Search

Background: Pulmonary rehabilitation (PR) is a core component of management people with chronic obstructive pulmonary disease (COPD); yet, people with COPD face significant barriers to attending centre-based PR programs. The emergence of new models of PR, remotely delivered directly into people's homes, has the potential to improve rehabilitation access and completion by providing patients with a choice of rehabilitation location (centre or home). However, offering patients a choice of rehabilitation model is not usual practice. We are undertaking a 14-site cluster randomised controlled trial to determine whether offering choice of PR location improves rehabilitation completion rates resulting in reduced all-cause unplanned hospitalisation over 12 months. The aim of this paper is to describe the protocol for the process evaluation of the HomeBase2 trial., Methods: A mixed methods process evaluation, to be undertaken in real time, has been developed in accordance with UK Medical Research Council (MRC) recommendations on process evaluation of complex interventions. This protocol describes the intended use of two theoretical frameworks (RE-AIM framework (Reach; Effectiveness; Adoption; Implementation; Maintenance) and Theoretical Domains Framework (TDF)) to synthesise findings and interpret data from a combination of qualitative (semi-structured interviews) and quantitative (questionnaires, clinical outcome data, intervention fidelity) methodologies. Data will be collected at an intervention, patient and clinician level. Qualitative and quantitative data will be used to derive context-specific potential and actual barriers and facilitators to offering patients choice of rehabilitation location. Acceptability and sustainability of the intervention will be evaluated for future scale-up., Discussion: The process evaluation described here will appraise the clinical implementation of offering a choice of rehabilitation program location for people with COPD. It will identify and evaluate key factors for future scale-up and sustainability and scale-up of offering choice of pulmonary rehabilitation program model for people., Trial Registration: ClinicalTrials.gov NCT04217330 Registration date: January 3 2020., (© 2023. The Author(s).)

Introduction: Chronic obstructive pulmonary disease (COPD) is a treatable and preventable disease characterised by persistent respiratory symptoms and chronic airflow limitation on spirometry. COPD is highly prevalent and is associated with exacerbations and comorbid conditions. "COPD-X" provides quarterly updates in COPD care and is published by the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand., Main Recommendations: The COPD-X guidelines (version 2.65) encompass 26 recommendations addressing: case finding and confirming diagnosis; optimising function; preventing deterioration; developing a plan of care; and managing an exacerbation., Changes in Management as a Result of These Guidelines: Both non-pharmacological and pharmacological strategies are included within these recommendations, reflecting the importance of a holistic approach to clinical care for people living with COPD to delay disease progression, optimise quality of life and ensure best practice care in the community and hospital settings when managing exacerbations. Several of the new recommendations, if put into practice in the appropriate circumstances, and notwithstanding known variations in the social determinants of health, could improve quality of life and reduce exacerbations, hospitalisations and mortality for people living with COPD., (© 2022 AMPCo Pty Ltd.)

Introduction: There is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model., Method and Analysis: This is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation.Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is implemented and explore sustainability beyond the clinical trial., Ethics and Dissemination: Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients across Australia with support from national lung charities and societies., Trial Registration Number: NCT04217330., Competing Interests: Competing interests: AEH, AM, CFM, GH, NAL, NC and PO declare grant funding from the Commonwealth of Australia Medical Research Future Fund paid to their institution for the conduct of the trial. CFM declares non-financial board roles as Chair COPD National Programme, Lung Foundation Australia and Medical Director Institute for Breathing and Sleep. No other competing interests are declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Chronic obstructive pulmonary disease (COPD) is characterised by exacerbations of respiratory disease, frequently requiring hospital admission. Pulmonary rehabilitation can reduce the likelihood of future hospitalisation, but programme uptake is poor. This study aims to compare hospital readmission rates, clinical outcomes and costs between people with COPD who undertake a home-based programme of pulmonary rehabilitation commenced early (within 2 weeks) of hospital discharge with usual care., Methods: A multisite randomised controlled trial, powered for superiority, will be conducted in Australia. Eligible patients admitted to one of the participating sites for an exacerbation of COPD will be invited to participate. Participants will be randomised 1:1. Intervention group participants will undertake an 8-week programme of home-based pulmonary rehabilitation commencing within 2 weeks of hospital discharge. Control group participants will receive usual care and a weekly phone call for attention control. Outcomes will be measured by a blinded assessor at baseline, after the intervention (week 9-10 posthospital discharge), and at 12 months follow-up. The primary outcome is hospital readmission at 12 months follow-up., Ethics and Dissemination: Human Research Ethics approval for all sites provided by Alfred Health (Project 51216). Findings will be published in peer-reviewed journals, conferences and lay publications., Trial Registration Number: ACTRN12619001122145., Competing Interests: Competing interests: NSC and AEH: declare grant funding from the NHMRC paid to their institution for the conduct of the trial. CFM declares board roles as Chair COPD National Program, Lung Foundation Australia; and Medical Director Institute for Breathing and Sleep. For all other authors, no competing interests are declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Dyspnoea is a cardinal symptom of fibrotic interstitial lung disease (ILD), with a lack of proven effective therapies. With emerging evidence of the role of facial and nasal airflow for relieving breathlessness, this pilot study was conducted to examine the feasibility of conducting a clinical trial of a handheld fan (HHF) for dyspnoea management in patients with fibrotic ILD. In this mixed-methods, randomised, assessor-blinded, controlled trial, 30 participants with fibrotic ILD who were dyspnoeic with a modified Medical Research Council Dyspnoea grade ≥ 2 were randomised to a HHF for symptom control or no intervention for 2 weeks. Primary outcomes were trial feasibility, change in Dyspnoea-12 scores at Week 2, and participants' perspectives on using a HHF for dyspnoea management. Study recruitment was completed within nine months at a single site. Successful assessor blinding was achieved in the fan group [Bang's Blinding Index - 0.08 (95% CI - 0.45, 0.30)] but not the control group [0.47 (0.12, 0.81)]. There were no significant between-group differences for the change in Dyspnoea-12 or secondary efficacy outcomes. During qualitative interviews, participants reported that using the HHF relieved breathlessness and provided relaxation, despite initial scepticism about its therapeutic benefit. Oxygen-experienced participants described the HHF being easier to use, but not as effective for symptomatic relief, compared to oxygen therapy. Our results confirmed the feasibility of a clinical trial of a HHF in fibrotic ILD. There was a high level of patient acceptance of a HHF for managing dyspnoea, with patients reporting both symptomatic benefits and ease of use.

