Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), are a leading cause of morbidity and mortality.1 Individuals with COPD often suffer progressive declines in health status, increasing symptom burden, and frequent interactions with the healthcare system due to exacerbations and hospitalisations.2 The significant and growing burden of chronic respiratory disease underscores the need for innovations in treatment and delivery of services. Thorax presents two papers that attempt to address this need—albeit with different outcomes.3 4 Cox and colleagues3 report on a large, multicentred, randomised controlled trial that evaluates whether home-based telerehabilitation (TR) was equivalent to centre-based pulmonary rehabilitation (PR) in patients with chronic respiratory disease. This study addresses a major priority for the care of individuals with chronic respiratory disease—how to improve availability and accessibility for PR, a highly effective intervention. PR improves dyspnoea, exercise capacity and functional status, and decreases healthcare utilisation in stable COPD.5 It also improves outcomes after a COPD exacerbation, with reduced readmissions and improved survival.6 Despite these proven benefits, PR is delivered to less than 2% of patients who would benefit. The reasons for underutilisation are complex and multifactorial, but common obstacles include lack of available programmes and limited accessibility to established programmes.7 The investigators report on 142 participants randomised to 16 sessions of either TR or centre-based PR, demonstrating no significant differences between groups for the primary outcome of dyspnoea, as measured by the dyspnoea domain of the Chronic Respiratory …

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改善慢性呼吸道疾病患者的生活：创新的必要性

慢性呼吸系统疾病，包括慢性阻塞性肺病 (COPD)，是发病率和死亡率的主要原因。 1 COPD 患者的健康状况通常会进行性下降，症状负担增加，并且由于病情加重和住院而与医疗保健系统频繁互动.2 慢性呼吸道疾病的沉重负担和日益增加的负担突显了在治疗和提供服务方面创新的必要性。Thorax 提出了两篇试图解决这一需求的论文——尽管结果不同。3 4 Cox 及其同事 3 报告了一项大型、多中心、随机对照试验，该试验评估了基于家庭的远程康复 (TR) 是否等同于基于中心的肺康复 ( PR) 慢性呼吸道疾病患者。这项研究解决了慢性呼吸道疾病患者护理的一个主要优先事项——如何提高 PR 的可用性和可及性，这是一种高效的干预措施。PR 可改善呼吸困难、运动能力和功能状态，并降低稳定期 COPD 患者的医疗保健利用率。 5 它还可以改善 COPD 恶化后的结果，减少再入院率并提高生存率。 6 尽管有这些已证实的益处，但 PR 仅提供给不到 2%受益的患者。未充分利用的原因是复杂和多因素的，但常见的障碍包括缺乏可用的项目和对既定项目的可及性有限。 7 研究人员报告了 142 名参与者随机分配到 TR 或基于中心的 PR 的 16 次会议，