The following is a summary of “Pulmonary rehabilitation for acute exacerbations of COPD: A systematic review,” published in the November 2023 issue of Pulmonology by Meneses-Echavez, et al.

For a study, researchers sought to provide a comprehensive summary of pulmonary rehabilitation’s benefits and potential harms for individuals experiencing acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

The inclusion criteria encompassed randomized controlled trials comparing pulmonary rehabilitation to either active interventions or usual care, irrespective of the setting. The search, conducted in March 2022, encompassed databases such as MEDLINE, Scopus, CENTRAL, CINAHL, Web of Sciences, and trial registries. Two reviewers performed record screening, data extraction, and risk of bias assessment. The GRADE approach was utilized to evaluate the certainty of the evidence.

The systematic review incorporated 18 studies (n = 1,465), with a combination of mixed settings (8 studies), inpatient settings (8 studies), and outpatient settings (2 studies). The studies demonstrated high risks of performance, detection, and reporting biases. In comparison to usual care, pulmonary rehabilitation likely improves AECOPD-related hospital readmissions (relative risk 0.56, 95% CI 0.36 to 0.86; moderate certainty evidence) and cardiovascular submaximal capacity (standardized mean difference 0.73, 95% CI 0.48 to 0.99; moderate certainty evidence). Low certainty evidence suggested potential benefits on re-exacerbations, dyspnoea, and the impact of the disease. However, evidence regarding the effects of pulmonary rehabilitation on health-related quality of life and mortality was very uncertain (very low certainty evidence).

The systematic review results suggested that pulmonary rehabilitation may be an effective treatment option for individuals with AECOPD, regardless of the setting. However, the certainty in the evidence base was limited due to small studies, heterogeneous rehabilitation programs, numerous methodological weaknesses, and inconsistent reporting of findings. It was recommended that trialists adhere to the latest reporting standards to enhance the strength of the body of evidence.

Source: resmedjournal.com/article/S0954-6111(23)00313-X/fulltext