Background: Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease (COPD), but its benefits are poorly maintained. The aim of this study was to evaluate the impact of COPD exacerbations in the year following pulmonary rehabilitation on outcomes at 12 months., Methods: This was a secondary analysis from a trial of home versus hospital-based rehabilitation in COPD, with 12 months of follow-up. Moderate and severe exacerbations were identified using administrative data (prescriptions) and hospital records (admissions) respectively. The impact of exacerbations at 12 months following pulmonary rehabilitation was evaluated for quality of life (Chronic Respiratory Questionnaire, CRQ), dyspnea (modified Medical Research Council, mMRC), exercise capacity (6-minute walk distance, 6MWD) and objectively measured physical activity (moderate-to-vigorous physical activity, MVPA)., Results: A total of 166 participants were included, with mean age (SD) 69 (9) years and forced expiratory volume in one second (FEV 1 ) 49 (19)% predicted. Moderate exacerbations occurred in 68% and severe exacerbations in 34% of participants. Experiencing a severe exacerbation was an independent predictor of worse 12-month outcomes for CRQ (total, fatigue and emotional function domains), mMRC, 6MWD and MVPA (all p<0.05). Participants who completed pulmonary rehabilitation were less likely to have a severe exacerbation (29% vs 48%, p=0.02). Severe exacerbations were more likely in those with worse baseline CRQ total (odds ratio 0.97, 95% CI 0.95 to 0.99) and FEV 1% predicted (0.98, 95% CI 0.96 to 0.99)., Conclusion: Severe exacerbations occur frequently following pulmonary rehabilitation and predict worse 12-month outcomes. Strategies to maintain the benefits of pulmonary rehabilitation should address exacerbation prevention and management., Competing Interests: Christine F McDonald reports speaker fees paid to their institution from Menarini and AstraZeneca, outside the submitted work. The authors report no other potential conflicts of interest for this work., (© 2020 Wageck et al.)

Background: The optimal method to collect accurate healthcare utilisation data in people with chronic obstructive pulmonary disease (COPD) is not well established. The aim of this study was to determine feasibility and compare self-report and administrative data sources to capture health care resource use in people with COPD for 12 months following pulmonary rehabilitation., Methods: This is a secondary analysis of a randomised controlled equivalence trial comparing centre-based and home-based pulmonary rehabilitation. Healthcare utilisation data were collected for 12 months following pulmonary rehabilitation from self-report (monthly telephone questionnaires and diaries) and administrative sources (Medicare Benefits Schedule, medical records). Feasibility was assessed by the proportion of self-reports completed and accuracy was established using month-by-month and per participant comparison of self-reports with administrative data., Results: Data were available for 145/163 eligible study participants (89%, mean age 69 (SD 9) years, mean forced expiratory volume in 1 s 51 (SD 19) % predicted; n = 83 male). For 1725 months where data collection was possible, 1160 (67%) telephone questionnaires and 331 (19%) diaries were completed. Accuracy of recall varied according to type of health care encounter and self-report method, being higher for telephone questionnaire report of emergency department presentation (Kappa 0.656, p < 0.001; specificity 99%, sensitivity 59%) and hospital admission (Kappa 0.669, p < 0.001; specificity 97%, sensitivity 68%) and lower for general practitioner (Kappa 0.400, p < 0.001; specificity 62%, sensitivity 78%) and medical specialist appointments (Kappa 0.458, p < 0.001; specificity 88%, sensitivity 58%). A wide variety of non-medical encounters were reported (allied health and nursing) which were not captured in administrative data., Conclusion: For self-reported methods of healthcare utilisation in people with COPD following pulmonary rehabilitation, monthly telephone questionnaires were more frequently completed and more accurate than diaries. Compared to administrative records, self-reports of emergency department presentations and inpatient admissions were more accurate than for general practitioner and medical specialist appointments., Trial Registration: NCT01423227 at clinicaltrials.gov.

