{"paper_id":"4e05cdbc-7718-4263-bcda-6dcf29067400","body_text":"A multidisciplinary pulmonary rehabilitation pathway for hospitalized patients with chronic lung disease and post-COVID syndrome: a prospective controlled cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A multidisciplinary pulmonary rehabilitation pathway for hospitalized patients with chronic lung disease and post-COVID syndrome: a prospective controlled cohort study Aibo Zheng, Kai Sun², Shengjun Ma², Yan Jin², Wenjun Li², Zhiyu Chen², and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9505042/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Patients with chronic lung disease (CLD) and post-COVID syndrome suffer from multidimensional impairment that is often incompletely addressed by pharmacotherapy alone. We evaluated a ward-based multidisciplinary pathway integrating pharmacotherapy, psychological support, and pulmonary rehabilitation. Methods In this prospective controlled cohort study, 360 hospitalized patients with CLD and post-COVID syndrome received integrated multidisciplinary care (n = 120) or usual care (n = 240). The primary outcomes were changes in PaCO₂, FEV₁% predicted, and CT abnormality extent. Patient-reported outcomes, functional capacity, inflammation, and 6-month follow-up data were also assessed. Analyses used adjusted regression and IPTW. Results Integrated care was associated with greater improvements in gas exchange, lung function, radiological resolution, quality of life, anxiety, exercise capacity, and inflammation (all P < 0.001). The composite early clinical benefit rate was higher (51.7% vs 37.5%, P = 0.011). At 6 months, sleep quality was better and symptom-related medication use was lower, while rehospitalization and exacerbation rates were similar between groups. Conclusions A ward-based multidisciplinary pulmonary rehabilitation pathway improves short-term physiological, functional, and patient-reported outcomes in high-risk patients with CLD and post-COVID syndrome, and reduces long-term symptom-related treatment burden. Post-COVID syndrome chronic lung disease pulmonary rehabilitation multidisciplinary care pathway psychological support health-related quality of life patient-reported outcomes Figures Figure 1 Figure 2 Figure 3 Background Survivors of COVID-19 often experience persistent respiratory symptoms, impaired physical function, poor quality of life, sleep disturbance, and psychological distress. These issues are especially severe in patients with pre-existing chronic lung disease (CLD), in whom post-COVID manifestations are superimposed on underlying airway or parenchymal abnormalities [ 17 , 20 , 21 ] . Current clinical care remains largely pharmacological, with insufficient attention to physical deconditioning and psychological needs, despite the multidimensional nature of post-COVID recovery in CLD [ 23 ] .Many hospitalised COVID-19 survivors develop persistent interstitial abnormalities, which further complicate management in those with pre-existing CLD. Routine pharmacological care fails to address these complex impairments comprehensively [ 29 ] . Pulmonary rehabilitation is well established in chronic respiratory disease and improves exercise capacity, dyspnoea, and quality of life, with emerging benefits in post-COVID populations [ 1 , 2 , 5 , 6 , 14 , 16 ] . A recent meta-analysis of 37 randomized controlled trials confirmed that pulmonary rehabilitation significantly enhances physical capacity, lung function, quality of life, fatigue, and anxiety in long COVID, with optimal effects seen in 4–8-week multicomponent programs [ 8 ] . Usual care alone leads to incomplete recovery, and rehabilitation provides additive benefits for physical function and mental health [ 4 ] . Combined physical and psychological support further improves patient-reported outcomes [ 3 , 15 , 40 ] . We therefore evaluated a ward-based multidisciplinary pulmonary rehabilitation pathway integrating guideline-based pharmacotherapy, structured psychological support, and protocolized rehabilitation in hospitalized patients with CLD and post-COVID syndrome. We hypothesized that this integrated approach would yield broader short-term improvements across physiological, functional, and patient-reported domains, and lower symptom-related treatment burden during follow-up, compared with usual care. A prospective controlled cohort study was conducted to investigate this multidisciplinary strategy in a high-risk post-COVID respiratory population [ 18 , 19 , 20 , 21 , 22 ] . Methods Study design and setting This prospective, single-centre controlled cohort study was conducted in the Department of Respiratory and Critical Care Medicine at Zigong Fourth People’s Hospital, a tertiary public hospital in Zigong, Sichuan Province, China. The study was carried out within the framework of a municipal key science and technology project on integrated management for patients with chronic lung disease and post-COVID syndrome. Eligible patients were consecutively recruited during hospitalisation and were followed from admission to discharge, with outpatient follow-up planned at approximately six months after discharge. The study protocol was approved by the Ethics Committee of Zigong Fourth People’s Hospital (approval number: EC-2025-101). Written informed consent was obtained from all participants prior to enrolment. Participants Eligible participants were adults aged 18 years or older who were admitted to the respiratory department with underlying CLD and persistent symptoms following COVID-19. CLD was defined as physician-diagnosed chronic obstructive pulmonary disease, asthma, bronchiectasis, interstitial lung disease, or other chronic structural lung disorders. All participants had a documented history of SARS-CoV-2 infection at least 12 weeks before the index admission, persistent respiratory or systemic symptoms consistent with post-COVID syndrome, and residual parenchymal abnormalities on chest computed tomography. Exclusion criteria included active malignancy or tuberculosis, unstable cardiovascular disease, severe hepatic or renal dysfunction, severe psychiatric illness requiring intensive specialist management, pregnancy or breastfeeding, and any other condition considered likely to interfere with treatment adherence or study participation. Group allocation and masking Participants were allocated to the integrated or usual-care group according to clinical pathway availability. Blinding of patients and clinicians was not feasible; however, radiologists, technicians, and data analysts were blinded where possible. As allocation was non-random, analyses were interpreted as adjusted associations rather than causal effects. CT assessment CT-assessed fibrotic extent was evaluated on high-resolution CT by two blinded radiologists using a semi-quantitative method. Fibrotic extent was defined as the percentage of lung parenchyma showing reticulation, parenchymal bands, traction bronchiectasis, or architectural distortion. Discrepancies were resolved by consensus, and inter-reader agreement was assessed. Interventions Usual-care participants received standard pharmacological and supportive care per national and international guidelines for chronic lung disease and post-COVID respiratory symptoms, including inhaled bronchodilators, inhaled or systemic corticosteroids, mucolytics, antimicrobials (for suspected infection), oxygen therapy, and routine supportive measures. Integrated-management participants received identical guideline-based pharmacotherapy plus a bundled multidisciplinary intervention: pharmacotherapy optimisation (tailored to CLD phenotype and post-COVID manifestations, with selective antifibrotics for persistent interstitial abnormalities), structured psychological care, and ward-based pulmonary rehabilitation. Psychological care was delivered 2–3 times weekly by psychosomatic specialists (20–30 minutes/session), focusing on supportive counselling, anxiety management, sleep hygiene, and relaxation training. Ward-based pulmonary rehabilitation was provided 1–2 times daily (15–30 minutes/session) based on clinical stability and tolerance, with exercise intensity individualised to symptoms, oxygenation, haemodynamics, and perceived exertion. The program followed core pulmonary rehabilitation principles (individualised aerobic/resistance exercise, breathing retraining, education, self-management, psychosocial support) adapted for mixed CLD populations per clinical guidelines and literature [ 30 , 31 , 38 ] . The integrated intervention was a bundled multidisciplinary pathway; the study was not designed to isolate effects of individual components. Outcome measures The primary outcomes were changes from baseline to discharge in arterial carbon dioxide tension (PaCO₂), forced expiratory volume in one second as a percentage of the predicted value (FEV₁% predicted), and CT-assessed fibrotic extent. Secondary in-hospital outcomes included changes in St George’s Respiratory Questionnaire (SGRQ) score, Zung Self-rating Anxiety Scale (SAS) score, 15-minute walking distance, inflammatory markers, including C-reactive protein and erythrocyte sedimentation rate, and sleep-quality score. Daily ward assessments were used to determine time to relief of cough, sputum production, and dyspnoea, and to derive a composite early clinical benefit score (0–3) based on prespecified symptom-relief thresholds. The composite early clinical benefit score was prespecified by the investigators to summarise early multidomain symptom recovery, but it was not a formally validated external endpoint and should therefore be regarded as exploratory. Six-month outcomes included rehospitalisation, acute exacerbations of chronic lung disease, progression of CT abnormalities, sleep quality, use of anxiolytic or hypnotic medication, and rescue inhaler use. These follow-up outcomes were not intended to constitute a formal treatment-emergent adverse-event analysis. Functional capacity was assessed using a supervised 15-minute walking test performed according to a standardised ward protocol. Because this test is less widely used than the 6-minute walk test in the pulmonary rehabilitation literature, its findings