Comprehensive pulmonary rehabilitation in patients with bronchiolitis obliterans syndrome: A case series

Abstract

Introduction: Bronchiolitis obliterans syndrome (BOS) is obstructive airflow disease. The mortality of the BOS is high and there is still no effective treatment. Pulmonary rehabilitation (PR) is a standard treatment for patients with chronic obstructive lung disease by alleviating respiratory symptoms and optimizing functional capacity. There is a hypothesis that suggests that comprehensive PR may improve exercise capacity and dyspnea in BOS patients. Case 1)A 42-year-old woman was diagnosed with BOS, 14 months after receiving allogenic hematopoietic stem cell transplantation and referred to a PR clinic. Comprehensive PR programs include aerobic interval training, breathing technique education, and respiratory muscle strengthening. After PR, modified medical research council dyspnea scale was changed from 3 to 2. The forced vital capacity (FVC) increased from 44% to 71% of predicted but there was no change in forced expiratory volume in the first second (FEV1). The maximal inspiratory and expiratory pressure (MIP & MEP) increased. The six minute walk distance (6MWD) increased from 215 to 297 meter and peak oxygen comsumption (VO2peak) also increased from 15.7 to 18.4 ml/kg/min. Case 2)A 19-year-old man with BOS was enrolled PR. After 8weeks of PR, FVC was improved from 55% to 71%. MIP and MEP also increased. The 6MWD increased from 450m to 534m. Case 3)A 28-year-old man with BOS participated in PR. After 12 weeks of PR, FVC, MIP and MEP increased. The 6MWD and VO2peak showed marked improvement. Conclusion: Comprehensive PR could improved exercise capacity and dyspnea in BOS patients. PR should be considered as an adjunct treatment for BOS patients.