Christopher Mosher, MD, MHS: Updates on the Guidelines for Pulmonary Rehabilitation Delivery

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In this discussion, Dr. Mosher shared several key insights on the recently updated clinical practice guidelines for pulmonary rehabilitation delivery.

During this HCPLive interview with Christopher Mosher, MD, MHS, Mosher discussed some major takeaways from the recently updated clinical practice guidelines for pulmonary rehabilitation delivery.

Mosher is known for his work as a pulmonologist and clinical researcher for Duke University, as well as his work as assistant professor for Duke.

In his discussion, Mosher described the work of a recent study that created 6 research queries tackling pulmonary rehabilitation (PR). Specifically, these were regarding distinct patient cohorts: ones with chronic obstructive pulmonary disease (COPD), ones with interstitial lung disease, and ones with pulmonary hypertension.

As a result of this team’s work, they were able to formulate clinical recommendations utilizing the Grading of Recommendations, Assessment, Development, and Evaluation methodology.

“In pulmonary rehab, as you mentioned, there's a new set of clinical practice guidelines that just came out and that were released in the Blue Journal this week,” Mosher said. “They're an official (American Thoracic Society) statement. And this is an update from the 2007 guidelines which indicates that, really, there's been a lot of substantial evidence that's been created in these last 15 plus years, as well as novel and emerging delivery methods of pulmonary rehab and telerehabilitation.”

Mosher also commended the authors of the paper for their work in the space and their contribution to innovations in the treatment space.

“I think these guidelines really positioned the field both for healthcare providers, patients, and policymakers,” he said. “It really identifies where the evidence is and where the continued unmet needs are, and I think it'll be a big will kind of help propel the field forward in the years to come.”

Mosher then delved into a discussion about some of the key recommendations for the patient groups and the delivery models from the study.

“So the guidelines are really broken up into 6 individual questions and as you mentioned, they're focused on COPD, interstitial lung disease, and pulmonary hypertension,” he explained. “As I'm sure many of the audience members know, there is has been evidence on other pulmonary diseases such as asthma or cystic fibrosis, but those were outside the scope for these guidelines specifically.”

Mosher added that the first 2 really focus primarily on COPD, adding that based upon the evidence that he alluded to which has come out in recent years, the guideline committee recommended that for patients with stable COPD, as well those who are recovering from an exacerbation of COPD, there is strong evidence to recommend this medical intervention for those patients.

Mosher also elaborated on a description of pulmonary rehabilitation, to clarify for viewers who may not be aware.

“So for those who aren't familiar, pulmonary rehab is a medical intervention,” he said. “The way I like to think about it is the comprehensive intervention, you can think about it kind of like a 3- legged stool. It's made up of individualized progressive exercise training, education, and coaching around behavior change.”

He further explained that those 3 components are often delivered in an outpatient setting, typically over the course of 6 to 8 weeks and typically 2 to 3 visits a week at an outpatient rehabilitation center by trained professionals from multiple disciplines.

“As these guidelines reflect, the bulk of evidence has been in patients with COPD,” Mosher said. “That's where the largest evidence bases and there are 5 demonstrated benefits in patients with COPD. But also there has been shown to be benefit in ILD and pulmonary hypertension which I'm sure we'll get into. But I've wanted us to first just kind of set the landscape for what pulmonary rehab is for our audience today.”

For more information on the latest guidelines, view the full HCPLive interview segment above.

The quotes contained in the article have been edited for clarity.

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