# Evolution and Outcome of a Pediatric Pulmonary Rehabilitation Program in Hong Kong Over the Past Decade

## TL;DR

A pediatric pulmonary rehabilitation program in Hong Kong improved lung function and exercise capacity in children over the past decade.

## Contribution

The study evaluates the evolution and effectiveness of a pediatric PR program, including the development of community-based alternatives during the pandemic.

## Key findings

- Participants showed significant improvements in FEV1, FVC, and 6MWT results after the program.
- Both inpatient and community-based PR improved outcomes, with inpatient showing benefits in lung function.
- No adverse events were reported, indicating the safety of the program.

## Abstract

Background: Pulmonary rehabilitation (PR) is a well-established treatment for adults with chronic obstructive respiratory disease and other chronic respiratory diseases. Although the treatment has proved effective for pediatric asthma and cystic fibrosis, its utility for other conditions is in need of study. Since 2015, the Duchess of Kent Children’s Hospital (DKCH) in Hong Kong has been running an inpatient PR program for children with compromised lung function resulting from various underlying causes. During the lockdown amid the COVID-19 pandemic, community-based PR was developed to address patients’ needs.

Methods: We retrospectively reviewed participants in the multidisciplinary PR program from 2015 to 2024. The program included regular physiotherapy sessions that consisted of breathing training, aerobic exercises, postural correction exercises, muscle-strengthening exercises, airway clearance techniques, nutritional counseling, and disease education. Inpatient and community-based PR were employed. The lung function parameters of forced expiratory volume (FEV1) and forced vital capacity (FVC), as well as exercise capacity (as measured by the six-minute walk test (6MWT)), were assessed before and after the program.

Results: Forty-three participants were included in the study, while 11 potential participants were excluded because they were unable to perform the lung function tests. The mean age of the participants was 11.6 ± 3.8 years. The mean duration of the PR program was 68.2 ± 43.2 days. Twenty-two of the participants were referred because of chronic respiratory diseases, and 10 were referred because of deconditioning after major acute respiratory events. Their lung function parameters significantly improved (FEV1: 62.2% to 68.4%, p = 0.004, FVC: 72.6% to 79.2%, p = 0.004), as did their exercise capacity (6MWT: 472.6 m to 515.2 m; p = 0.002). Similar improvements were observed in the participants with chronic respiratory diseases (n = 22) and those with deconditioning following acute respiratory events (n = 10). The inpatient PR program resulted in significant improvements in both lung function parameters and exercise capacity, while the community-based PR improved exercise capacity. No adverse events were reported.

Conclusions: The pediatric PR program is a safe and effective treatment for children with impaired lung function or exercise capacity resulting from acute or chronic respiratory diseases. With advances in technology, community-based PR programs have become a potential alternative to inpatient programs, though further large-scale studies of the former are needed to establish their effectiveness for a broad population.