Context: Chronic breathlessness is a clinical syndrome that results in significant distress and disability. Morphine can reduce chronic breathlessness when the contributing etiologies are optimally treated., Objectives: Does oxycodone reduce chronic breathlessness compared with placebo?, Methods: A multisite, randomized, placebo-controlled, double-blind, parallel-arm, fixed-dose trial of oral controlled-release oxycodone 15 mg (5 mg, eight hourly) or placebo (ACTRN12609000806268 at www.anzctr.org.au). As-needed immediate-release morphine (2.5 mg per dose; six and less doses/day) was available for both arms as required by one ethics committee overseeing the trial. Recruitment occurred from 2010 to 2014 in 14 inpatient and outpatient respiratory, cardiology, and palliative care services across Australia. Participants were adults, with chronic breathlessness (modified Medical Research Council Scale 3 or 4), who were opioid naive. The primary end point was the proportion of people with greater than 15% reduction from baseline in the intensity of breathlessness now (0-100 mm visual analogue scale) comparing arms Days 5-7. Secondary end points were average and worst breathlessness, quality of life, function, and harms., Results: Of 157 participants randomized, 155 were included (74 oxycodone and 81 placebo), but the study did not reach target recruitment. There was difference in neither between groups for the primary outcome (P = 0.489) nor any of the prespecified secondary outcomes. Placebo participants used more as-needed morphine (mean 7.0 vs. 4.2 doses; P ≤ 0.001). Oxycodone participants reported more nausea (P < 0.001)., Conclusion: There was no signal of benefit from oxycodone over placebo. Future research should focus on investigating the existence of an opioid class effect on the reduction of chronic breathlessness., (Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Almost half the patients referred to pulmonary rehabilitation with chronic obstructive pulmonary disease (COPD) desaturate during exercise. Although oxygen supplementation may ameliorate oxygen desaturation, the effects on outcomes of exercise training have not been rigorously evaluated. This study aimed to determine whether supplemental oxygen during exercise training was more effective than medical air in improving exercise capacity and health-related quality of life (HRQoL) in people with COPD.People with COPD who demonstrated oxygen desaturation <90% during the 6-min walk test were recruited to this multicentre trial with randomisation (independent, concealed allocation) to either an Oxygen group or Air group, blinding (participants, exercise trainers and European Respiratory Journal assessors) and intention-to-treat analysis. Both groups received the respective gas from concentrators via nasal prongs at 5 L·min -1 during exercise training consisting of treadmill and cycle exercise, three times per week for 8 weeks. Primary outcomes were the endurance shuttle walk test (ESWT) time and Chronic Respiratory Disease Questionnaire (CRQ)-Total score.111 participants (60 males), mean±sd age 69±7 years, with moderate to severe COPD were recruited and 97 completed (Oxygen group n=52; Air group n=45). At the end of the 8-week training programme there were no between-group differences in change in ESWT (mean difference 15 s (95% CI -106-136 s) or change in CRQ-Total (0.0 points (95% CI -0.3-0.3 points)). Within-group changes at end-training were significant for ESWT and CRQ-Total (all p<0.01).Exercise capacity and HRQoL improved in both groups, with no greater benefit from training with supplemental oxygen than medical air., Competing Interests: Conflict of interest: J.A. Alison reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: Z.J. McKeough reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: R.W.M. Leung reports grants and personal fees from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: A.E. Holland reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: K. Hill reports grants from National Health and Medical Research Council, Australia, during the conduct of the study; personal fees for lecturing from Menarini Australia, personal fees for meeting attendance from Journal of Physiotherapy, grants from Better Breathing Foundation, personal fees (royalties) from SLACK publishing, outside the submitted work. Conflict of interest: N.R. Morris reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: S. Jenkins reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: L.M. Spencer reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: C.J. Hill reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: A.L. Lee reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: H. Seale reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: N. Cecins reports grants from National Health and Medical Research Council, Australia, during the conduct of the study. Conflict of interest: C.F. McDonald reports personal fees from Pfizer, GSK and Novartis, institutional fees for lecturing from Menarini, outside the submitted work., (Copyright ©ERS 2019.)

Background: Pulmonary rehabilitation is an effective therapeutic intervention for people with chronic respiratory disease. However, fewer than 5% of eligible individuals receive pulmonary rehabilitation on an annual basis, largely due to limited availability of services and difficulties associated with travel and transport. The Rehabilitation Exercise At Home (REAcH) study is an assessor-blinded, multi-centre, randomised controlled equivalence trial designed to compare the efficacy of home-based telerehabilitation and traditional centre-based pulmonary rehabilitation in people with chronic respiratory disease., Methods: Participants will undertake an 8-week group-based pulmonary rehabilitation program of twice-weekly supervised exercise training, either in-person at a centre-based pulmonary rehabilitation program or remotely from their home via the Internet. Supervised exercise training sessions will include 30 min of aerobic exercise (cycle and/or walking training). Individualised education and self-management training will be delivered. All participants will be prescribed a home exercise program of walking and strengthening activities. Outcomes will be assessed by a blinded assessor at baseline, after completion of the intervention, and 12-months post intervention. The primary outcome is change in dyspnea score as measured by the Chronic Respiratory Questionnaire - dyspnea domain (CRQ-D). Secondary outcomes will evaluate the efficacy of telerehabilitation on 6-min walk distance, endurance cycle time during a constant work rate test, physical activity and quality of life. Adherence to pulmonary rehabilitation between the two models will be compared. A full economic analysis from a societal perspective will be undertaken to determine the cost-effectiveness of telerehabilitation compared to centre-based pulmonary rehabilitation., Discussion: Alternative models of pulmonary rehabilitation are required to improve both equity of access and patient-related outcomes. This trial will establish whether telerehabilitation can achieve equivalent improvement in outcomes compared to traditional centre-based pulmonary rehabilitation. If efficacious and cost-effective, the proposed telerehabilitation model is designed to be rapidly deployed into clinical practice., Trial Registration: Clinical trial registered with the Australian and New Zealand Clinical Trials Register at ( ACTRN12616000360415 ). Registered 21 March 2016.

Purpose: To explore the influence of descriptive differences in items evaluating mobility on index scores generated from two generic preference-based health-related quality of life (HRQoL) instruments., Methods: The study examined cross-sectional data from a postal survey of individuals receiving assisted ventilation in two state/province-wide home mechanical ventilation services, one in British Columbia, Canada and the other in Victoria, Australia. The Assessment of Quality of Life 8-dimension (AQoL-8D) and the EQ-5D-5L were included in the data collection. Graphical illustrations, descriptive statistics, and measures of agreement [intraclass correlation coefficients (ICCs) and Bland-Altman plots] were examined using index scores derived from both instruments. Analyses were performed on the full sample as well as subgroups defined according to respondents' self-reported ability to walk., Results: Of 868 individuals receiving assisted ventilation, 481 (55.4%) completed the questionnaire. Mean index scores were 0.581 (AQoL-8D) and 0.566 (EQ-5D-5L) with 'moderate' agreement demonstrated between the two instruments (ICC = 0.642). One hundred fifty-nine (33.1%) reported level 5 ('I am unable to walk about') on the EQ-5D-5L Mobility item. The walking status of respondents had a marked influence on the comparability of index scores, with a larger mean difference (0.206) and 'slight' agreement (ICC = 0.386) observed when the non-ambulant subgroup was evaluated separately., Conclusions: This study provides further evidence that between-measure discrepancies between preference-based HRQoL instruments are related in part to the framing of mobility-related items. Longitudinal studies are necessary to determine the responsiveness of preference-based HRQoL instruments in cohorts that include non-ambulant individuals.

