Christopher Mosher, MD, MHS: Key Recommendations on Pulmonary Rehabilitation for Chronic Respiratory Diseases

In this HCPLive interview segment, Christopher Mosher, MD, MHS, spoke more about the recent updates to the clinical practice guidelines for pulmonary rehabilitation delivery, including recommendations for COPD, interstitial lung disease, and pulmonary hypertension.

Mosher currently works as a pulmonologist and as a clinical researcher for Duke University, in addition to working as an assistant professor for Duke.

He continued his discussion on the new clinical practice guidelines, the contents of which led to recommendations for pulmonary rehabilitation for those with COPD who have been updated with modern evidence as well as newer recommendations for those with interstitial lung disease, and pulmonary hypertension.

“More recently, there's robust evidence both in efficacy trials and effectiveness studies that demonstrate pulmonary rehab after hospitalization for COPD has been shown to reduce future hospitalization rate as well as improved one year mortality,” he explained. “So these 5 domains, the fact that you can get improvement in all of them with this intervention are really exciting and why many of us feel like there needs to be more attention and more advocacy for this really life changing intervention.”

Outside of COPD-related ones, the newer guidelines then go on to focus on groups, such as those with interstitial lung disease and pulmonary hypertension. Mosher added that there is pulmonary rehab available and recommended for patients with interstitial lung disease.

“And then they also looked at a subgroup of patients who have idiopathic pulmonary fibrosis or IPF,” he said. “And similar to those with COPD, they recommended and there is strong evidence to recommend pulmonary rehabilitation in patients with interstitial lung disease. The evidence collectively in that group demonstrated that there was improvement in exercise capacity, as well as shortness of breath and quality of life both at the end of rehab and 6 to 12 months thereafter.”

Another element of the new guidelines Mosher tackled related to rehabilitation recommended for those with pulmonary hypertension.

“And this patient population, as many of the listeners will know, can be much more tenuous,” he said. “And their hemodynamic stability is much more dynamic. In part, the evidence for this intervention in these patients is more scarce by comparison to patients with COPD. So there was a conditional recommendation to recommend pulmonary rehab in this population of patients with pulmonary hypertension. But the evidence for this is low for the reasons that I alluded to.”

Mosher was later asked about the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach that was used in the study to formulate the team’s clinical recommendations. He was also asked how it enhances the credibility of the recommendations.

“So the GRADE approach is a common formal approach that is used to develop these types of guidelines, and really ensures like you had alluded to that there's a standardized approach that's well-validated, in order to come to these conclusions,” he said. “It helps prevent any kind of expert opinion from leaking in and makes sure that all the recommendations are really grounded in strong empirical evidence.”

To find out more about these updated guidelines, view the interview segment posted above.

The quotes used in this article were edited for the purposes of clarity.