Utility of rehabilitation prior to bronchoscopic lung volume reduction: post hoc analysis of the VENT trial

Judith Maria Brock; Konstantina Kontogianni; Frank C Sciurba; Gerard J Criner; Felix Herth

doi:10.1183/23120541.00735-2023

Utility of rehabilitation prior to bronchoscopic lung volume reduction: post hoc analysis of the VENT trial

ERJ Open Res. 2024 Jan 22;10(1):00735-2023. doi: 10.1183/23120541.00735-2023. eCollection 2024 Jan.

Authors

Judith Maria Brock^{1

2}, Konstantina Kontogianni^{1

2}, Frank C Sciurba³, Gerard J Criner⁴, Felix Herth^{1

2}

Affiliations

¹ Department for Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
² Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.
³ Pulmonary Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁴ Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.

Abstract

Background and objective: Rehabilitation programmes are a valuable treatment modality for patients with COPD to increase exercise capacity and quality of life. The utility of pulmonary rehabilitation prior to bronchoscopic lung volume reduction (BLVR) is unclear.

Methods: We performed a post hoc analysis of the Valve for Emphysema Palliation Trial (VENT) trial, the first multicentre randomised trial comparing the safety and efficacy of BLVR. Patients completed a pulmonary rehabilitation programme prior to BLVR over 6-10 weeks and maintained by daily practice, consisting of endurance training, strength training and upper/lower limb exercise. Lung function and exercise parameters (6-min walk distance (6MWD)) were assessed before and after rehabilitation and we tried to identify predictors for pulmonary rehabilitation benefit.

Results: Lung function and exercise capacity of 403 patients (mean±sd age 63.3±7.4 years, 37.5% female, mean±sd forced expiratory volume in 1 s 30.1±7.6 L) were analysed. Exercise capacity significantly improved from 331.6±98.8 m to 345.6±95.3 m (p<0.001) in 6-min walk testing (6MWT), with 40.3% showing clinically meaningful improvements. Patients also experienced less dyspnoea after 6MWT, while pulmonary function parameters did not change significantly overall. Patients with lower exercise capacity at screening (6MWD <250 m) benefited more from pulmonary rehabilitation. The indication and prerequisites for BLVR were still present in all patients after pulmonary rehabilitation.

Conclusion: The national mandatory requirements for rehabilitation prior to BLVR, which apply to all COPD patients, should be reconsidered and specified for COPD patients who really benefit.