Rationale: Domiciliary oxygen therapy is commonly prescribed for patients with interstitial lung disease and hypoxemia, either at rest or during exertion, with the aim of improving symptoms and functional status., Objectives: This study aimed to explore perspectives of adults with interstitial lung disease about domiciliary oxygen therapy, comparing insights from patients using and not using oxygen therapy., Methods: A qualitative study using semistructured interviews was undertaken on 24 adults residing in and near Melbourne, Australia who had a diagnosis of interstitial lung disease and met the Thoracic Society of Australia and New Zealand guidelines for domiciliary oxygen therapy. Study subjects included individuals who were oxygen-naive (n = 12) and oxygen-experienced (n = 12). Interviews were transcribed verbatim and coded independently by two investigators in accordance with the grounded theory method of analysis. Themes were established by consensus., Results: Patients using domiciliary oxygen therapy described widespread variation in usage. Oxygen-naive patients expected oxygen therapy to relieve dyspnea, whereas oxygen-experienced patients emphasized the benefits of oxygen on other, non-dyspnea-related physical symptoms. Practical and psychosocial challenges of using oxygen therapy were raised by both groups of patients., Conclusions: This study highlights the different expectations and experiences of domiciliary oxygen therapy for adults with interstitial lung disease. It is important to understand and address patients' concerns about the use of oxygen therapy for these patients.

Rationale: Comparisons of home mechanical ventilation services have demonstrated considerable regional variation in patient populations managed with this therapy. The respiratory care practices used to support individuals receiving assisted ventilation also appear to vary, but they are not well described. It is uncertain whether differences in the approach to care could influence health outcomes for individuals receiving assisted ventilation., Objectives: We sought to identify and describe the respiratory care practices of home ventilation providers in two different regions and determine whether care practice differences influence health-related quality of life., Methods: We conducted a cross-national survey of individuals receiving assisted ventilation managed by two statewide home mechanical ventilation providers, one in Victoria, Australia, and the other in British Columbia, Canada. The survey was used to evaluate care practices, functional and physical measures, socioeconomic attributes, and health-related quality of life., Measurements and Main Results: Overall, 495 individuals receiving assisted ventilation (57.2%) responded to the survey. Responders had clinical attributes similar to those of nonresponders. The Canadian population had a greater proportion of individuals with neuromuscular disorders and lesser percentages with obesity hypoventilation syndrome and chronic obstructive pulmonary disease. We also found marked differences in the reported care practices in Canada that were not fully explained by population differences. Subjects in the Canadian sample were more likely than their Australian counterparts to use invasive mechanical ventilation (24.2% vs. 2.5%; P < 0.001), to use routine airway clearance techniques (28.9% vs. 14.8%; P < 0.001), and to have had home implementation of noninvasive ventilation (39.9% vs. 3.6%; P < 0.001). Subjects in the Australian population were more likely than those in Canada to have undergone polysomnography to evaluate their ventilatory support (93.9% vs. 37.4%; P < 0.001). There was no difference in summary measures of health-related quality of life between the two sites. In a multivariable regression model, age, ability to perform activities of daily living, physical function, employment, and household income were all independently associated with health-related quality of life, but neither geographic location (Canada vs. Australia) nor underlying diagnosis were significant factors in the model., Conclusions: In two cohorts of individuals receiving assisted ventilation, one in Australia and the other in Canada, we found marked differences in both the care practices employed and the populations served. Despite these regional differences, measures of health-related quality of life were not different. Further research is required to examine costly or burdensome interventions that are currently used routinely in the management of individuals receiving assisted ventilation.

Background: The chronic respiratory disease questionnaire (CRDQ) is designed to assess health-related quality of life (HRQOL) in chronic respiratory conditions, but its reliability, validity and responsiveness in individuals with mild to moderate non-cystic fibrosis (CF) bronchiectasis are unclear., Objectives: This study aimed to determine measurement properties of the CRDQ in non-CF bronchiectasis., Methods: Participants with non-CF bronchiectasis involved in a randomised controlled trial of exercise training were recruited. Internal consistency was assessed using Cronbach's α. Over 8 weeks, reliability was evaluated using intra-class correlation coefficients and Bland-Altman analysis for measures of agreement. Convergent and divergent validity was assessed by correlations with the other HRQOL questionnaires and the Hospital Anxiety and Depression Scale (HADS). The responsiveness to exercise training was assessed using effect sizes and standardised response means., Results: Eighty-five participants were included (mean age ± SD, 64 ± 13 years). Internal consistency was adequate (>0.7) for all CRDQ domains and the total score. Test-retest reliability ranged from 0.69 to 0.85 for each CRDQ domain and was 0.82 for the total score. Dyspnoea (CRDQ) was related to St George's respiratory questionnaire (SGRQ) symptoms only (r = 0.38), with no relationship to the Leicester cough questionnaire (LCQ) or HADS. Moderate correlations were found between the total score of the CRDQ, the SGRQ (rs = -0.49) and the LCQ score (rs = 0.51). Lower CRDQ scores were associated with higher anxiety and depression (rs = -0.46 to -0.56). The responsiveness of the CRDQ was small (effect size 0.1-0.24)., Conclusions: The CRDQ is a valid and reliable measure of HRQOL in mild to moderate non-CF bronchiectasis, but responsiveness was limited., (© 2015 S. Karger AG, Basel.)