should be interpreted primarily as an internal comparative measure within this cohort. Statistical analysis Continuous variables are presented as mean ± standard deviation or median (interquartile range), and categorical variables as counts and percentages. Between-group comparisons were performed using appropriate parametric or non-parametric tests.Adjusted between-group differences were estimated using multivariable linear and logistic regression models, with prespecified adjustment for baseline covariates. Inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis. Covariate balance is reported using standardized mean differences.Analyses were conducted using R (version 4.3.2). A two-sided P < 0.05 was considered statistically significant. Results Patient flow and baseline characteristics Between October 2024 and October 2025, 360 eligible inpatients were enrolled (120 integrated care, 240 usual care). Six-month follow-up loss was low and balanced between groups. Baseline characteristics were generally comparable (Table 1 ); small residual imbalances were adjusted for in multivariable and IPTW analyses (Supplementary Table S1 ). Table 1 a. Baseline characteristics (continuous variables) Variable Integrated programme Usual care p-value Age, years 65.8 ± 10.2 65.4 ± 11.5 0.718 Body mass index, kg/m² 23.6 ± 3.8 24.4 ± 3.6 0.055 Data are presented as mean ± standard deviation. BMI, body mass index. Table 1 b. Baseline characteristics (categorical variables) Variable Integrated programme Usual care p-value Sex: Female 61 (50.8%) 104 (43.3%) 0.217 Sex: Male 59 (49.2%) 136 (56.7%) 0.217 Smoking status: Non-smoker 71 (59.2%) 158 (65.8%) 0.261 Smoking status: Current/former smoker 49 (40.8%) 82 (34.2%) 0.261 Long-term respiratory medication: No 62 (51.7%) 121 (50.4%) 0.911 Long-term respiratory medication: Yes 58 (48.3%) 119 (49.6%) 0.911 Obstructive sleep apnoea–hypopnoea: No 92 (76.7%) 196 (81.7%) 0.328 Obstructive sleep apnoea–hypopnoea: Yes 28 (23.3%) 44 (18.3%) 0.328 Gut dysbiosis: No 82 (68.3%) 170 (70.8%) 0.714 Gut dysbiosis: Yes 38 (31.7%) 70 (29.2%) 0.714 Underlying chronic lung disease: COPD 45 (37.5%) 94 (39.2%) 0.848 Underlying chronic lung disease: Asthma 27 (22.5%) 51 (21.2%) 0.892 Underlying chronic lung disease: Bronchiectasis 19 (15.8%) 42 (17.5%) 0.804 Underlying chronic lung disease: Interstitial lung disease/other ILD 29 (24.2%) 53 (22.1%) 0.756 Data are presented as number (percentage) of patients unless otherwise indicated. COPD, chronic obstructive pulmonary disease; ILD, interstitial lung disease; OSAHS, obstructive sleep apnoea–hypopnoea syndrome. Table 2 Primary in-hospital outcomes Variable Group n Baseline mean ± SD Discharge mean ± SD Change mean ± SD Between-group p value (change) PaCO₂, mmHg Integrated programme 120 42.7 ± 5.8 40.3 ± 6.0 -2.4 ± 1.1 p < 0.001 PaCO₂, mmHg Usual care 240 42.2 ± 5.7 40.8 ± 5.8 -1.4 ± 0.9 p < 0.001 FEV₁% predicted Integrated programme 120 69.7 ± 18.4 76.2 ± 18.9 6.5 ± 3.8 p < 0.001 FEV₁% predicted Usual care 240 69.4 ± 17.4 73.5 ± 18.0 4.1 ± 3.3 p < 0.001 CT fibrotic extent, % of lung Integrated programme 120 8.9 ± 6.1 6.9 ± 5.6 -2.0 ± 1.5 0.003 CT fibrotic extent, % of lung Usual care 240 9.3 ± 5.5 7.8 ± 5.4 -1.5 ± 1.3 0.003 Data are presented as mean ± standard deviation. Changes are calculated as discharge minus baseline. The repeated p values within paired rows represent a single between-group comparison of change for each endpoint. PaCO₂, arterial partial pressure of carbon dioxide; FEV₁, forced expiratory volume in 1 second; CT, computed tomography. Table 3 Secondary in-hospital outcomes Variable Group n Baseline mean ± SD Discharge mean ± SD Change mean ± SD Between-group p value (change) SGRQ total score Integrated programme 120 47.5 ± 17.2 37.6 ± 15.9 -9.9 ± 5.2 p < 0.001 SGRQ total score Usual care 240 46.8 ± 17.2 40.5 ± 18.2 -6.3 ± 5.0 p < 0.001 SAS anxiety score Integrated programme 120 55.4 ± 9.8 48.3 ± 10.4 -7.0 ± 3.1 p < 0.001 SAS anxiety score Usual care 240 56.0 ± 8.7 51.5 ± 9.2 -4.5 ± 2.9 p < 0.001 15-min walking distance, m Integrated programme 120 673.2 ± 143.4 755.1 ± 149.5 81.9 ± 38.0 p < 0.001 15-min walking distance, m Usual care 240 687.7 ± 136.2 736.2 ± 142.8 48.6 ± 33.1 p < 0.001 CRP, mg/L Integrated programme 120 8.1 ± 5.1 5.5 ± 4.7 -2.5 ± 1.9 p < 0.001 CRP, mg/L Usual care 240 7.6 ± 5.6 6.0 ± 5.4 -1.5 ± 1.6 p < 0.001 ESR, mm/h Integrated programme 120 21.4 ± 14.6 16.8 ± 14.2 -4.6 ± 3.2 p < 0.001 ESR, mm/h Usual care 240 20.3 ± 13.6 17.1 ± 13.5 -3.2 ± 3.2 p < 0.001 In-hospital sleep-quality score Integrated programme 120 9.8 ± 3.8 7.5 ± 4.1 -2.4 ± 1.4 p < 0.001 In-hospital sleep-quality score Usual care 240 10.2 ± 3.8 8.6 ± 3.9 -1.7 ± 1.3 p < 0.001 Data are presented as mean ± standard deviation. Changes are calculated as discharge minus baseline. The repeated p values within paired rows represent a single between-group comparison of change for each endpoint. SGRQ, St George’s Respiratory Questionnaire; SAS, Zung Self-rating Anxiety Scale; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate. Data are presented as median (interquartile range) for time to symptom relief and number (percentage) of patients achieving prespecified early relief thresholds. Early relief was defined as symptom improvement within 7 days for cough and sputum production, and within 14 days for dyspnoea. “—” indicates not applicable. Primary in-hospital outcomes From admission to discharge, the integrated care group showed significantly greater improvements in all primary endpoints: • PaCO₂: adjusted β − 0.98 mmHg (95% CI − 1.21 to − 0.75; P < 0.001) • FEV₁% predicted: adjusted β 2.35 percentage points (95% CI 1.53 to 3.17; P < 0.001) • CT abnormality extent: adjusted β − 0.55 percentage points (95% CI − 0.87 to − 0.24; P < 0.001) IPTW analyses confirmed consistent results (Supplementary Tables S2–S3). Secondary in-hospital outcomes Integrated care was associated with larger improvements in all secondary metrics (all P < 0.001): • SGRQ: adjusted β − 3.66 (95% CI − 4.79 to − 2.53) • SAS: adjusted β − 2.51 (95% CI − 3.18 to − 1.84) • 15-minute walking distance: adjusted β 34.02 m (95% CI 25.82 to 42.21) • CRP: adjusted β − 0.98 mg/L (95% CI − 1.36 to − 0.60) • ESR: adjusted β − 1.35 mm/h (95% CI − 2.06 to − 0.63) • Sleep-quality score: adjusted β − 0.66 (95% CI − 0.98 to − 0.35) Early symptom relief Integrated care was associated with higher odds of sputum relief within 7 days (adjusted OR 1.62, 95% CI 1.03 to 2.55; P = 0.037). Differences in cough relief (P = 0.541) and dyspnea relief (P = 0.496) were not significant (Table 4 ). Table 4 Time to symptom relief and early relief proportions Endpoint Group n Median (IQR), days Early relief ≤ 7 days, n (%) Early relief ≤ 14 days, n (%) Time to cough relief, days Integrated programme 120 10.0 (6.0–16.0) 46 (38.3%) — Time to cough relief, days Usual care 240 11.0 (6.0–17.0) 85 (35.4%) — Time to sputum relief, days Integrated programme 120 7.0 (4.0–11.2) 62 (51.7%) — Time to sputum relief, days Usual care 240 9.0 (5.0–14.0) 97 (40.4%) — Time to dyspnoea relief, days Integrated programme 120 13.0 (7.0–18.0) — 67 (55.8%) Time to dyspnoea relief, days Usual care 240 14.0 (7.0–20.0) — 126 (52.5%) Data are presented as median (interquartile range) for time to symptom relief and number (percentage) of patients achieving early relief within the indicated thresholds. The composite early clinical benefit score was calculated as the sum of three prespecified early symptom-relief domains: cough relief within 7 days, sputum relief within 7 days, and dyspnoea relief within 14 days. One point was assigned for each domain, yielding a total score ranging from 0 to 3. Higher scores indicate broader early symptomatic benefit. This investigator-defined composite should be interpreted as exploratory. Composite early clinical benefit and subgroup analyses Integrated care increased the likelihood of composite early clinical benefit score ≥ 2 (adjusted OR 1.91, 95% CI 1.21 to 3.01; P = 0.006; Table 5 ). Exploratory subgroup analyses showed consistent benefit across most subgroups, with numerically larger effects in patients < 65 years, women, non-smokers, and those with COPD; no significant heterogeneity was observed (Fig. 2 ). Table 5 Distribution of composite early clinical benefit scores Group Composite score n (%) Integrated programme 0 16 (13.3%) Integrated programme 1 42 (35.0%) Integrated programme 2 53 (44.2%) Integrated programme 3 9 (7.5%) Usual care 0 43 (17.9%) Usual care 1 107 (44.6%) Usual care 2 69 (28.7%) Usual care 3 21 (8.8%) Composite early clinical benefit score was calculated as the sum of early relief of cough (≤ 7 days), sputum production (≤ 7 days) and dyspnoea (≤ 14 days), yielding a total score ranging from 0 to 3. This investigator-defined composite should be interpreted as exploratory. Data are presented as mean ± standard deviation or number (percentage), as appropriate. Lower scores indicate lower symptom burden for sleep disturbance and lower treatment burden for anxiolytic/hypnotic and rescue inhaler use. These follow-up data should not be interpreted as a formal adverse-event analysis. DDD, defined daily dose; CT, computed tomography. Six-month outcomes At 6 months, integrated care was associated with: • Lower sleep-quality score: adjusted β − 1.69 (95% CI − 2.04 to − 1.34; P < 0.001) • Fewer anxiolytic/hypnotic uses: adjusted β − 0.84 DDD/week (95% CI − 1.13 to − 0.55; P < 0.001) • Fewer rescue inhaler uses: adjusted β − 0.73 uses/week (95% CI − 1.16 to − 0.31; P < 0.001) Rehospitalization, acute exacerbations, and CT progression were rare and similar between groups (all P > 0.05; Table 6 ). Table 6 Six-month clinical follow-up outcomes Variable Group n Mean ± SD Between-group p Sleep-quality score at 6 months Integrated programme 120 6.0 ± 4.0 p < 0.001 Sleep-quality score at 6 months Usual care 240 8.2 ± 4.0 p < 0.001 Anxiolytic/hypnotic DDD per week at 6 months Integrated programme 120 1.4 ± 1.2 p < 0.001 Anxiolytic/hypnotic DDD per week at 6 months Usual care 240 2.2 ± 1.5 p < 0.001 Rescue inhaler use per week at 6 months Integrated programme 120 2.4 ± 1.9 0.001 Rescue inhaler use per week at 6 months Usual care 240 3.1 ± 2.0 0.001 Rehospitalisation