Effectiveness of exercise training in people with non-cystic fibrosis bronchiectasis with and without COPD

TL;DR

Exercise training as part of pulmonary rehabilitation improves exercise capacity and symptoms in people with non-CF bronchiectasis, whether or not they also have COPD.

Contribution

Demonstrates that pulmonary rehabilitation benefits non-CF bronchiectasis patients equally, regardless of COPD status.

Findings

Exercise capacity improved similarly in non-CF bronchiectasis patients with and without COPD.

Patient-reported outcomes like dyspnea and physical performance also improved significantly in both groups.

No significant differences were found in clinical improvement between the two groups.

Abstract

Non-Cystic Fibrosis (CF) bronchiectasis is associated with reduced exercise tolerance and symptoms such as dyspnea and fatigue, impairing functional capacity and limiting physical activity. In addition to airway clearance techniques, pulmonary rehabilitation (PR), including aerobic and resistance training, is recommended in these individuals. This retrospective, multicentric study covering a ten-year period compared in non-CF bronchiectasis people with and without COPD the effectiveness of PR, including exercise training, on exercise tolerance (primary objective) and other patient-centered outcomes.

Before and after PR, the following assessments had been performed: Six-minute walking test (6MWT), Barthel Index (BI), Barthel Index dyspnea (BId), COPD assessment test (CAT), Short physical performance battery (SPPB).

125 participants without and 1,346 with concomitant COPD were studied. Non-COPD bronchiectasis was more prevalent in females, showed a higher association with asthma, whereas Chronic Respiratory Failure (CRF) and pneumonia were more prevalent in COPD-related bronchiectasis, resulting in more prevalent referral from acute care hospitals or need for oxygen therapy. All baseline outcome measures, except CAT, were worse in people with concomitant COPD. After PR, 6MWT improved significantly in both groups [by 39 (11–70) and 40 (10–75) meters for non-COPD and COPD-related bronchiectasis, respectively, p = 0.7469], without any between-group difference. The other outcome measures also improved significantly in both groups. The proportions of participants reaching the minimal clinically important difference in assessed outcomes were not significantly different between the studied populations.

Pulmonary rehabilitation, including exercise training, yields l equivalent benefits in exercise capacity and patient-reported outcomes in non-CF bronchiectasis people with or without COPD. Our results suggest the routine clinical provision of PR to people with non-CF bronchiectasis, regardless of concomitant COPD.

Figures