Background and Objective: Pulmonary rehabilitation is beneficial for people with chronic obstructive pulmonary disease (COPD) and typically includes exercise and disease-specific education components. However, the benefits directly attributable to the education component remain unclear. This trial sought to determine whether the addition of education to exercise training resulted in greater improvements in health outcomes than pulmonary rehabilitation where education has been omitted., Methods: A randomized trial with allocation concealment, assessor blinded to group allocation and intention-to-treat analysis was conducted. Two hundred and sixty-seven people with COPD (mean age 72(9) years, forced expiratory volume in 1 s, 59(23)% predicted) were allocated to receive either 8 weeks of twice weekly group exercise training plus education or exercise training alone. Education was disease specific with a self-management focus. Primary outcome measures included 6-min walk distance and Chronic Respiratory Questionnaire. Secondary outcomes included dyspnoea, health behaviours, generic health-related quality of life, self-efficacy and healthcare usage with measurements taken immediately following completion and at 6 and 12 months., Results: There were no significant differences that indicated greater improvement in any health outcome with the addition of education. The two intervention groups had similar significant improvements immediately following intervention, and these were maintained comparably in the subsequent 12 months., Conclusions: The results of this investigation suggest that disease-specific group education is not an essential component of pulmonary rehabilitation. Pulmonary rehabilitation based on exercise training is an effective option in the management of patients with COPD if multidisciplinary education cannot be offered., (© 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.)

Background: Positive expiratory pressure (PEP) is a technique used to enhance sputum clearance during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The impact of PEP therapy during acute exacerbations on clinically important outcomes is not clear. This study sought to determine the effect of PEP therapy on symptoms, quality of life and future exacerbations in patients with AECOPD., Methods: 90 inpatients (58 men; mean age 68.6 years, FEV(1) 40.8% predicted) with AECOPD and sputum expectoration were randomised to receive usual care (including physical exercise)±PEP therapy. The Breathlessness, Cough and Sputum Scale (BCSS), St George's Respiratory Questionnaire (SGRQ) and BODE index (Body mass index, airflow Obstruction, Dyspnoea, Exercise tolerance) were measured at discharge, 8 weeks and 6 months following discharge, and analysed via linear mixed models. Exacerbations and hospitalisations were recorded using home diaries., Results: There were no significant between-group differences over time for BCSS score [mean (SE) at discharge 5.2 (0.4) vs 5.0 (0.4) for PEP and control group, respectively; p=0.978] or SGRQ total score [41.6 (2.6) vs 40.8 (2.8) at 8 weeks, p=0.872]. Dyspnoea improved more rapidly in the PEP group over the first 8 weeks (p=0.006), however these benefits were not observed at 6 months. Exacerbations (p=0.986) and hospitalisations (p=0.359) did not differ between groups., Conclusions: We found no evidence that PEP therapy during AECOPD improves important short-term or long-term outcomes. There does not appear to be a routine role for PEP therapy in the management of such individuals.

Background: Non-cystic fibrosis bronchiectasis is characterised by sputum production, exercise limitation and recurrent infections. Although pulmonary rehabilitation is advocated for this patient group, its effects are unclear. The aims of this study are to determine the short and long term effects of pulmonary rehabilitation on exercise capacity, cough, quality of life and the incidence of acute pulmonary exacerbations., Methods/design: This randomised controlled trial aims to recruit 64 patients with bronchiectasis from three tertiary institutions. Participants will be randomly allocated to the intervention group (supervised, twice weekly exercise training with regular review of airway clearance therapy) or a control group (twice weekly telephone support). Measurements will be taken at baseline, immediately following the intervention and at six and 12 months following the intervention period by a blinded assessor. Exercise capacity will be measured using the incremental shuttle walk test and the six-minute walk test. Quality of life and health status will be measured using the Chronic Respiratory Questionnaire, Leicester Cough Questionnaire, Assessment of Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale. The rate of hospitalisation will be captured as well as the incidence of acute pulmonary exacerbations using a daily symptom diary., Discussion: Results from this study will help to determine the efficacy of supervised twice-weekly pulmonary rehabilitation upon exercise capacity and quality of life in patients with bronchiectasis and will contribute to clinical practice guidelines for physiotherapists in the management of this population., Trial Registration: This study protocol is registered with ClinicalTrials.gov (NCT00885521).

This Thoracic Society of Australia and New Zealand Guideline on the provision of home oxygen therapy in adults updates a previous Guideline from 2015. The Guideline is based upon a systematic review and meta‐analysis of literature to September 2022 and the strength of recommendations is based on GRADE methodology. Long‐term oxygen therapy (LTOT) is recommended for its mortality benefit for patients with COPD and other chronic respiratory diseases who have consistent evidence of significant hypoxaemia at rest (PaO2 ≤ 55 mm Hg or PaO2 ≤59 mm Hg in the presence of hypoxaemic sequalae) while in a stable state. Evidence does not support the use of LTOT for patients with COPD who have moderate hypoxaemia or isolated nocturnal hypoxaemia. In the absence of hypoxaemia, there is no evidence that oxygen provides greater palliation of breathlessness than air. Evidence does not support the use of supplemental oxygen therapy during pulmonary rehabilitation in those with COPD and exertional desaturation but normal resting arterial blood gases. Both positive and negative effects of LTOT have been described, including on quality of life. Education about how and when to use oxygen therapy in order to maximize its benefits, including the use of different delivery devices, expectations and limitations of therapy and information about hazards and risks associated with its use are key when embarking upon this treatment. See relatededitorial [ABSTRACT FROM AUTHOR]

BACKGROUND: Pulse oximeters are often used at home by patients with chronic respiratory diseases and more recently for remote monitoring of patients with COVID-19. There are no published data outside a supervised telemedicine setting regarding patients' experiences with these devices. Our objective was to explore patients' usage patterns and perceptions of using pulse oxi-metry at home. METHODS: Patients with chronic respiratory disease who had a pulse oximeter at home were recruited to complete a structured survey. RESULTS: Thirty participants with a range of chronic respiratory diseases (mean age 71 y, 16 females) were recruited. Most participants (83%) used home oxygen therapy. Pulse oximeters were bought online (46.7%), at a pharmacy (40%), at a medical equipment store (6.7%), through a clinic (3.3%), or from an oxygen supplier (3.3%). Use was self-initiated in 56.7% of cases and was based on a health care-related recommendation in 26.7% of cases. Sixty percent of participants used the oximeter daily, with 90% expressing confidence in interpreting their oximeter readings primarily due to education from health care professionals and in-patient experiences. Almost all participants adjusted their activity levels or management based upon oximeter readings. Most participants reported that using a pulse oximeter at home was helpful in judging their physical limitations and provided reassurance and confidence in their disease management. CONCLUSIONS: Subjects appeared confident in their use of home pulse oximetry. Health professionals should identify patients who use pulse oximeters for monitoring and ensure that they are able to interpret readings correctly and, if appropriate, adjust management safely. [ABSTRACT FROM AUTHOR]