within 6 months Integrated programme 120 14 (11.7%) 1.000 Rehospitalisation within 6 months Usual care 240 28 (11.7%) 1.000 Acute exacerbation within 6 months Integrated programme 120 21 (17.5%) 0.739 Acute exacerbation within 6 months Usual care 240 47 (19.6%) 0.739 CT lesion progression at 6 months Integrated programme 120 21 (17.5%) 0.960 CT lesion progression at 6 months Usual care 240 40 (16.7%) 0.960 Data are presented as mean ± standard deviation or number (percentage) of patients, as appropriate. These data represent clinical follow-up outcomes rather than a dedicated adverse-event dataset. DDD, defined daily dose; CT, computed tomography. Odds ratios for achieving early composite clinical benefit (score ≥ 2) with the integrated programme versus usual care in prespecified patient subgroups. Events/N are shown for each stratum. Subgroup analyses were prespecified and exploratory, no formal statistical tests for interaction were performed, and the findings should be considered hypothesis-generating only. CI, confidence interval; COPD, chronic obstructive pulmonary disease; OSAHS, obstructive sleep apnoea-hypopnoea syndrome. Sensitivity analyses IPTW sensitivity analyses replicated all primary and secondary findings. The composite benefit score remained significant (IPTW OR 1.71, P = 0.018); sputum relief was directionally consistent but no longer significant (IPTW OR 1.46, P = 0.094). Discussion In this prospective, single-centre controlled cohort study of hospitalised patients with chronic lung disease and post-COVID syndrome, an integrated management model combining optimised pharmacotherapy, structured psychological care, and pulmonary rehabilitation was associated with broader short-term clinical improvement than usual care. In adjusted analyses, integrated management was associated with better gas exchange, lung function, radiological outcomes, quality of life, anxiety, functional capacity, and inflammatory markers, as well as a higher likelihood of achieving composite early clinical benefit. Improvements in sleep quality and reduced symptom-related medication use were also observed at 6 months, whereas rehospitalisation and other medium-term clinical outcomes were similar between groups. These findings are consistent with previous post-COVID rehabilitation studies demonstrating improvements in exercise capacity, dyspnoea, symptom burden, and quality of life, and highlighting the importance of integrating physical and mental health support [ 7 , 9 , 10 , 11 , 12 , 13 , 25 , 26 ] . The present study extends this evidence to a high-risk population with underlying chronic lung disease, in whom recovery is typically more complex and may benefit from a multidisciplinary management approach. The intervention was delivered as a bundled multidisciplinary pathway, and the relative contribution of individual components cannot be determined. However, the overall pattern of benefit is consistent with improved disease control, ventilatory efficiency, physical conditioning, and treatment engagement, together with reduced psychological symptom amplification . An important implication is that post-COVID rehabilitation in patients with chronic respiratory disease should not be viewed as exercise alone. In routine practice, patients often present with overlapping physiological impairment, persistent symptoms, sleep disturbance, and psychological burden. A ward-based integrated model may therefore be more clinically relevant than isolated rehabilitation interventions, particularly in settings with limited outpatient rehabilitation resources. The lower use of anxiolytic or hypnotic medication and rescue inhalers at six months suggests a sustained reduction in symptom-related treatment burden beyond the acute phase [ 24 , 37 , 38 , 39 ] . The radiological findings should be interpreted cautiously. Short-term reductions in CT-assessed abnormality extent are more likely to reflect partial resolution of inflammatory or organising abnormalities rather than reversal of established fibrosis [ 27 , 28 , 29 ] . Medium-term outcomes further support this interpretation. Rehospitalisation, exacerbations, and CT progression were uncommon and similar between groups, suggesting that the primary benefit of the integrated programme lies in improving symptom burden, patient-reported outcomes, and supportive medication use rather than reducing hard clinical endpoints within the available follow-up. This is clinically relevant, as persistent symptoms and reduced functional capacity are key drivers of morbidity in this population. From an implementation perspective, the ward-based delivery model is a strength, as it integrates rehabilitation into routine care and may improve feasibility in settings with limited outpatient infrastructure. This approach is aligned with current recommendations supporting flexible and individualised pulmonary rehabilitation pathways in chronic respiratory disease, including post-COVID conditions [ 32 , 33 , 34 , 35 , 36 ] . Several limitations should be acknowledged. First, the non-randomized design introduces potential residual confounding despite multivariable adjustment and IPTW analysis, and calendar-time effects cannot be excluded. Second, intervention fidelity and adherence were not fully quantified. Third, the heterogeneous chronic lung disease population may limit disease-specific interpretation. Fourth, the composite early clinical benefit score was exploratory, and the 15-minute walking test is less widely used than the 6-minute walk test in pulmonary rehabilitation research. Despite these limitations, this study provides prospective evidence that a structured multidisciplinary management pathway may improve short-term recovery in hospitalised patients with chronic lung disease and post-COVID syndrome. The consistency of findings across adjusted and IPTW analyses supports the robustness of the results. Future multicentre studies with more rigorous designs and longer follow-up are needed to confirm these findings and to clarify the contribution of individual components of integrated care. Conclusions In patients with CLD and post-COVID syndrome, the integrated management programme was associated with broader and more consistent short-term clinical benefit than usual care based mainly on pharmacological treatment. In addition to improving gas exchange, lung function, short-term evolution of residual radiological abnormalities, quality of life, anxiety, functional capacity, inflammation, and sleep, the programme was associated with a higher likelihood of achieving composite early clinical benefit and with lower symptom-related treatment burden at follow-up, while medium-term clinical follow-up outcomes were similar between groups. These findings suggest that structured multidisciplinary care may be a useful management approach for selected high-risk respiratory patients with post-COVID conditions and warrant confirmation in larger multicentre studies. Declarations Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of Zigong Fourth People’s Hospital (approval number: EC-2025-101). Written informed consent was obtained from all participants prior to enrolment. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Zigong Key Science and Technology Plan (Collaborative Innovation Project of Zigong Academy of Medical Sciences), 2024 (No. 2024-YKY-03-07). Authors’ contributions Aibo Zheng and Kai Sun conceived and designed the study. Wenjun Li, Yan Jin, and Zhiyu Chen collected the data. Aibo Zheng and Shengjun Ma performed the statistical analysis. Aibo Zheng and Kai Sun drafted the manuscript. Feizhong Gong, Xin Ming, and Juan Pen delivered the psychological intervention and completed the relevant psychological assessments. All authors critically revised the manuscript, read and approved the final manuscript, and agreed to its submission for publication. Acknowledgements The authors thank all patients and their families for their participation. The authors also thank the multidisciplinary clinical team of Zigong Fourth People’s Hospital for their support in delivering the integrated management programme. References Nopp S, Moik F, Klok FA et al (2022) Outpatient pulmonary rehabilitation in patients with long COVID improves exercise capacity, functional status, dyspnea, fatigue, and quality of life. 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Front Rehabil Sci 2:710410. https://doi.org/10.3389/fresc.2021.710410 Harenwall S, Heywood-Everett S, Henderson R et al (2021) Post-COVID-19 syndrome: improvements in health-related quality of life following psychology-led interdisciplinary virtual rehabilitation. J Prim Care Community Health 12:21501319211067674. https://doi.org/10.1177/21501319211067674 Hawke LD, Rice DB, Sheikh-Mohamed S et al (2024) Systematic review of interventions for mental health, cognition and psychological well-being in long COVID. BMJ Ment Health 27(1):e301133. https://doi.org/10.1136/bmjment-2024-301133 Zeraatkar M et al (2024) Interventions for the management of long COVID (post-COVID condition): living systematic review. BMJ 387:e081318. https://doi.org/10.1136/bmj-2024-081318 Egger M, Wimmer C, Stummer S et al (2024) Reduced health-related quality of life, fatigue, anxiety and depression affect COVID-19 patients in the long-term after chronic critical illness. Sci Rep 14(1):3016. https://doi.org/10.1038/s41598-024-52908-5 Abramoff BA, Dillingham TR, Brown LA et al (2023) Psychological and cognitive functioning among patients receiving outpatient rehabilitation for post-COVID sequelae: an observational study. Arch Phys Med Rehabil 104(1):11–17. https://doi.org/10.1016/j.apmr.2022.09.013 Visca D et al (2023) Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease. Int J Tuberc Lung Dis 27(10):729–741. https://doi.org/10.5588/ijtld.23.0248 Kewalramani N, Heenan KM, McKeegan D et al (2023) Post-COVID interstitial lung disease—the tip of the iceberg. Immunol Allergy Clin North Am 43(2):389–410. https://doi.org/10.1016/j.iac.2023.01.004 Johnston J, Dorrian D, Linden D et al (2023) Pulmonary sequelae of COVID-19: focus on interstitial lung disease. Cells 12(18):2238. https://doi.org/10.3390/cells12182238 Barash M, Ramalingam V (2023) Post-COVID interstitial lung disease and other lung sequelae. Clin Chest Med 44(2):263–277. https://doi.org/10.1016/j.ccm.2022.11.019 Vasarmidi E, Ghanem M, Crestani B (2022) Interstitial lung disease following coronavirus disease 2019. Curr Opin Pulm Med 28(5):399–406. https://doi.org/10.1097/MCP.0000000000000900 Fesu D, Polivka L, Barczi E et al (2023) Post-COVID interstitial lung disease in symptomatic patients after COVID-19 disease. Inflammopharmacology 31(2):565–571. https://doi.org/10.1007/s10787-023-01191-3 Cha MJ, Solomon JJ, Lee JE et al (2024) Chronic lung injury after COVID-19 pneumonia: clinical, radiologic, and histopathologic perspectives. Radiology 310(1):e231643. https://doi.org/10.1148/radiol.231643 Rochester CL, Alison JA, Carlin B et al (2023) Pulmonary rehabilitation for adults with chronic respiratory disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med 208(4):e7–e26. https://doi.org/10.1164/rccm.202306-1066ST Jenkins AR, Cox NS, Tappan RS et al (2024) Summary for clinicians: clinical practice guideline on pulmonary rehabilitation for adults with chronic respiratory disease. Ann Am Thorac Soc 21(4):533–537. https://doi.org/10.1513/AnnalsATS.202310-909CME Ries AL, Bauldoff GS, Carlin BW et al (2007) Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest 131(5 Suppl). https://doi.org/10.1378/chest.06-2418 . :4S-42S Ries AL (2008) Pulmonary rehabilitation: summary of an evidence-based guideline. Respir Care 53(9):1203–1207 Garvey C, Bayles MP, Hamm LF et al (2016) Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease: review of selected guidelines. J Cardiopulm Rehabil Prev 36(2):75–83. https://doi.org/10.1097/HCR.0000000000000171 Lamberton CE, Mosher CL (2024) Review of the evidence for pulmonary rehabilitation in COPD: clinical benefits and cost-effectiveness. Respir Care 69(6):686–696. https://doi.org/10.4187/respcare.11541 Corhay JL, Nguyen Dang D, Van Cauwenberge H et al (2014) Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy. Int J Chron Obstruct Pulmon Dis 9:27–39. https://doi.org/10.2147/COPD.S52012 Evans RA (2024) The rationale, evidence, and adaptations to pulmonary rehabilitation for chronic respiratory diseases other than COPD. Respir Care 69(6):697–712. https://doi.org/10.4187/respcare.12089 Menson KE, Dowman L (2024) Pulmonary rehabilitation for diseases other than COPD. J Cardiopulm Rehabil Prev 44(6):425–431. https://doi.org/10.1097/HCR.0000000000000915 Reina-Gutiérrez S, Torres-Costoso A, Martínez-Vizcaíno V et al (2021) Effectiveness of pulmonary rehabilitation in interstitial lung disease, including coronavirus diseases: a systematic review and meta-analysis. Arch Phys Med Rehabil 102(10):1989–1997e3. https://doi.org/10.1016/j.apmr.2021.03.035 Tsutsui M, Gerayeli F, Sin DD (2021) Pulmonary rehabilitation in a post-COVID-19 world: telerehabilitation as a new standard in patients with COPD. Int J Chron Obstruct Pulmon Dis 16:379–391. https://doi.org/10.2147/COPD.S263031 Additional Declarations No competing interests reported. Supplementary Files SupplementaryTablesS1S3.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 12 May, 2026 Reviews received at journal 12 May, 2026 Reviews received at journal 04 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviewers invited by journal 28 Apr, 2026 Editor assigned by journal 27 Apr, 2026 Submission checks completed at journal 27 Apr, 2026 First submitted to journal 23 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9505042\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":634357241,\"identity\":\"734a123a-3a98-4f3b-81fc-ef1c54f63db0\",\"order_by\":0,\"name\":\"Aibo Zheng\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYBACxobznx9IVLDJ2bc3EKmFufGAmYHFGT5jA54DRGphbz5gIFHZIpdoIJFApBbetgMJBjcbzBLMJR9vvMFQYxNNUItkz4EDD2fuSMuznJ1WbMFwLC23gZAWwxkHG4wlzxwrZridYybB2HCYsBb7+48ZpP+2/U9suHmGSC2MDccYJCTb2BI33OAhWssZNgOJM2zGkj1AvyQQ4xegFmZwVPKzH95440ONDWEtyID4qEHSQqqOUTAKRsEoGBkAAAJ7RV8orq1DAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Zigong Fourth People’s Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Aibo\",\"middleName\":\"\",\"lastName\":\"Zheng\",\"suffix\":\"\"},{\"id\":634357242,\"identity\":\"63c0347b-d9ae-41c0-83ac-ba2b55b9316a\",\"order_by\":1,\"name\":\"Kai Sun²\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Zigong Fourth People’s Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kai\",\"middleName\":\"\",\"lastName\":\"Sun²\",\"suffix\":\"\"},{\"id\":634357243,\"identity\":\"87aa52bf-10f2-4ff9-806c-8255a0d3daf2\",\"order_by\":2,\"name\":\"Shengjun Ma²\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Zigong Fourth People’s Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shengjun\",\"middleName\":\"\",\"lastName\":\"Ma²\",\"suffix\":\"\"},{\"id\":634357244,\"identity\":\"70e14690-072f-4e64-9e96-ba80528e83b4\",\"order_by\":3,\"name\":\"Yan Jin²\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Zigong Fourth People’s Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yan\",\"middleName\":\"\",\"lastName\":\"Jin²\",\"suffix\":\"\"},{\"id\":634357245,\"identity\":\"8e96a92b-d6ff-4176-9103-d368e036cbf5\",\"order_by\":4,\"name\":\"Wenjun Li²\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Zigong Fourth People’s Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Wenjun\",\"middleName\":\"\",\"lastName\":\"Li²\",\"suffix\":\"\"},{\"id\":634357246,\"identity\":\"e1d2849c-a82e-410c-912b-ab7c764859f2\",\"order_by\":5,\"name\":\"Zhiyu Chen²\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Zigong Fourth People’s Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zhiyu\",\"middleName\":\"\",\"lastName\":\"Chen²\",\"suffix\":\"\"},{\"id\":634357247,\"identity\":\"7a4667a9-fcaf-4175-bea5-dbc47942c4c4\",\"order_by\":6,\"name\":\"Feizhong Gong³\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Zigong Fourth People’s Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Feizhong\",\"middleName\":\"\",\"lastName\":\"Gong³\",\"suffix\":\"\"},{\"id\":634357248,\"identity\":\"1c0a1897-f16e-4057-8d31-f3c8c40e6ac8\",\"order_by\":7,\"name\":\"Juan Pen²\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Zigong Fourth People’s Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Juan\",\"middleName\":\"\",\"lastName\":\"Pen²\",\"suffix\":\"\"},{\"id\":634357249,\"identity\":\"8bf0cc16-6848-4b21-b5c9-e027cb8691dc\",\"order_by\":8,\"name\":\"Xin Ming²\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Zigong Fourth People’s Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xin\",\"middleName\":\"\",\"lastName\":\"Ming²\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-04-23 09:41:07\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-9505042/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9505042/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":108978309,\"identity\":\"65f82328-edca-413f-b7e1-dfd84239a05f\",\"added_by\":\"auto\",\"created_at\":\"2026-05-11 11:36:06\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":65106,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eStudy flow diagram of patient screening, allocation, follow-up, and analysis\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9505042/v1/f59c28ae0a73f3f655c0c31e.png\"},{\"id\":108950243,\"identity\":\"3aa40acf-4ca3-4598-97ed-b6d7139cce89\",\"added_by\":\"auto\",\"created_at\":\"2026-05-11 07:04:33\",\"extension\":\"jpeg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":819811,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSubgroup analysis of the effect of the integrated programme on early composite clinical benefit (score ≥2). Odds ratios (ORs) and 95% confidence intervals (CIs) are shown for the overall population and prespecified subgroups. Values to the right of 1.0 favour the integrated programme. Subgroup analyses were exploratory, and no formal tests for interaction were performed.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9505042/v1/f2d3f00444d86869b6979b60.jpeg\"},{\"id\":108977611,\"identity\":\"32aaa8ef-333e-4238-ba73-d03fae269cc2\",\"added_by\":\"auto\",\"created_at\":\"2026-05-11 11:32:18\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":126654,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDistribution of composite early clinical benefit scores in the integrated management and usual-care groups. Stacked bars show the percentage of patients with scores of 0, 1, 2, or 3. Higher scores indicate broader early symptomatic improvement across prespecified respiratory domains.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9505042/v1/e1c43f3fb862dcf89cc0b36b.png\"},{\"id\":108979875,\"identity\":\"971bfcdb-3d1e-4285-87aa-3a7078bb6f27\",\"added_by\":\"auto\",\"created_at\":\"2026-05-11 12:02:10\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1451847,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9505042/v1/653234b3-fb9e-48ee-b579-d2387355e1d0.pdf\"},{\"id\":108950241,\"identity\":\"d8b0e10d-5696-4449-9c15-6ece1a8bca48\",\"added_by\":\"auto\",\"created_at\":\"2026-05-11 07:04:33\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":61320,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryTablesS1S3.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9505042/v1/825da555ab1099fa692d2172.