Linzy Houchen-Wolloff PhD MCSP:
Senior Research Associate and OT & Physiotherapy Research Lead, Glenfield Hospital, Leicester, UK.
The American Thoracic Society (ATS) annual conference took place in a rather humid Dallas, Texas this year on 17th - 22nd May 2019. A symposium devoted to the best abstracts in Pulmonary Rehabilitation took place on Tuesday morning, chaired by Dr William Man and there was standing room only. Not bad considering the 9.15am start.
The session started with an excellent talk by Dr Carolyn Rochester, dissecting her ‘top papers’ in the field of Pulmonary Rehabilitation from 2019. For this talk, Dr Rochester selected (amongst others) ‘Disparities in geographic access to hospital outpatient Pulmonary Rehabilitation programs in the United States (US)’ (1Moscovice et al, Chest 2019) and ‘Participation in Pulmonary Rehabilitation After hospitalization for COPD among Medicare beneficiaries’ (2Spitzer et al, Annals of the ATS, 2019). The first paper1 found that access is the poorest in more rural areas. There are lower percentages of hospitals offering rehabilitation in the West (at 35.5%) and the South (at 39.0%) of the US. This was of additional concern to the authors, given the large distances between hospitals in many parts of the West and the high incidence of COPD in many Southern states. In the second paper2, only 1.9% of individuals hospitalised, received Pulmonary Rehabilitation within 6 months. Those aged over 75 years, more than 10 miles away from a hospital and lower socioeconomic status had the lowest likelihood of receiving rehabilitation. Although the ‘top papers’ were from the US, both studies highlight the challenges faced by the international Pulmonary Rehabilitation community as a whole. In that, we know that rehabilitation is a highly effective intervention for those who attend, however the access to and uptake to programmes is poor across the globe. Access is particularly problematic in remote areas and following a hospital admission.
This theme of access and hospitalisation largely carried through to the top scoring abstracts from the assembly, selected to give an oral presentation in this session (see table 1).
Table 1, best abstracts from the assembly session:
1st author |
Title |
Key message |
|
Lindenauer |
Association between Pulmonary Rehabilitation following hospitalization for COPD and 1-year mortality. |
Initiation of Pulmonary Rehabilitation within 3-months post-hospitalisation is associated with a reduced 1- year mortality rate. |
|
Tang |
Does an immediate commencement of Pulmonary Rehabilitation following hospitalization for an exacerbation of Chronic Obstructive Pulmonary Disease positively impact attendance and completion rates: a pilot randomized controlled trial? |
Patients starting Pulmonary Rehabilitation at the time of admission are more likely to attend but just as likely to complete a programme (compared to those starting at 4/8 weeks post-discharge). |
|
Spitzer |
Geographic and racial disparities in receipt of Pulmonary Rehabilitation following hospital discharge for COPD exacerbations. |
Rates of rehabilitation receipt were lower for black beneficiaries, regardless of programme density. |
|
Rossiter |
A randomized, double-blind, placebo-controlled, crossover study to assess the effect of Reldesemtiv on exercise tolerance in subjects with Chronic Obstructive Pulmonary Disease. |
Reldesemtiv was tolerable and safe. There was a small increase in inspiratory capacity in the active group (vs placebo) but no effect on cycle endurance time. |
|
Hansen |
Pulmonary tele-rehabilitation versus conventional Pulmonary Rehabilitation: a multicenter, single blinded, superiority RCT. |
Small improvements in both groups but tele-rehabilitation was not superior to Pulmonary Rehabilitation for the primary outcome (6 minute walk test). |
|
Wan |
Internet-mediated, pedometer-based physical activity intervention reduces risk of future acute exacerbations in COPD: a randomized trial. |
The 3-month physical activity intervention was associated with a reduced risk of future exacerbations. However the improvements in daily physical activity were not sustained at 6 and 12 months. |
|
Casaburi |
Influence of spirometric impairment on improvement in constant work rate cycling endurance in COPD patients: differences in response to Bronchodilator therapy and exercise training. |
Change in constant work rate tests (CWRT) following exercise training, occurs independent of baseline airflow limitation. For Bronchodilators, change in CWRT is influenced by the severity of airflow limitation. |
All abstracts are available at 3https://www.atsjournals.org/doi/book/10.1164/ajrccm-conference.2019
You can also tweets from the assembly @PR_assembly under the hashtag #ATS2019
Congratulations to all those who were successfully selected to present in this session, it was truly inspiring to see the breadth of fantastic work taking place within the assembly. Also thank you to the chair, organising committee and audience for making the session interactive with plenty of useful discussion.
I look forward to seeing what the ATS in 2020 has to offer- see you in Philadelphia! (15th - 20th May 2020). If you feel motivated to submit an abstract for next year, the abstract deadline is WEDNESDAY, OCTOBER 30th, 2019 (5:00 pm Eastern Time). More details can be found at: https://conference.thoracic.org/program/call_for_abstracts/
References
1. Moscovice IS, Casey MM and Wu Z. Disparities in Geographic Access to Hospital Outpatient Pulmonary Rehabilitation Programs in the United States. Chest. 2019 Apr 9. pii: S0012-3692(19)30820-7. [Epub ahead of print].
2. Spitzer KA, Stefan MS, Priya A et al. Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease among Medicare Beneficiaries. Ann Am Thorac Soc. 2019 Jan;16(1):99-106.
3. American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. Am J Resp Crit Care Med, 2019. 199.