Introduction: Morphine may decrease the intensity of chronic breathlessness but data from a large randomised controlled trial (RCT) are lacking. This first, large, parallel-group trial aimed to test the efficacy and safety of regular, low-dose, sustained-release (SR) morphine compared with placebo for chronic breathlessness.Methods: Multisite (14 inpatient and outpatient cardiorespiratory and palliative care services in Australia), parallel-arm, double-blind RCT. Adults with chronic breathlessness (modified Medical Research Council≥2) were randomised to 20 mg daily oral SR morphine and laxative (intervention) or placebo and placebo laxative (control) for 7 days. Both groups could take ≤6 doses of 2.5 mg, 'as needed', immediate-release morphine (≤15 mg/24 hours) as required by the ethics review board. The primary endpoint was change from baseline in intensity of breathlessness now (0-100 mm visual analogue scale; two times per day diary) between groups. Secondary endpoints included: worst, best and average breathlessness; unpleasantness of breathlessness now, fatigue; quality of life; function; and harms.Results: Analysed by intention-to-treat, 284 participants were randomised to morphine (n=145) or placebo (n=139). There was no difference between arms for the primary endpoint (mean difference -0.15 mm (95% CI -4.59 to 4.29; p=0.95)), nor secondary endpoints. The placebo group used more doses of oral morphine solution during the treatment period (mean 8.7 vs 5.8 doses; p=0.001). The morphine group had more constipation and nausea/vomiting. There were no cases of respiratory depression nor obtundation.Conclusion: No differences were observed between arms for breathlessness, but the intervention arm used less rescue immediate-release morphine.Trial Registration Number: ACTRN12609000806268. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is one of the most commonly diagnosed cancers, and is a leading cause of cancer mortality world-wide. Due to lack of early specific symptoms, the majority of patients present with advanced, inoperable disease and five-year relative survival across all stages of non-small cell lung cancer (NSCLC) is 14%. People with lung cancer also report higher levels of symptom distress than those with other forms of cancer. Several benefits for survival and patient reported outcomes are reported from physical activity and exercise in other tumour groups. We report the protocol for a study investigating the benefits of exercise, behaviour change and symptom self-management for patients with recently diagnosed, inoperable, NSCLC.Methods: This multi-site, parallel-group, assessor-blinded randomised controlled trial, powered for superiority, aims to assess functional and patient-reported outcomes of a multi-disciplinary, home-based exercise and supportive care program for people commencing treatment. Ninety-two participants are being recruited from three tertiary-care hospitals in Melbourne, Australia. Following baseline testing, participants are randomised using concealed allocation, to receive either: a) 8 weeks of home-based exercise (comprising an individualised endurance and resistance exercise program and behaviour change coaching) and nurse-delivered symptom self-management intervention or b) usual care. The primary outcome is the between-group difference in the change in functional exercise capacity (six-minute walk distance) from baseline to post-program assessment. Secondary outcomes include: objective and self-reported physical activity levels, physical activity self-efficacy, behavioural regulation of motivation to exercise and resilience, muscle strength (quadriceps and grip), health-related quality of life, anxiety and depression and symptom interference.Discussion: There is a lack of evidence regarding the benefit of exercise intervention for people with NSCLC, particularly in those with inoperable disease receiving treatment. This trial will contribute to evidence currently being generated in national and international trials by implementing and evaluating a home-based program including three components not yet combined in previous research, for people with inoperable NSCLC receiving active treatment and involving longer-term follow-up of outcomes. This trial is ongoing and currently recruiting.Trial Registration: This trial was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12614001268639 : (4/12/14). [ABSTRACT FROM AUTHOR]

Background: Uncertainty exists regarding the clinical relevance of exercise training across the range of interstitial lung diseases (ILDs).Objective: To establish the impact of exercise training in patients with ILDs of differing aetiology and severity.Methods: 142 participants with ILD (61 idiopathic pulmonary fibrosis (IPF), 22 asbestosis, 23 connective tissue disease-related ILD (CTD-ILD) and 36 with other aetiologies) were randomised to either 8 weeks of supervised exercise training or usual care. Six-minute walk distance (6MWD), Chronic Respiratory Disease Questionnaire (CRDQ), St George Respiratory Questionnaire IPF-specific version (SGRQ-I) and modified Medical Research Council dyspnoea score were measured at baseline, 9 weeks and 6 months.Measurements and Main Results: Exercise training significantly increased 6MWD (25 m, 95% CI 2 to 47 m) and health-related quality of life (CRDQ and SGRQ-I) in people with ILD. Larger improvements in 6MWD, CRDQ, SGRQ-I and dyspnoea occurred in asbestosis and IPF compared with CTD-ILD, but with few significant differences between subgroups. Benefits declined at 6 months except in CTD-ILD. Lower baseline 6MWD and worse baseline symptoms were associated with greater benefit in 6MWD and symptoms following training. Greater gains were seen in those whose exercise prescription was successfully progressed according to the protocol. At 6 months, sustained improvements in 6MWD and symptoms were associated with better baseline lung function and less pulmonary hypertension.Conclusions: Exercise training is effective in patients across the range of ILDs, with clinically meaningful benefits in asbestosis and IPF. Successful exercise progression maximises improvements and sustained treatment effects favour those with milder disease.Trial Registration Number: Results, ACTRN12611000416998. [ABSTRACT FROM AUTHOR]