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"A multidisciplinary pulmonary rehabilitation pathway for hospitalized patients with chronic lung disease and post-COVID syndrome: a prospective controlled cohort study\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eSurvivors of COVID-19 often experience persistent respiratory symptoms, impaired physical function, poor quality of life, sleep disturbance, and psychological distress. These issues are especially severe in patients with pre-existing chronic lung disease (CLD), in whom post-COVID manifestations are superimposed on underlying airway or parenchymal abnormalities \\u003csup\\u003e[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]\\u003c/sup\\u003e. Current clinical care remains largely pharmacological, with insufficient attention to physical deconditioning and psychological needs, despite the multidimensional nature of post-COVID recovery in CLD \\u003csup\\u003e[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]\\u003c/sup\\u003e.Many hospitalised COVID-19 survivors develop persistent interstitial abnormalities, which further complicate management in those with pre-existing CLD. Routine pharmacological care fails to address these complex impairments comprehensively \\u003csup\\u003e[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003ePulmonary rehabilitation is well established in chronic respiratory disease and improves exercise capacity, dyspnoea, and quality of life, with emerging benefits in post-COVID populations \\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/sup\\u003e. A recent meta-analysis of 37 randomized controlled trials confirmed that pulmonary rehabilitation significantly enhances physical capacity, lung function, quality of life, fatigue, and anxiety in long COVID, with optimal effects seen in 4\\u0026ndash;8-week multicomponent programs \\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e. Usual care alone leads to incomplete recovery, and rehabilitation provides additive benefits for physical function and mental health \\u003csup\\u003e[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e. Combined physical and psychological support further improves patient-reported outcomes \\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eWe therefore evaluated a ward-based multidisciplinary pulmonary rehabilitation pathway integrating guideline-based pharmacotherapy, structured psychological support, and protocolized rehabilitation in hospitalized patients with CLD and post-COVID syndrome. We hypothesized that this integrated approach would yield broader short-term improvements across physiological, functional, and patient-reported domains, and lower symptom-related treatment burden during follow-up, compared with usual care. A prospective controlled cohort study was conducted to investigate this multidisciplinary strategy in a high-risk post-COVID respiratory population \\u003csup\\u003e[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eStudy design and setting\\u003c/p\\u003e \\u003cp\\u003eThis prospective, single-centre controlled cohort study was conducted in the Department of Respiratory and Critical Care Medicine at Zigong Fourth People\\u0026rsquo;s Hospital, a tertiary public hospital in Zigong, Sichuan Province, China. The study was carried out within the framework of a municipal key science and technology project on integrated management for patients with chronic lung disease and post-COVID syndrome. Eligible patients were consecutively recruited during hospitalisation and were followed from admission to discharge, with outpatient follow-up planned at approximately six months after discharge. The study protocol was approved by the Ethics Committee of Zigong Fourth People\\u0026rsquo;s Hospital (approval number: EC-2025-101). Written informed consent was obtained from all participants prior to enrolment.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eParticipants\\u003c/h2\\u003e \\u003cp\\u003eEligible participants were adults aged 18 years or older who were admitted to the respiratory department with underlying CLD and persistent symptoms following COVID-19. CLD was defined as physician-diagnosed chronic obstructive pulmonary disease, asthma, bronchiectasis, interstitial lung disease, or other chronic structural lung disorders. All participants had a documented history of SARS-CoV-2 infection at least 12 weeks before the index admission, persistent respiratory or systemic symptoms consistent with post-COVID syndrome, and residual parenchymal abnormalities on chest computed tomography. Exclusion criteria included active malignancy or tuberculosis, unstable cardiovascular disease, severe hepatic or renal dysfunction, severe psychiatric illness requiring intensive specialist management, pregnancy or breastfeeding, and any other condition considered likely to interfere with treatment adherence or study participation.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eGroup allocation and masking\\u003c/h3\\u003e\\n\\u003cp\\u003eParticipants were allocated to the integrated or usual-care group according to clinical pathway availability. Blinding of patients and clinicians was not feasible; however, radiologists, technicians, and data analysts were blinded where possible. As allocation was non-random, analyses were interpreted as adjusted associations rather than causal effects.\\u003c/p\\u003e\\n\\u003ch3\\u003eCT assessment\\u003c/h3\\u003e\\n\\u003cp\\u003eCT-assessed fibrotic extent was evaluated on high-resolution CT by two blinded radiologists using a semi-quantitative method. Fibrotic extent was defined as the percentage of lung parenchyma showing reticulation, parenchymal bands, traction bronchiectasis, or architectural distortion. Discrepancies were resolved by consensus, and inter-reader agreement was assessed.\\u003c/p\\u003e\\n\\u003ch3\\u003eInterventions\\u003c/h3\\u003e\\n\\u003cp\\u003eUsual-care participants received standard pharmacological and supportive care per national and international guidelines for chronic lung disease and post-COVID respiratory symptoms, including inhaled bronchodilators, inhaled or systemic corticosteroids, mucolytics, antimicrobials (for suspected infection), oxygen therapy, and routine supportive measures.\\u003c/p\\u003e \\u003cp\\u003eIntegrated-management participants received identical guideline-based pharmacotherapy plus a bundled multidisciplinary intervention: pharmacotherapy optimisation (tailored to CLD phenotype and post-COVID manifestations, with selective antifibrotics for persistent interstitial abnormalities), structured psychological care, and ward-based pulmonary rehabilitation. Psychological care was delivered 2\\u0026ndash;3 times weekly by psychosomatic specialists (20\\u0026ndash;30 minutes/session), focusing on supportive counselling, anxiety management, sleep hygiene, and relaxation training. Ward-based pulmonary rehabilitation was provided 1\\u0026ndash;2 times daily (15\\u0026ndash;30 minutes/session) based on clinical stability and tolerance, with exercise intensity individualised to symptoms, oxygenation, haemodynamics, and perceived exertion. The program followed core pulmonary rehabilitation principles (individualised aerobic/resistance exercise, breathing retraining, education, self-management, psychosocial support) adapted for mixed CLD populations per clinical guidelines and literature \\u003csup\\u003e[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e. The integrated intervention was a bundled multidisciplinary pathway; the study was not designed to isolate effects of individual components.\\u003c/p\\u003e\\n\\u003ch3\\u003eOutcome measures\\u003c/h3\\u003e\\n\\u003cp\\u003eThe primary outcomes were changes from baseline to discharge in arterial carbon dioxide tension (PaCO₂), forced expiratory volume in one second as a percentage of the predicted value (FEV₁% predicted), and CT-assessed fibrotic extent. Secondary in-hospital outcomes included changes in St George\\u0026rsquo;s Respiratory Questionnaire (SGRQ) score, Zung Self-rating Anxiety Scale (SAS) score, 15-minute walking distance, inflammatory markers, including C-reactive protein and erythrocyte sedimentation rate, and sleep-quality score. Daily ward assessments were used to determine time to relief of cough, sputum production, and dyspnoea, and to derive a composite early clinical benefit score (0\\u0026ndash;3) based on prespecified symptom-relief thresholds. The composite early clinical benefit score was prespecified by the investigators to summarise early multidomain symptom recovery, but it was not a formally validated external endpoint and should therefore be regarded as exploratory.\\u003c/p\\u003e \\u003cp\\u003eSix-month outcomes included rehospitalisation, acute exacerbations of chronic lung disease, progression of CT abnormalities, sleep quality, use of anxiolytic or hypnotic medication, and rescue inhaler use. These follow-up outcomes were not intended to constitute a formal treatment-emergent adverse-event analysis. Functional capacity was assessed using a supervised 15-minute walking test performed according to a standardised ward protocol. Because this test is less widely used than the 6-minute walk test in the pulmonary rehabilitation literature, its findings should be interpreted primarily as an internal comparative measure within this cohort.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eContinuous variables are presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation or median (interquartile range), and categorical variables as counts and percentages. Between-group comparisons were performed using appropriate parametric or non-parametric tests.Adjusted between-group differences were estimated using multivariable linear and logistic regression models, with prespecified adjustment for baseline covariates. Inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis. Covariate balance is reported using standardized mean differences.Analyses were conducted using R (version 4.3.2). A two-sided P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 was considered statistically significant.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePatient flow and baseline characteristics\\u003c/h2\\u003e \\u003cp\\u003eBetween October 2024 and October 2025, 360 eligible inpatients were enrolled (120 integrated care, 240 usual care). Six-month follow-up loss was low and balanced between groups. Baseline characteristics were generally comparable (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e); small residual imbalances were adjusted for in multivariable and IPTW analyses (Supplementary Table \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ea. Baseline characteristics (continuous variables)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariable\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge, years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e65.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e65.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.718\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBody mass index, kg/m\\u0026sup2;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.055\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e\\u003cem\\u003eData are presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation. BMI, body mass index.