April 2024
Should patients with persistent dyspnoea after pulmonary embolism be referred for exercise therapy?

Those who underwent rehabilitation had better exercise capacity and quality of life. 

Cardiopulmonary rehabilitation programs are a cornerstone of managing chronic obstructive pulmonary disease and cardiovascular disorders and improve patients’ symptoms, exercise capacity and quality of life (QoL). Among patients with acute pulmonary embolism (PE) who receive guideline-directed treatment, as many as 50% will develop long-term sequela of dyspnoea and poor QoL, sometimes termed ‘post-PE syndrome,’ a condition without any well-studied therapeutic interventions.

Researchers in Norway identified 211 patients who had persistent dyspnoea at six to 72 months after acute PE but no evidence of chronic thromboembolic pulmonary hypertension or other cardiopulmonary comorbidities. Patients were randomised to twice-weekly sessions of physical exercise for eight weeks plus a home-based exercise program or to usual care. Those in the rehabilitation group significantly increased mean walking distance (from 680m to 790m) on the Incremental Shuttle Walk Test compared with the usual-care group (mean change, 730m to 760m). Patients who received rehabilitation for six to 12 months derived the most benefit. Rehabilitation patients also recorded improved disease-specific QoL scores.

Comment: We still have much to learn about optimal timing, regimen and modality of exercise rehabilitation in patients with post-PE dyspnoea, but this study suggests that follow-up care for patients with acute PE should include routine assessment for ongoing dyspnoea. Those with symptoms should be referred to an exercise rehabilitation program.

Aaron J. Calderon, MD, FACP, SFHM, Program Director, Internal Medicine Residency, Saint Joseph Hospital; Clinical Professor of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Denver, USA.

Jervan Ø, et al. The effects of exercise training in patients with persistent dyspnea following pulmonary embolism: a randomized controlled trial. Chest 2023; 164: 981-991.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.