Background: Pulmonary rehabilitation is a cornerstone of care for COPD but uptake of traditional centre-based programmes is poor. We assessed whether home-based pulmonary rehabilitation, delivered using minimal resources, had equivalent outcomes to centre-based pulmonary rehabilitation.Methods: A randomised controlled equivalence trial with 12 months follow-up. Participants with stable COPD were randomly assigned to receive 8 weeks of pulmonary rehabilitation by either the standard outpatient centre-based model, or a new home-based model including one home visit and seven once-weekly telephone calls from a physiotherapist. The primary outcome was change in 6 min walk distance (6MWD).Results: We enrolled 166 participants to receive centre-based rehabilitation (n=86) or home-based rehabilitation (n=80). Intention-to-treat analysis confirmed non-inferiority of home-based rehabilitation for 6MWD at end-rehabilitation and the confidence interval (CI) did not rule out superiority (mean difference favouring home group 18.6 m, 95% CI -3.3 to 40.7). At 12 months the CI did not exclude inferiority (-5.1 m, -29.2 to 18.9). Between-group differences for dyspnoea-related quality of life did not rule out superiority of home-based rehabilitation at programme completion (1.6 points, -0.3 to 3.5) and groups were equivalent at 12 months (0.05 points, -2.0 to 2.1). The per-protocol analysis showed the same pattern of findings. Neither group maintained postrehabilitation gains at 12 months.Conclusions: This home-based pulmonary rehabilitation model, delivered with minimal resources, produced short-term clinical outcomes that were equivalent to centre-based pulmonary rehabilitation. Neither model was effective in maintaining gains at 12 months. Home-based pulmonary rehabilitation could be considered for people with COPD who cannot access centre-based pulmonary rehabilitation.Trial Registration Number: NCT01423227, clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Background and objective Poorly controlled asthma during pregnancy is hazardous for both mother and foetus. Better asthma control may be achieved if patients are involved in regular self-monitoring of symptoms and self-management according to a written asthma action plan. Telehealth applications to optimize asthma management and outcomes in pregnant women have not yet been evaluated. This study evaluated the efficacy of a telehealth programme supported by a handheld respiratory device in improving asthma control during pregnancy. Methods Pregnant women with asthma ( n = 72) from two antenatal clinics in Melbourne, Australia, were randomized to one of two groups: (i) intervention-involving a telehealth programme (management of asthma with supportive telehealth of respiratory function in pregnancy (MASTERY©)) supported by a handheld respiratory device and an Android smart phone application ( Breathe-easy©) and written asthma action plan or (ii) control-usual care. The primary outcome was change in asthma control at 3 and 6 months (prenatal). Secondary outcomes included changes in quality of life and lung function, and perinatal/neonatal outcomes. Results At baseline, participants' mean (± standard deviation) age was 31.4 ± 4.5 years and gestational age 16.7 ± 3.1 weeks. At 6 months, the MASTERY group had better asthma control ( P = 0.02) and asthma-related quality of life ( P = 0.002) compared with usual care. There were no significant differences between groups in lung function, unscheduled health-care visits, days off work/study, oral corticosteroid use, or perinatal outcomes. Differences between groups were not significant at 3 months. Conclusion Telehealth interventions supporting self-management are feasible and could potentially improve asthma control and asthma-related quality of life during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Oxygen desaturation during exercise is common in people with chronic obstructive pulmonary disease (COPD). The aim of the study is to determine, in people with COPD who desaturate during exercise, whether supplemental oxygen during an eight-week exercise training program is more effective than medical air (sham intervention) in improving exercise capacity and health-related quality of life both at the completion of training and at six-month follow up.Methods/design: This is a multi-centre randomised controlled trial with concealed allocation, blinding of participants, exercise trainers and assessors, and intention-to-treat analysis. 110 people with chronic obstructive pulmonary disease who demonstrate oxygen desaturation lower than 90 % during the six-minute walk test will be recruited from pulmonary rehabilitation programs in seven teaching hospitals in Australia. People with chronic obstructive pulmonary disease on long term oxygen therapy will be excluded. After confirmation of eligibility and baseline assessment, participants will be randomised to receive either supplemental oxygen or medical air during an eight-week supervised treadmill and cycle exercise training program, three times per week for eight weeks, in hospital outpatient settings. Primary outcome measures will be endurance walking capacity assessed by the endurance shuttle walk test and health-related quality of life assessed by the Chronic Respiratory Disease Questionnaire. Secondary outcomes will include peak walking capacity measured by the incremental shuttle walk test, dyspnoea via the Dyspnoea-12 questionnaire and physical activity levels measured over seven days using an activity monitor. All outcomes will be measured at baseline, completion of training and at six-month follow up.Discussion: Exercise training is an essential component of pulmonary rehabilitation for people with COPD. This study will determine whether supplemental oxygen during exercise training is more effective than medical air in improving exercise capacity and health-related quality of life in people with COPD who desaturate during exercise.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000395831, 5th Jan,2012. [ABSTRACT FROM AUTHOR]