\\u003c/em\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eb. Baseline characteristics (categorical variables)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariable\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex: Female\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e61 (50.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e104 (43.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.217\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex: Male\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e59 (49.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e136 (56.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.217\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSmoking status: Non-smoker\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e71 (59.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e158 (65.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.261\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSmoking status: Current/former smoker\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e49 (40.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e82 (34.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.261\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLong-term respiratory medication: No\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e62 (51.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e121 (50.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.911\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLong-term respiratory medication: Yes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e58 (48.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e119 (49.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.911\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eObstructive sleep apnoea\\u0026ndash;hypopnoea: No\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e92 (76.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e196 (81.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.328\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eObstructive sleep apnoea\\u0026ndash;hypopnoea: Yes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e28 (23.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e44 (18.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.328\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGut dysbiosis: No\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e82 (68.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e170 (70.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.714\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGut dysbiosis: Yes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e38 (31.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e70 (29.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.714\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUnderlying chronic lung disease: COPD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e45 (37.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e94 (39.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.848\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUnderlying chronic lung disease: Asthma\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e27 (22.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e51 (21.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.892\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUnderlying chronic lung disease: Bronchiectasis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19 (15.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e42 (17.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.804\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUnderlying chronic lung disease: Interstitial lung disease/other ILD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e29 (24.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e53 (22.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.756\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e\\u003cem\\u003eData are presented as number (percentage) of patients unless otherwise indicated. COPD, chronic obstructive pulmonary disease; ILD, interstitial lung disease; OSAHS, obstructive sleep apnoea\\u0026ndash;hypopnoea syndrome.\\u003c/em\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePrimary in-hospital outcomes\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariable\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eBaseline mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eDischarge mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eChange mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eBetween-group p value\\u003c/p\\u003e \\u003cp\\u003e(change)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePaCO₂, mmHg\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e42.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e40.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-2.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePaCO₂, mmHg\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e42.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e40.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-1.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFEV₁% predicted\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e69.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e76.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e6.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFEV₁% predicted\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e69.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;17.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e73.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCT fibrotic extent, % of lung\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-2.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.003\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCT fibrotic extent, % of lung\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-1.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.003\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003eData are presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation. Changes are calculated as discharge minus baseline. The repeated p values within paired rows represent a single between-group comparison of change for each endpoint. PaCO₂, arterial partial pressure of carbon dioxide; FEV₁, forced expiratory volume in 1 second; CT, computed tomography.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSecondary in-hospital outcomes\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariable\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eBaseline mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eDischarge mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eChange mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eBetween-group p value\\u003c/p\\u003e \\u003cp\\u003e(change)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSGRQ total score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e47.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;17.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e37.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;15.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-9.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSGRQ total score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e46.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;17.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e40.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;18.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-6.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSAS anxiety score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e55.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e48.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-7.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSAS anxiety score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e56.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e51.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-4.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e15-min walking distance, m\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e673.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;143.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e755.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;149.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e81.9\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;38.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e15-min walking distance, m\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e687.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;136.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e736.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;142.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e48.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;33.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCRP, mg/L\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-2.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCRP, mg/L\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-1.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eESR, mm/h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e21.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-4.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eESR, mm/h\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-3.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIn-hospital sleep-quality score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-2.