Authors (including presenting author) :
Chan LKK (1), Choi WC (2), Chau SK(1)
Affiliation :
(1)Paediatrics and Adolescents Medicine, The Duchess of Kent Children's Hospital at Sandy Bay (2)Physiotherapy, The Duchess of Kent Children's Hospital at Sandy Bay
Keyword 1: :
Pulmonary Rehabilitation
Keyword 3: :
Multidisciplinary
Keyword 4: :
Acute respiratory diseases
Keyword 5: :
Chronic respiratory diseases
Introduction :
Pulmonary rehabilitation (PR) is a well-established intervention for adults with chronic obstructive pulmonary disease; however, its application in paediatric populations remains largely underexplored. Most existing studies have focused on specific conditions, such as asthma and cystic fibrosis. Thus, the role, design, and efficacy of PR in paediatric settings require further investigation. Since 2015, the Duchess of Kent Children’s Hospital at Sandy Bay (DKCH) has launched a pilot inpatient PR program tailored for children with compromised lung function due to various conditions, encompassing both acute and chronic respiratory illnesses. Additionally, during the COVID-19 pandemic, a community-based PR model was developed to better address the needs of patients.
Objectives :
PR in paediatric populations is less frequently implemented and evaluated compared to adult practices, primarily due to the diverse spectrum of respiratory diseases in children and the challenges associated with creating age-appropriate exercises and programs. The primary aim of this study is to evaluate the effectiveness of a paediatric PR program designed to enhance lung function and exercise capacity in children with both acute and chronic respiratory conditions. While PR has demonstrated favourable outcomes in paediatric asthma and cystic fibrosis, evidence supporting its applicability to other chronic conditions―such as primary ciliary dyskinesia and bronchiectasis―remains limited, particularly in local contexts lacking comprehensive reviews. This study also aims to assess whether the benefits of PR can be extended to acute respiratory conditions in addition to chronic diseases. Furthermore, in light of the emergence of COVID-19 and rapid technological advancements, the comparison between inpatient and community-based PR will inform the restructuring of the program to meet evolving patient needs and healthcare demands.
Methodology :
This study retrospectively reviewed participants in the multidisciplinary PR program over a 10-year period in a paediatric rehabilitation hospital, from 2015 to 2024. Approval was obtained from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (Approval No. UW25-340). Medical assessments were conducted by a multidisciplinary team, including doctors, physiotherapists and dietitians. In the inpatient PR program, participants engaged in supervised training sessions lasting 30 to 60 minutes, two to three times per week. Following initial assessments, participants received nutritional counselling and disease education, complemented by physiotherapy sessions focused on breathing exercises, aerobic training, postural correction, muscle strengthening, and airway clearance techniques. In the community-based PR program, after the initial assessment and training session with physiotherapists, participants performed regular home-based aerobic and breathing exercises, supplemented by one to two outpatient follow-ups per month for skill reinforcement. Lung function parameters, including forced expiratory volume (FEV1) and forced vital capacity (FVC), as well as exercise capacity (measured by the six-minute walk test, 6MWT), were assessed before and after the program, and any adverse events during the PR sessions were documented. Participants unable to perform lung function or exercise capacity assessments were excluded from the analysis.
Result & Outcome :
A total of 32 participants were included for analysis, with mean age of 11.6 ± 3.8 years and average duration of participation of 68.2 ± 43.2 days. Among these, 22 were referred for chronic respiratory diseases, while 10 were referred for deconditioning following major acute respiratory events. Our cohort exhibited lower-than-average body weight and BMI (Body weight z score -0.63, BMI z score -1.01 compared with the local paediatric population), highlighting the importance of nutritional counseling as part of the disease education. After the PR program, statistically significant improvements were observed in lung function parameters (FEV1 increased from 62.2% to 68.4%, p=0.004; FVC increased from 72.6% to 79.2%, p=0.004) and exercise capacity (6MWT increased from 472.6m to 515.2m; p=0.002). Similar enhancements were noted in both chronic respiratory disease patients (n=22) and those experiencing deconditioning post-acute respiratory events (n=10), with no adverse events reported. Comparing inpatient and community-based PR programs, mean durations were 39.8 ± 14.7 days and 104.6 ± 40.4 days, respectively. Inpatient group demonstrated significantly improvement in both lung function and exercise capacity [FEV1 increased from 57.0% to 67.0% (p=0.003), FVC increased from 68.3% to 79.2% (p=≤0.001), 6MWT distance increased from 417.0 m to 535.1 m (p=0.003)]. In the community-based group, exercise capacity significantly improved [6MWT distance increased from 477.2 m to 517.7m (p = 0.021)]. Their lung function parameters, however, did not differ significantly post PR program [FEV1 68.9% to 70.3%(p=0.49), FVC 78.1% to 79.3%(p=0.68)]. This might be attributed to their higher baseline lung function, which could make achieving statistically significant improvements more challenging. Additionally, there was insufficient data to fully evaluate the adherence of aerobic and breathing exercise in the community-based group. These findings indicate that paediatric PR programs are both safe and effective for children with impaired lung function or exercise capacity. They support the expansion of recruitment criteria to accommodate a wider range of children with both acute and chronic respiratory conditions. With advancements in technology, community-based PR programs have emerged as viable alternatives to inpatient options. However, larger-scale studies incorporating enhanced measures to monitor adherence are needed to further evaluate the efficacy of community-based PR initiatives. Nonetheless, a structured multidisciplinary PR program should be integrated as a fundamental component of respiratory care to mitigate long-term paediatric disease burdens that may extend into adulthood.
