Abstract：
OBJECTIVE: Both bronchoscopic lung volume reduction with endobronchial valves (BLVR-EBV) and pulmonary rehabilitation (PR) are effective treatments for improving exercise capacity and patient-reported outcomes in patients with severe Chronic Obstructive Pulmonary Disease (COPD). According to current recommendations, all BLVR-EBV patients should have undergone PR first. Our aim was to study the effects of PR both before and after BLVR-EBV compared to BLVR-EBV alone.
METHODS: We included patients with severe COPD who were eligible for BLVR-EBV and PR. Participants were randomized into three groups: PR before BLVR-EBV, PR after BLVR-EBV or BLVR-EBV without PR. The primary outcome was change in constant work rate cycle test (CWRT) endurance time at 6-month follow-up of the PR groups compared to BLVR-EBV alone. Secondary endpoints included changes in 6-minute walking test, daily step count, dyspnoea and health-related quality of life.
RESULTS: Ninety-seven participants were included. At 6-month follow-up, there was no difference in change in CWRT endurance time between the PR before BLVR-EBV and BLVR-EBV alone groups (median: 421 [IQR: 44; 1304] vs. 787 [123; 1024] seconds, p = 0.82) or in any of the secondary endpoints, but the PR after BLVR-EBV group exhibited a smaller improvement in CWRT endurance time (median: 107 [IQR: 2; 573], p = 0.04) and health-related quality of life compared to BLVR-EBV alone.
CONCLUSIONS: The addition of PR to BLVR-EBV did not result in increased exercise capacity, daily step count or improved patient-reported outcomes compared to BLVR-EBV alone, neither when PR was administered before BLVR-EBV nor when PR was administered after BLVR-EBV.
METHODS: We included patients with severe COPD who were eligible for BLVR-EBV and PR. Participants were randomized into three groups: PR before BLVR-EBV, PR after BLVR-EBV or BLVR-EBV without PR. The primary outcome was change in constant work rate cycle test (CWRT) endurance time at 6-month follow-up of the PR groups compared to BLVR-EBV alone. Secondary endpoints included changes in 6-minute walking test, daily step count, dyspnoea and health-related quality of life.
RESULTS: Ninety-seven participants were included. At 6-month follow-up, there was no difference in change in CWRT endurance time between the PR before BLVR-EBV and BLVR-EBV alone groups (median: 421 [IQR: 44; 1304] vs. 787 [123; 1024] seconds, p = 0.82) or in any of the secondary endpoints, but the PR after BLVR-EBV group exhibited a smaller improvement in CWRT endurance time (median: 107 [IQR: 2; 573], p = 0.04) and health-related quality of life compared to BLVR-EBV alone.
CONCLUSIONS: The addition of PR to BLVR-EBV did not result in increased exercise capacity, daily step count or improved patient-reported outcomes compared to BLVR-EBV alone, neither when PR was administered before BLVR-EBV nor when PR was administered after BLVR-EBV.
摘要：
目的：支气管镜下支气管瓣肺减容术（BLVR-EBV）和肺康复术（PR）是改善重度慢性阻塞性肺疾病（COPD）患者运动能力和患者报告预后的有效治疗方法。根据目前的建议，所有BLVR-EBV患者均应先接受PR治疗.我们的目的是研究与单独的BLVR-EBV相比，BLVR-EBV前后PR的影响。
方法：我们纳入符合BLVR-EBV和PR的重度COPD患者。参与者被随机分为三组：在BLVR-EBV之前进行PR，BLVR-EBV或无PR的BLVR-EBV后的PR。与单独的BLVR-EBV相比，主要结果是PR组6个月随访时恒定工作速率循环测试（CWRT）耐力时间的变化。次要终点包括6分钟步行测试的变化，每日步数，呼吸困难和健康相关的生活质量。
结果：97名参与者被纳入。在6个月的随访中，在BLVR-EBV之前的PR和单独的BLVR-EBV组之间，CWRT耐力时间的变化没有差异（中位数：421[IQR：44;1304]vs.787[123;1024]秒,p=0.82)或在任何次要终点，但BLVR-EBV组的PR显示CWRT耐久时间的改善较小（中位数：107[IQR：2;573]，p=0.04）和与单独BLVR-EBV相比的健康相关生活质量。
结论：在BLVR-EBV中添加PR并没有导致运动能力增加，与单独使用BLVR-EBV相比，每日步数或患者报告的结局得到改善，无论是在BLVR-EBV之前施用PR还是在BLVR-EBV之后施用PR。
方法：我们纳入符合BLVR-EBV和PR的重度COPD患者。参与者被随机分为三组：在BLVR-EBV之前进行PR，BLVR-EBV或无PR的BLVR-EBV后的PR。与单独的BLVR-EBV相比，主要结果是PR组6个月随访时恒定工作速率循环测试（CWRT）耐力时间的变化。次要终点包括6分钟步行测试的变化，每日步数，呼吸困难和健康相关的生活质量。
结果：97名参与者被纳入。在6个月的随访中，在BLVR-EBV之前的PR和单独的BLVR-EBV组之间，CWRT耐力时间的变化没有差异（中位数：421[IQR：44;1304]vs.787[123;1024]秒,p=0.82)或在任何次要终点，但BLVR-EBV组的PR显示CWRT耐久时间的改善较小（中位数：107[IQR：2;573]，p=0.04）和与单独BLVR-EBV相比的健康相关生活质量。
结论：在BLVR-EBV中添加PR并没有导致运动能力增加，与单独使用BLVR-EBV相比，每日步数或患者报告的结局得到改善，无论是在BLVR-EBV之前施用PR还是在BLVR-EBV之后施用PR。
