In what appears to be the first study of its kind, physician-researchers from Nationwide Children’s Hospital have found that a formalized, exercise-based pulmonary rehabilitation (PR) program can improve lung function and quality of life for children with asthma.
Limited data exist on the effects of PR on adults with asthma, and even less is known about PR in the pediatric population. This study, published in Pediatric Pulmonology, suggests a role for a nonpharmacological approach to treatment along with more traditional pharmacological interventions.
“Our study demonstrated evidence of clinical benefit of pulmonary rehabilitation in pediatric asthma” says Stephen Kirkby, MD, a member of the Section of Pulmonary Medicine at Nationwide Children’s and lead author on the study. “We believe that the standard program of exercise, asthma education, and nutritional counseling that were the main features of our pulmonary rehab program have potential to really make a difference in improving asthma control in children, particularly those who are obese. Pulmonary rehab is one of the mainstays of treating adults with chronic lung diseases such as COPD. This work demonstrates the importance of pulmonary rehab in children as well.”
A total of 38 patients were enrolled, with 32 identified as obese. Of the patients who completed the 6-minute walk test, it was found their distance was significantly improved upon completion of the PR program. Improvements were also found in patients who completed pulmonary function tests and symptom and quality of life (QOL) questionnaires, with a significant improvement in FEV1, shortness of breath score and in patient-reported physical QOL. There was no measurable improvement in psychological QOL score or in nutritional parameters. However, 24 patients had evidence of a positive clinical outcome after program completion at a follow-up visit with the referring asthma clinician.
No other accredited pediatric PR programs existed in the country prior to the development of the program at Nationwide Children’s in 2004. The team studied adult rehab programs, used input from the American Association of Cardiovascular and Pulmonary Rehabilitation and closely evaluated the needs of chronic cardio-pulmonary disease patients to build the program from the ground up.
The multidisciplinary program is certified by the American Association of Cardiovascular and Pulmonary Rehabilitation and includes physical therapy, asthma and nutritional education, massage therapy and psychological evaluation. Patients have medically supervised sessions 2-3 times a week for 6-8 weeks, and undergo a variety of clinical assessments before and after program completion.
“The goal is to improve endurance and strength, and actually also some confidence” says Alpa Patel, MD, director of the Pulmonary Rehabilitation Program at Nationwide Children’s and senior author of the study. “I think if you’re sick and not feeling good, you also don’t feel like doing anything. You’re scared. The formal, structured pulmonary rehab program enables you to work with trained staff within the individual disciplines, and be monitored, and along the way they also provide some encouragement and hope.”
Dr. Patel attributes the program’s success to the support of the hospital on many different levels. “We have amazing resources and we have every discipline actively involved, enthusiastically willing to work to make this program stand out” says Dr. Patel. “They juggle their schedule to be part of this program because we all see the smile and the joy [of] the patient, and that’s not measurable. I think that itself is what keeps the program going.”
In areas or institutions without a structured PR program, health providers can still “assess and prioritize the patient’s needs and aim to reach out to the closest available resource(s) to address the most urgent issue” says Dr. Patel. “This could be a team member obtaining information for the patient through websites or via contacting facilities, and then working with the patient to implement it. This could help start a QI process at the local level.”
“With internet and social media, resources don’t have to be in a physically located facility but could be web based learning,” she says.
Kirkby S, Rossetti A, Hayes D Jr, Allen E, Sheikh S, Kopp B, Patel A. Benefits of pulmonary rehabilitation in pediatric asthma. Pediatric Pulmonology. 2018 May 7. [Epub ahead of print]