Patients with idiopathic pulmonary fibrosis (IPF) who are undergoing pulmonary rehabilitation and receiving antifibrotic therapy have better outcomes than patients undergoing pulmonary rehabilitation alone, according to a study published in the Brazilian Journal of Pulmonology.

Currently, 2 antifibrotic therapies have shown great promise and are routinely used in clinical practice: pirfenidone and nintedanib. Nevertheless, some studies suggest that they do not improve dyspnea, exercise capacity, or health-related quality of life (HRQoL). 

Pulmonary rehabilitation, on the other hand, has been shown to improve both functional outcomes and HRQoL. The authors of this study hence conducted an investigation to understand whether patients who underwent pulmonary rehabilitation and received antifibrotic therapy had better overall outcomes. 

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The research team recruited 16 consecutive patients diagnosed with IPF who were undergoing pulmonary rehabilitation and receiving antifibrotic therapy at a referral center for lung transplantation in Brazil. They also recruited 16 controls, defined as patients with IPF undergoing pulmonary rehabilitation who were not on any antifibrotic therapy. The pulmonary rehabilitation program consisted of appointments with the pulmonary rehabilitation team every 2 months; these sessions included psychiatric assessments, nutritional advice, medical education, and social assistance.

Read more about IPF etiology 

The researchers performed pulmonary function tests according to the standards set by the American Thoracic Society (ATS)/European Respiratory Society (ERS). They also administered the 6-minute walking distance (6MWD) test and requested that participants fill in the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), which evaluates HRQoL. The study lasted for 12 weeks. 

Pereira and colleagues discovered that patients who underwent pulmonary rehabilitation and were on antifibrotic therapy had better 6MWD and HRQoL than patients who underwent pulmonary rehabilitation alone. However, there were no significant differences between the groups in terms of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), or FEV1/FVC ratio. 

“Our findings suggest that the use of [antifibrotic therapy] can increase the beneficial effects of [pulmonary rehabilitation] on functional outcomes in these patients,” the authors of the study concluded. 


Pereira MP, Branchini G, Nunes FB, et al. Antifibrotic therapy in idiopathic pulmonary fibrosis candidates for lung transplantation undergoing pulmonary rehabilitationJ Bras Pneumol. 2023;49(1):e20220250. doi:10.36416/1806-3756/e20220250