[Pulmonary telerehabilitation†: a new standard†?] / Télé-réhabilitation pulmonaire†: un nouveau standard†?

Pulmonary rehabilitation is effective to improve shortness of breath, health status and exercise capacity. Telerehabilitation uses information and communication technologies to deliver rehabilitation program from a distance. A Cochrane review published in 2021 shows its equivalence to conventional pulmonary rehabilitation. The confinement induced by the COVID-19 pandemic has made patients with respiratory failure even more fragile and vulnerable, promoting the development of telerehabilitation. This article describes its modalities, sets out the scientific evidence for its effectiveness and develops perspectives for its development.

La réhabilitation pulmonaire est efficace pour réduire les symptômes, améliorer l'état de santé et la capacité d'effort. La télé-réhabilitation utilise les technologies de l'information et de la communication pour dispenser des activités de réhabilitation à distance. Une revue Cochrane parue en 2021 montre son équivalence à la réhabilitation pulmonaire conventionnelle. Le confinement induit par la pandémie de Covid-19 a rendu les patients avec insuffisance respiratoire encore plus fragiles et vulnérables, favorisant le développement de la télé-réhabilitation. Cet article en décrit les modalités, énonce les preuves scientifiques de son efficacité et propose des perspectives quant à son développement.

Pulmonary Perfusion Changes as Assessed by Contrast-Enhanced Dual-Energy Computed Tomography after Endoscopic Lung Volume Reduction by Coils.

BACKGROUND: Endoscopic lung volume reduction by coils (LVRC) is a recent treatment approach for severe emphysema. Furthermore, dual-energy computed tomography (DECT) now offers a combined assessment of lung morphology and pulmonary perfusion. OBJECTIVES: The aim of our study was to assess the impact of LVRC on pulmonary perfusion with DECT. METHODS: Seventeen patients (64.8 ± 6.7 years) underwent LVRC. DECT was performed prior to and after LVRC. For each patient, lung volumes and emphysema quantification were automatically calculated. Then, 6 regions of interest (ROIs) on the iodine perfusion map were drawn in the anterior, mid, and posterior right and left lungs at 4 defined levels. The ROI values were averaged to obtain lung perfusion as assessed by the lung's iodine concentration (CLung, µg·cm-3). The CLung values were normalized using the left atrial iodine concentration (CLA) to take into account differences between successive DECT scans. RESULTS: The 6-min walk distance (6MWD) improved significantly after the procedure (p = 0.0002). No lung volume changes were observed between successive DECT scans for any of the patients (p = 0.32), attesting the same suspended inspiration. After LVRC, the emphysema index was significantly reduced in the treated lung (p = 0.0014). Lung perfusion increased significantly adjacent to the treated areas (CLung/CLA from 3.4 ± 1.7 to 5.6 ± 2.2, p < 0.001) and in the ipsilateral untreated areas (from 4.1 ± 1.4 to 6.6 ± 1.7, p < 0.001), corresponding to a mean 65 and 61% increase in perfusion, respectively. No significant difference was observed in the contralateral upper and lower areas (from 4.4 ± 1.9 to 4.8 ± 2.1, p = 0.273, and from 4.9 ± 2.0 to 5.2 ± 1.7, p = 0.412, respectively). A significant correlation between increased 6MWD and increased perfusion was found (p = 0.0027, R2 = 0.3850). CONCLUSIONS: Quantitative analysis based on DECT acquisition revealed that LVRC results in a significant increase in perfusion in the coil-free areas adjacent to the treated ones, as well as in the ipsilateral untreated areas. This suggests a possible role for LVRC in the improvement of the ventilation/perfusion relationship.