‘Thank you for asking’: patient-centred research helps drive change in lung disease treatment

Monash University researchers are giving new hope to people with chronic obstructive pulmonary disease (COPD), with the COVID-19 pandemic prompting some of the first innovations in treatment models in 30 years.

COPD incorporates many different kinds of lung disease and all of them leave you feeling breathless. It disrupts daily routines and productivity and is expected to be one of the leading causes of death worldwide in the next few years.

The condition can be developed from smoking cigarettes, exposure to pollution, different drugs, dust such as coal dust or asbestos, and some genetic predispositions also play a role.

People living with COPD (including emphysema, bronchitis, asthma and interstitial lung disease) have access to a range of drug treatment options, but it is engaging them in rehabilitation programs that can significantly help with their quality of life. However, patient participation has always been low with programs being delivered to less than five per cent of people who would benefit from it.

For people with stable chronic respiratory disease, pulmonary rehabilitation is a cornerstone of treatment. The rehabilitation model conventionally consists of supervised exercise training, education, self-management strategies, and support delivered to groups of patients at least twice a week for eight weeks or longer in either an inpatient or outpatient setting by a multidisciplinary team.

Participation reduces the likelihood of patients being admitted to the hospital, but there are well-documented health-system barriers to participation, including the lack of available programs and a poor referral rate.

However, whole-body exercise training can be a terrifying task for somebody with a lung problem, especially for older patients who might have other health conditions. Travelling to a rehabilitation centre for regular appointments can seem like an insurmountable obstacle to people who are breathless with even small amounts of physical activity. The COVID-19 pandemic has exacerbated these problems, as vulnerable patients are shielding at home.

For people who are more isolated, a new remote model of virtual group rehabilitation is proving crucial to their wellbeing.

A recent study led by Professor Anne Holland, Head of Respiratory Research@Alfred at the Monash Central Clinical School, has found that home-based pulmonary telerehabilitation, delivered directly into the home using videoconferencing to deliver supervised group-based exercise, is safe. (See also first author, Dr Narelle Cox, describing the research: video 2:57 mins)

While it is not equivalent to centre-based rehabilitation for all cases, home-based telerehabilitation does achieve clinically meaningful outcomes and has gone some way to improving access and service delivery. During the pandemic, this model, designed by Professor Holland, has been rapidly implemented in clinical care at many pulmonary rehabilitation centres.

Professor Holland says: “I think we are now starting to finally see some innovation in the treatment models which haven’t changed in 30 years. Working together with patients, and listening to their needs, we are starting to do things differently. However, we need to be vigilant around quality and define what the essential components of rehabilitation need to be regardless of the model of delivery.

“The future of pulmonary rehabilitation will involve more choices for patients and greater personalisation of programs. We are getting better at diagnosing this condition, with early diagnosis key to improving quality of life.”

Professor Holland will outline developments in treatments and new opportunities to address the research priorities of people with chronic lung disease at a virtual public lecture hosted by the Monash Central Clinical School in the Faculty of Medicine, Nursing and Health Sciences:

  • ‘Thank you for asking’: Addressing consumer priorities in respiratory medicine research, will be held online from 12.30-1.30 pm on Friday, 29 October 2021.

To register for the event click here.