. The aims of this project are to establish the impact of exercise training across the range of disease severity and to identify whether there is an optimal time for patients with interstitial lung disease to receive exercise training. Methods/Design: One hundred and sixteen participants with interstitial lung disease recruited from three tertiary institutions will be randomised to either an exercise training group (supervised exercise training twice weekly for eight weeks) or a usual care group (weekly telephone support). The 6-minute walk distance, peripheral muscle strength, health-related quality of life, dyspnoea, anxiety and depression will be measured by a blinded assessor at baseline, immediately following the intervention and at six months following the intervention. The primary outcome will be change in 6-minute walk distance following the intervention, with planned subgroup analyses for participants with idiopathic pulmonary fibrosis, dust-related interstitial lung disease and connective-tissue related interstitial lung disease. The effects of disease severity on outcomes will be evaluated using important markers of disease severity and survival, such as forced vital capacity, carbon monoxide transfer factor and pulmonary hypertension. Discussion: This trial will provide certainty regarding the role of exercise training in interstitial lung disease and will identify at what time point within the disease process this treatment is most effective. The results from this study will inform and optimise the clinical management of people with interstitial lung disease. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12611000416998
ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases
European Respiratory Review
The objective of this document was to standardise published cardiopulmonary exercise testing (CPET) protocols for improved interpretation in clinical settings and multicentre research projects. This document: 1) summarises the protocols and procedures used in published studies focusing on incremental CPET in chronic lung conditions; 2) presents standard incremental protocols for CPET on a stationary cycle ergometer and a treadmill; and 3) provides patients' perspectives on CPET obtained through an online survey supported by the European Lung Foundation. We systematically reviewed published studies obtained from EMBASE, Medline, Scopus, Web of Science and the Cochrane Library from inception to January 2017. Of 7914 identified studies, 595 studies with 26 523 subjects were included. The literature supports a test protocol with a resting phase lasting at least 3 min, a 3-min unloaded phase, and an 8- to 12-min incremental phase with work rate increased linearly at least every minut...
Thorax, 2017
Uncertainty exists regarding the clinical relevance of exercise training across the range of interstitial lung diseases (ILDs). To establish the impact of exercise training in patients with ILDs of differing aetiology and severity. 142 participants with ILD (61 idiopathic pulmonary fibrosis (IPF), 22 asbestosis, 23 connective tissue disease-related ILD (CTD-ILD) and 36 with other aetiologies) were randomised to either 8 weeks of supervised exercise training or usual care. Six-minute walk distance (6MWD), Chronic Respiratory Disease Questionnaire (CRDQ), St George Respiratory Questionnaire IPF-specific version (SGRQ-I) and modified Medical Research Council dyspnoea score were measured at baseline, 9 weeks and 6 months. Exercise training significantly increased 6MWD (25 m, 95% CI 2 to 47 m) and health-related quality of life (CRDQ and SGRQ-I) in people with ILD. Larger improvements in 6MWD, CRDQ, SGRQ-I and dyspnoea occurred in asbestosis and IPF compared with CTD-ILD, but with few si...
2017
Reviewer 1, Nathan Sandbo We thank the reviewer for the precise and thorough reviewing process of our work. While we have appreciated all of his comments, we still believe that our manuscript could help clinicians in reinforcing the knowledge on the effects of pulmonary rehabilitation when delivered to ILD patients. Major comments Comments to the Author In this manuscript by Tonelli and colleagues, the authors undertook a prospective cohort study to examine the efficacy of pulmonary rehabilitation in patients with interstitial lung disease and seek to determine how specific ILD diagnoses and severity of disease is associated with response to this therapy. This was a multicenter (two centers) study, however, the cohort size was relatively small (41 patients). Most patients had IPF (63%). The authors' primary findings were that in the majority of patients with ILD participation in pulmonary rehab was associated with a positive response in 6MW distance. Secondly, they found that a low baseline 6MW distance was associated with greater improvement in 6MWD by the end of pulmonary rehabilitation. The authors did not identify any association of greater or lesser treatment response with specific ILD entities. Overall, the authors rightly identified some of the questions that remain in the field vis-à-vis patient selection for participation in pulmonary rehabilitation; namely does illness severity or specific ILD diagnosis impact response to this therapy. However, it appears that their study was underpowered to answer these questions. It is unclear if the authors performed power calculations to try to estimate how many patients need to be included to see a difference in the stated endpoints.
European Respiratory Review
Patient-reported outcome measures (PROMs), tools to assess patient self-report of health status, are now increasingly used in research, care and policymaking. While there are two well-developed disease-specific PROMs for interstitial lung diseases (ILD) and idiopathic pulmonary fibrosis (IPF), many unmet and urgent needs remain. In December 2019, 64 international ILD experts convened in Erice, Italy to deliberate on many topics, including PROMs in ILD. This review summarises the history of PROMs in ILD, shortcomings of the existing tools, challenges of development, validation and implementation of their use in clinical trials, and the discussion held during the meeting. Development of disease-specific PROMs for ILD including IPF with robust methodology and validation in concordance with guidance from regulatory authorities have increased user confidence in PROMs. Minimal clinically important difference for bidirectional changes may need to be developed. Cross-cultural validation and...