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIn-hospital sleep-quality score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8.6\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\"\\u0026plusmn;\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-1.7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003eData are presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation. Changes are calculated as discharge minus baseline. The repeated p values within paired rows represent a single between-group comparison of change for each endpoint. SGRQ, St George\\u0026rsquo;s Respiratory Questionnaire; SAS, Zung Self-rating Anxiety Scale; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003eData are presented as median (interquartile range) for time to symptom relief and number (percentage) of patients achieving prespecified early relief thresholds. Early relief was defined as symptom improvement within 7 days for cough and sputum production, and within 14 days for dyspnoea. \\u0026ldquo;\\u0026mdash;\\u0026rdquo; indicates not applicable.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePrimary in-hospital outcomes\\u003c/h2\\u003e \\u003cp\\u003eFrom admission to discharge, the integrated care group showed significantly greater improvements in all primary endpoints:\\u003c/p\\u003e \\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; PaCO₂: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;0.98 mmHg (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;1.21 to \\u0026minus;\\u0026thinsp;0.75; P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; FEV₁% predicted: adjusted β 2.35 percentage points (95% CI 1.53 to 3.17; P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; CT abnormality extent: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;0.55 percentage points (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;0.87 to \\u0026minus;\\u0026thinsp;0.24; P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001)\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003c/p\\u003e \\u003cp\\u003eIPTW analyses confirmed consistent results (Supplementary Tables S2\\u0026ndash;S3).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSecondary in-hospital outcomes\\u003c/h2\\u003e \\u003cp\\u003eIntegrated care was associated with larger improvements in all secondary metrics (all P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001):\\u003c/p\\u003e \\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; SGRQ: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;3.66 (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;4.79 to \\u0026minus;\\u0026thinsp;2.53)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; SAS: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.51 (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;3.18 to \\u0026minus;\\u0026thinsp;1.84)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; 15-minute walking distance: adjusted β 34.02 m (95% CI 25.82 to 42.21)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; CRP: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;0.98 mg/L (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;1.36 to \\u0026minus;\\u0026thinsp;0.60)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; ESR: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;1.35 mm/h (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.06 to \\u0026minus;\\u0026thinsp;0.63)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; Sleep-quality score: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;0.66 (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;0.98 to \\u0026minus;\\u0026thinsp;0.35)\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eEarly symptom relief\\u003c/h2\\u003e \\u003cp\\u003eIntegrated care was associated with higher odds of sputum relief within 7 days (adjusted OR 1.62, 95% CI 1.03 to 2.55; P\\u0026thinsp;=\\u0026thinsp;0.037). Differences in cough relief (P\\u0026thinsp;=\\u0026thinsp;0.541) and dyspnea relief (P\\u0026thinsp;=\\u0026thinsp;0.496) were not significant (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eTime to symptom relief and early relief proportions\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEndpoint\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMedian\\u003c/p\\u003e \\u003cp\\u003e(IQR), days\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eEarly relief\\u0026thinsp;\\u0026le;\\u0026thinsp;7 days, n\\u003c/p\\u003e \\u003cp\\u003e(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eEarly relief\\u0026thinsp;\\u0026le;\\u0026thinsp;14 days, n\\u003c/p\\u003e \\u003cp\\u003e(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTime to cough relief, days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.0 (6.0\\u0026ndash;16.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e46 (38.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026mdash;\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTime to cough relief, days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11.0 (6.0\\u0026ndash;17.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e85 (35.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026mdash;\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTime to sputum relief, days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.0 (4.0\\u0026ndash;11.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e62 (51.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026mdash;\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTime to sputum relief, days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.0 (5.0\\u0026ndash;14.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e97 (40.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026mdash;\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTime to dyspnoea relief, days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13.0 (7.0\\u0026ndash;18.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026mdash;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e67 (55.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTime to dyspnoea relief, days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14.0 (7.0\\u0026ndash;20.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026mdash;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e126 (52.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003eData are presented as median (interquartile range) for time to symptom relief and number (percentage) of patients achieving early relief within the indicated thresholds.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003eThe composite early clinical benefit score was calculated as the sum of three prespecified early symptom-relief domains: cough relief within 7 days, sputum relief within 7 days, and dyspnoea relief within 14 days. One point was assigned for each domain, yielding a total score ranging from 0 to 3. Higher scores indicate broader early symptomatic benefit. This investigator-defined composite should be interpreted as exploratory.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eComposite early clinical benefit and subgroup analyses\\u003c/h2\\u003e \\u003cp\\u003eIntegrated care increased the likelihood of composite early clinical benefit score\\u0026thinsp;\\u0026ge;\\u0026thinsp;2 (adjusted OR 1.91, 95% CI 1.21 to 3.01; P\\u0026thinsp;=\\u0026thinsp;0.006; Table\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e). Exploratory subgroup analyses showed consistent benefit across most subgroups, with numerically larger effects in patients\\u0026thinsp;\\u0026lt;\\u0026thinsp;65 years, women, non-smokers, and those with COPD; no significant heterogeneity was observed (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDistribution of composite early clinical benefit scores\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eComposite score\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16 (13.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e42 (35.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e53 (44.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9 (7.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e43 (17.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e107 (44.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e69 (28.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21 (8.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"3\\\"\\u003eComposite early clinical benefit score was calculated as the sum of early relief of cough (\\u0026le;\\u0026thinsp;7 days), sputum production (\\u0026le;\\u0026thinsp;7 days) and dyspnoea (\\u0026le;\\u0026thinsp;14 days), yielding a total score ranging from 0 to 3. This investigator-defined composite should be interpreted as exploratory.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"3\\\"\\u003eData are presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation or number (percentage), as appropriate. Lower scores indicate lower symptom burden for sleep disturbance and lower treatment burden for anxiolytic/hypnotic and rescue inhaler use. These follow-up data should not be interpreted as a formal adverse-event analysis. DDD, defined daily dose; CT, computed tomography.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSix-month outcomes\\u003c/h2\\u003e \\u003cp\\u003eAt 6 months, integrated care was associated with:\\u003c/p\\u003e \\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; Lower sleep-quality score: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;1.69 (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;2.04 to \\u0026minus;\\u0026thinsp;1.34; P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; Fewer anxiolytic/hypnotic uses: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;0.84 DDD/week (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;1.13 to \\u0026minus;\\u0026thinsp;0.55; P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001)\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003e\\u0026bull; Fewer rescue inhaler uses: adjusted β\\u0026thinsp;\\u0026minus;\\u0026thinsp;0.73 uses/week (95% CI\\u0026thinsp;\\u0026minus;\\u0026thinsp;1.16 to \\u0026minus;\\u0026thinsp;0.31; P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001)\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003c/p\\u003e \\u003cp\\u003eRehospitalization, acute exacerbations, and CT progression were rare and similar between groups (all P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05; Table\\u0026nbsp;\\u003cspan refid=\\\"Tab7\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab7\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 6\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSix-month clinical follow-up outcomes\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariable\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGroup\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eMean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eBetween-group p\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSleep-quality score at 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.0\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSleep-quality score at 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnxiolytic/hypnotic DDD per week at 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnxiolytic/hypnotic DDD per week at 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRescue inhaler use per week at 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.4\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRescue inhaler use per week at 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRehospitalisation within 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14 (11.