Background: Exercise training is recommended for non-cystic fibrosis (CF) bronchiectasis, but the long-term effects are unclear. This randomised controlled trial aimed to determine the effects of exercise training and review of airway clearance therapy (ACT) on exercise capacity, health related quality of life (HRQOL) and the incidence of acute exacerbations in people with non-CF bronchiectasis. Methods: Participants were randomly allocated to 8 weeks of supervised exercise training and review of ACT, or control. Primary outcomes of exercise capacity and HRQOL (Chronic respiratory disease questionnaire) and secondary outcomes of cough-related QOL (Leicester cough questionnaire) and psychological symptoms (Hospital anxiety and depression scale) were measured at baseline, following completion of the intervention period and at 6 and 12 months follow up. Secondary outcomes of the exacerbation rate and time to first exacerbation were analysed over 12 months. Results: Eighty-five participants (mean FEV1 74% predicted; median Modified Medical Research Council Dyspnoea grade of 1 (IQR [1-3]) were included. Exercise training increased the incremental shuttle walk distance (mean difference to control 62 m, 95% CI 24 to 101 m) and the 6-minute walking distance (mean difference to control 41 m, 95% CI 19 to 63 m), but these improvements were not sustained at 6 or 12 months. Exercise training reduced dyspnoea (p = 0.009) and fatigue (p = 0.01) but did not impact on cough-related QOL or mood. Exercise training reduced the frequency of acute exacerbations (median 1[IQR 1-3]) compared to the control group (2[1-3]) over 12 months follow up (p = 0.012), with a longer time to first exacerbation with exercise training of 8 months (95% CI 7 to 9 months) compared to the control group (6 months [95% CI 5 to 7 months], p = 0.047). Conclusions: Exercise training in bronchiectasis is associated with short term improvement in exercise capacity, dyspnoea and fatigue and fewer exacerbations over 12 months. Trial registry: ClinicalTrials.gov (NCT00885521). [ABSTRACT FROM AUTHOR]

Source Citation: Hodkinson A, Bower P, Grigoroglou C, et al. Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: systematic review and network meta-analysis. BMJ. 2020;370:m2521. 32816816 Clinical Impact Ratings: GIM/FP/GP: 6 out of 7 Allerg & Immunol: 6 out of 7 Pulmonology: 6 out of 7 [ABSTRACT FROM AUTHOR]

Question In patients with obstructive sleep apnea (OSA), how do continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) compare for health-related quality of life (QoL)? Review scope Included English-language studies compared ≥ 2 of CPAP, MAD, and inactive control (sham or no treatment) in adults > 18 years of age who had OSA, and reported ≥ 1 of the 36-Item Short-Form Health Survey (SF-36) summary scores. Primary outcomes were the mental component score (MCS) and physical component score (PCS) of the SF-36. Review methods MEDLINE and Cochrane Library (Nov 2015), reference lists, and trial registries were searched for randomized controlled trials (RCTs). 23 RCTs (n = 2342) met the selection criteria, of which 15 (n = 1891, mean age 44 to 71 y, 59% to 100% men) reported MCS and PCS and were eligible for meta-analysis of the primary outcomes. Follow-up duration was 4 to 126 weeks. Of the 15 RCTs included in the network meta-analysis, 11 (n = 1561) compared CPAP with inactive control, 2 (n = 153) compared MADs with inactive control, and 2 (n = 177) compared CPAP with MADs. Of the 15 RCTs, 9 reported adequate allocation concealment, 7 reported adequate blinding of patients and outcome assessors, and 9 adequately addressed incomplete outcomes data. Main results Network meta-analysis showed that CPAP increased the SF-36 MCS and PCS scores more than control; MADs did not differ from control (Table). MADs did not differ from CPAP for either score (Table). Pairwise meta-analysis found that MAD improved the MCS subscore more than control (difference in SF-36 score 2.7, 95% CI 0.1 to 5.3); all other pairwise meta-analyses were consistent with network meta-analyses. Conclusions In patients with obstructive sleep apnea, continuous positive airway pressure (CPAP) improves health-related quality of life compared with inactive control. Mandibular advancement devices (MADs) did not have a consistent effect compared with inactive control. Evidence is insufficient for head-to-head conclusions for CPAP compared with MAD. [ABSTRACT FROM AUTHOR]

Objective To examine the effect of pulmonary rehabilitation (PR) (exercise and education) or exercise training (ET) on exercise capacity, health-related quality of life (HRQOL), symptoms, frequency of exacerbations, and mortality compared with no treatment in adults with bronchiectasis. Data Sources Computer-based databases were searched from their inception to February 2016. Study Selection Randomized controlled trials of PR or ET versus no treatment in adults with bronchiectasis were included. Data Extraction Two reviewers independently extracted data and assessed methodologic quality using the Cochrane risk-of-bias tool. Data Synthesis Four trials with 164 participants were included, with variable study quality. Supervised outpatient PR or ET of 8 weeks improved incremental shuttle walk distance (weighted mean difference [WMD]=67m; 95% confidence interval [CI], 52–82m) and disease-specific HRQOL (WMD=−4.65; 95% CI, −6.7 to −2.6 units) immediately after intervention, but these benefits were not sustained at 6 months. There was no effect on cough-related quality of life (WMD=1.3; 95% CI, −0.9 to 3.4 units) or psychological symptoms. PR commenced during an acute exacerbation and continued beyond discharge had no effect on exercise capacity or HRQOL. The frequency of exacerbations over 12 months was reduced with outpatient ET (median, 2 vs 1; P =.013), but PR initiated during an exacerbation had no impact on exacerbation frequency or mortality. Conclusions Short-term improvements in exercise capacity and HRQOL were achieved with supervised PR and ET programs, but sustaining these benefits is challenging in people with bronchiectasis. The frequency of exacerbations over 12 months was reduced with ET only. [ABSTRACT FROM AUTHOR]

The article focuses on the research "Pulmonary rehabilitation improves health-related QoL and exercise capacity more than usual care in COPD" by Christine F. McDonald. Topics discussed include improvement in health-related quality of life by pulmonary rehabilitation, exercise therapy with aerobically demanding physical activity, with or without education or psychological support, and the outcomes achieved with pharmacotherapies.

The author comments on a study conducted to analyze whether pulmonary rehabilitation improves health-related quality of life (HRQoL) and exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Topics discussed include searching of database such as Medline and AMED for randomized controlled trials; meta-analysis of pulmonary rehabilitation improved functional exercise capacity and HRQoL with usual care.

The article offers information on a randomized controlled trial to analyze whether nutritional supplementation has any uncertain effects on patient-important outcomes in Chronic Obstructive Pulmonary Disease (COPD). The conclusions of the trial suggest that patients with chronic obstructive pulmonary disease gain a small weight gain with nutritional supplementation.