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Professor Anne Holland - ARCH Chair at Alfred Health

Pulmonary rehabilitation to improve the lives of people with pulmonary fibrosis

Pulmonary fibrosis is a debilitating lung condition resulting in breathlessness and poor quality of life. There are few treatment options. In 2008 Professor Anne Holland published results of the first ever clinical trial of pulmonary rehabilitation (consisting of exercise training and education) for people with pulmonary fibrosis, conducted at Alfred Health. Pulmonary rehabilitation participants had important improvements in exercise capacity, symptoms and quality of life. This led to a paradigm shift in the care of people with pulmonary fibrosis, who were previously assumed to be too unwell to exercise. In 2011 the international guidelines for treatment of pulmonary fibrosis made the first ever recommendation for rehabilitation in pulmonary rehabilitation. Pulmonary rehabilitation is now considered the standard of care for patients with pulmonary fibrosis across the world.

A recent clinical trial led by Dr Leona Dowman (part of her doctoral studies at Alfred ARCH) and supervised by Professor Anne Holland, is the largest trial of pulmonary rehabilitation ever conducted in this group. This trial showed that participants who had less impaired lung function achieved longer lasting benefits following pulmonary rehabilitation. This provides a strong rationale for health professionals to refer patients to pulmonary rehabilitation as early as possible.

Recently two drug treatments that slow disease progression in pulmonary rehabilitation have become available, but neither improves exercise capacity, symptoms or quality of life. Pulmonary rehabilitation is currently the only treatment to achieve this.

Publications
  1. Dowman LM, McDonald CF, Hill CJ, Lee AL, Barker K, Boote C, Glaspole I, Goh NSL, Southcott AM, Burge AT, Gillies R, Martin A, Holland AE. The evidence of benefits of exercise training in interstitial lung disease: a randomized controlled trial. Thorax 2017;72: 610–619.
  2. Dowman LM, McDonald CF, Bozinovski S, Vlahos R, Gillies R, Pouniotis D, Hill CJ, Goh NSL, Holland AE. Greater endurance capacity and improved dyspnoea with acute oxygen supplementation in idiopathic pulmonary fibrosis patients without resting hypoxemia. Respirology 2017; 22 (5): 957–964.
  3. Dowman L, McDonald CF, Hill CJ, Lee AL, Barker K, Boote C, Glaspole I, Goh N, Southcott A, Burge AT, Ndongo R, Martin A, Holland AE. Reliability of the hand held dynamometer in measuring muscle strength in people with interstitial lung disease. Physiotherapy 2016; 102 (3): 249-55. doi: 10.1016/j.physio.2015.10.002.
  4. Holland AE, Fiore Jr JF, Goh N, Symons K, Dowman L, Westall G, Hazard A, Glaspole I. Be honest and help me prepare for the future: what people with interstitial lung disease want from education in pulmonary rehabilitation. Chronic Respiratory Disease 2015; 12(2):93-101
  5. Holland AE, Dowman L, Hill CJ. Principles of rehabilitation and reactivation: Interstitial lung disease, sarcoidosis and rheumatoid disease with respiratory involvement. Respiration 2015; 89(2): 89
  6. Dowman L, Hill CJ, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database of Systematic Reviews 2014; Oct 6;10:CD006322. doi: 10.1002/14651858.CD006322.pub3
  7. Holland AE, Hill CJ, Glaspole I, Goh N, McDonald CF. Predictors of benefit following pulmonary rehabilitation for interstitial lung disease. Respiratory Medicine 2012; 106(3): 429-35
  8. Holland AE, Hill CJ, Conron M, Munro P, McDonald CF. Small changes in six minute walk distance are important in diffuse parenchymal lung disease. Respiratory Medicine. 2009; 103:1430-35.
  9. Holland AE, Hill CJ, Conron M, Munro P, McDonald CF. Short-term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease. Thorax 2008; 63(6):549-54.