Daily Respiratory Research Analysis
Three impactful studies reshape respiratory care: an RCT shows mobile health pulmonary rehabilitation is equivalent to center-based programs for COPD, a multinational cohort finds extremely high mortality in cancer patients with ARDS without benefit from ECMO, and a nationwide registry/meta-analysis shows anticoagulation does not improve survival in pulmonary arterial hypertension. Together, they inform scalable care models, ICU decision-making, and de-implementation of low-yield therapies.
Summary
Three impactful studies reshape respiratory care: an RCT shows mobile health pulmonary rehabilitation is equivalent to center-based programs for COPD, a multinational cohort finds extremely high mortality in cancer patients with ARDS without benefit from ECMO, and a nationwide registry/meta-analysis shows anticoagulation does not improve survival in pulmonary arterial hypertension. Together, they inform scalable care models, ICU decision-making, and de-implementation of low-yield therapies.
Research Themes
- Digital and remote pulmonary rehabilitation for COPD
- Outcomes and technology use (ECMO) in ARDS among oncology patients
- Therapeutic value of anticoagulation in pulmonary arterial hypertension
Selected Articles
1. Mobile health pulmonary rehabilitation (m-PR): a randomised controlled equivalence trial.
This multicentre single-blind equivalence RCT (n=90) showed that 8 weeks of mobile health pulmonary rehabilitation achieved equivalent gains in 6-minute walk distance versus center-based PR and yielded superior improvements in health status (CAT). Findings support mHealth PR as an effective, scalable alternative for COPD rehabilitation.
Impact: Demonstrates with randomized evidence that a digital model can replace resource-intensive center-based pulmonary rehabilitation while maintaining clinical effectiveness and improving patient-reported health status.
Clinical Implications: Health systems can deploy mHealth PR to expand access, reduce waitlists, and deliver equivalent functional gains with improved health status in COPD. Programs should ensure digital literacy support and tele-coaching for optimal adherence.
Key Findings
- m-PR achieved equivalent improvement in 6MWD compared with center-based PR within a 30 m equivalence margin.
- m-PR produced superior improvement in CAT health status compared with center-based PR.
- Trial used intention-to-treat analysis over 8 weeks with single-blind, multicentre design.
Methodological Strengths
- Randomised, single-blind, multicentre equivalence design with intention-to-treat analysis
- Prespecified equivalence margins for both functional and patient-reported outcomes
Limitations
- Sample size modest (n=90) and short intervention duration (8 weeks)
- Generalizability may depend on digital literacy and access to technology
Future Directions: Evaluate long-term maintenance, cost-effectiveness, and implementation strategies across diverse health systems, including hybrid PR models and support for digitally underserved populations.
2. Acute respiratory distress syndrome in patients with cancer: the YELENNA prospective multinational observational cohort study.
In 715 cancer patients with ARDS across 13 countries, 90-day mortality was 73.2% overall and 82.2% in severe ARDS, with no survival benefit from venovenous ECMO after double-adjusted analyses. Predictors of mortality included older age, peripheral vascular disease, severe ARDS, acute kidney injury, and time-limited ICU trials, whereas lymphoma was associated with lower mortality.
Impact: Provides the largest prospective multinational characterization of ARDS in cancer, highlighting extraordinary mortality and the lack of ECMO benefit in severe cases, which directly informs ICU goals-of-care and resource allocation.
Clinical Implications: For oncology patients with ARDS—especially severe forms—clinicians should prioritize early, nuanced goals-of-care discussions and carefully individualize ECMO decisions, as routine ECMO use is unlikely to improve survival. Risk factors can aid prognostication and triage.
Key Findings
- Overall 90-day mortality was 73.2%; severe ARDS subgroup had 82.2% mortality.
- No survival benefit of venovenous ECMO in severe ARDS after overlap- and propensity-weighted Cox modeling (aHR 1.12; 95% CI 0.65–1.94).
- Independent mortality predictors: older age, peripheral vascular disease, severe ARDS at inclusion, acute kidney injury, and time-limited ICU trial; lymphoma associated with lower mortality.
Methodological Strengths
- Prospective, multinational cohort across 13 countries with large sample size (n=715)
- Rigorous double-adjusted analyses (overlap weighting and propensity weighting) for ECMO effect
Limitations
- Observational design cannot fully exclude residual confounding for ECMO selection
- Practice heterogeneity across countries and centers may affect generalizability
Future Directions: Develop validated prognostic tools specific to oncology-ARDS, evaluate patient-centered outcomes, and define contextualized ECMO criteria or alternative strategies tailored to cancer-related ARDS.
3. Association Between Anticoagulant Therapy and Survival in Pulmonary Arterial Hypertension: A Registry Report and Updated Meta-Analysis.
In a nationwide propensity-adjusted registry (n=1,597) and an updated meta-analysis, anticoagulant therapy did not improve survival in PAH overall or in key subgroups (idiopathic/heritable/anorexigen-associated PAH; connective tissue disease–associated PAH). Median survival was similar between anticoagulated and non-anticoagulated patients.
Impact: Clarifies a long-debated practice by showing no survival benefit of anticoagulation in PAH across subgroups, supporting de-implementation and focusing on disease-targeted therapies.
Clinical Implications: Routine anticoagulation should not be used solely to improve survival in PAH. Decisions should be individualized for other indications (e.g., atrial fibrillation, VTE) while prioritizing guideline-directed PAH therapies.
Key Findings
- No survival difference with anticoagulation in the French national PAH registry (HR 0.997; p=0.97).
- Updated meta-analysis showed no survival benefit overall (HR 0.98) or in idiopathic/heritable/anorexigen-related PAH and connective tissue disease–associated PAH.
- Median survival was similar between anticoagulated (5.62 years) and non-anticoagulated (5.37 years) patients.
Methodological Strengths
- Nationwide propensity-adjusted registry analysis with subgroup consistency
- Integration with updated meta-analysis across nationwide datasets
Limitations
- Observational design cannot exclude residual confounding and dosing/agent heterogeneity
- Lack of randomized data; bleeding outcomes not detailed in the abstract
Future Directions: Randomized trials or pragmatic registries with granular anticoagulation exposure and bleeding outcomes are needed; explore biomarkers or phenotypes identifying subgroups that might benefit.