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRehospitalisation within 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28 (11.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAcute exacerbation within 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e21 (17.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.739\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAcute exacerbation within 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e47 (19.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.739\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCT lesion progression at 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIntegrated programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e21 (17.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.960\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCT lesion progression at 6 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUsual care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40 (16.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.960\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003eData are presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation or number (percentage) of patients, as appropriate. These data represent clinical follow-up outcomes rather than a dedicated adverse-event dataset. DDD, defined daily dose; CT, computed tomography.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003eOdds ratios for achieving early composite clinical benefit (score\\u0026thinsp;\\u0026ge;\\u0026thinsp;2) with the integrated programme versus usual care in prespecified patient subgroups. Events/N are shown for each stratum. Subgroup analyses were prespecified and exploratory, no formal statistical tests for interaction were performed, and the findings should be considered hypothesis-generating only. CI, confidence interval; COPD, chronic obstructive pulmonary disease; OSAHS, obstructive sleep apnoea-hypopnoea syndrome.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSensitivity analyses\\u003c/h2\\u003e \\u003cp\\u003eIPTW sensitivity analyses replicated all primary and secondary findings. The composite benefit score remained significant (IPTW OR 1.71, P\\u0026thinsp;=\\u0026thinsp;0.018); sputum relief was directionally consistent but no longer significant (IPTW OR 1.46, P\\u0026thinsp;=\\u0026thinsp;0.094).\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this prospective, single-centre controlled cohort study of hospitalised patients with chronic lung disease and post-COVID syndrome, an integrated management model combining optimised pharmacotherapy, structured psychological care, and pulmonary rehabilitation was associated with broader short-term clinical improvement than usual care. In adjusted analyses, integrated management was associated with better gas exchange, lung function, radiological outcomes, quality of life, anxiety, functional capacity, and inflammatory markers, as well as a higher likelihood of achieving composite early clinical benefit. Improvements in sleep quality and reduced symptom-related medication use were also observed at 6 months, whereas rehospitalisation and other medium-term clinical outcomes were similar between groups.\\u003c/p\\u003e \\u003cp\\u003eThese findings are consistent with previous post-COVID rehabilitation studies demonstrating improvements in exercise capacity, dyspnoea, symptom burden, and quality of life, and highlighting the importance of integrating physical and mental health support \\u003csup\\u003e[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e. The present study extends this evidence to a high-risk population with underlying chronic lung disease, in whom recovery is typically more complex and may benefit from a multidisciplinary management approach.\\u003c/p\\u003e \\u003cp\\u003eThe intervention was delivered as a bundled multidisciplinary pathway, and the relative contribution of individual components cannot be determined. However, the overall pattern of benefit is consistent with improved disease control, ventilatory efficiency, physical conditioning, and treatment engagement, together with reduced psychological symptom amplification .\\u003c/p\\u003e \\u003cp\\u003eAn important implication is that post-COVID rehabilitation in patients with chronic respiratory disease should not be viewed as exercise alone. In routine practice, patients often present with overlapping physiological impairment, persistent symptoms, sleep disturbance, and psychological burden. A ward-based integrated model may therefore be more clinically relevant than isolated rehabilitation interventions, particularly in settings with limited outpatient rehabilitation resources. The lower use of anxiolytic or hypnotic medication and rescue inhalers at six months suggests a sustained reduction in symptom-related treatment burden beyond the acute phase \\u003csup\\u003e[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eThe radiological findings should be interpreted cautiously. Short-term reductions in CT-assessed abnormality extent are more likely to reflect partial resolution of inflammatory or organising abnormalities rather than reversal of established fibrosis \\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eMedium-term outcomes further support this interpretation. Rehospitalisation, exacerbations, and CT progression were uncommon and similar between groups, suggesting that the primary benefit of the integrated programme lies in improving symptom burden, patient-reported outcomes, and supportive medication use rather than reducing hard clinical endpoints within the available follow-up. This is clinically relevant, as persistent symptoms and reduced functional capacity are key drivers of morbidity in this population.\\u003c/p\\u003e \\u003cp\\u003eFrom an implementation perspective, the ward-based delivery model is a strength, as it integrates rehabilitation into routine care and may improve feasibility in settings with limited outpatient infrastructure. This approach is aligned with current recommendations supporting flexible and individualised pulmonary rehabilitation pathways in chronic respiratory disease, including post-COVID conditions \\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eSeveral limitations should be acknowledged. First, the non-randomized design introduces potential residual confounding despite multivariable adjustment and IPTW analysis, and calendar-time effects cannot be excluded. Second, intervention fidelity and adherence were not fully quantified. Third, the heterogeneous chronic lung disease population may limit disease-specific interpretation. Fourth, the composite early clinical benefit score was exploratory, and the 15-minute walking test is less widely used than the 6-minute walk test in pulmonary rehabilitation research.\\u003c/p\\u003e \\u003cp\\u003eDespite these limitations, this study provides prospective evidence that a structured multidisciplinary management pathway may improve short-term recovery in hospitalised patients with chronic lung disease and post-COVID syndrome. The consistency of findings across adjusted and IPTW analyses supports the robustness of the results. Future multicentre studies with more rigorous designs and longer follow-up are needed to confirm these findings and to clarify the contribution of individual components of integrated care.\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eIn patients with CLD and post-COVID syndrome, the integrated management programme was associated with broader and more consistent short-term clinical benefit than usual care based mainly on pharmacological treatment. In addition to improving gas exchange, lung function, short-term evolution of residual radiological abnormalities, quality of life, anxiety, functional capacity, inflammation, and sleep, the programme was associated with a higher likelihood of achieving composite early clinical benefit and with lower symptom-related treatment burden at follow-up, while medium-term clinical follow-up outcomes were similar between groups. These findings suggest that structured multidisciplinary care may be a useful management approach for selected high-risk respiratory patients with post-COVID conditions and warrant confirmation in larger multicentre studies.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study protocol was approved by the Ethics Committee of Zigong Fourth People\\u0026rsquo;s Hospital (approval number: EC-2025-101). Written informed consent was obtained from all participants prior to enrolment.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was supported by the Zigong Key Science and Technology Plan (Collaborative Innovation Project of Zigong Academy of Medical Sciences), 2024 (No. 2024-YKY-03-07).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAibo Zheng and Kai Sun conceived and designed the study. Wenjun Li, Yan Jin, and Zhiyu Chen collected the data. Aibo Zheng and Shengjun Ma performed the statistical analysis. Aibo Zheng and Kai Sun drafted the manuscript. Feizhong Gong, Xin Ming, and Juan Pen delivered the psychological intervention and completed the relevant psychological assessments. All authors critically revised the manuscript, read and approved the final manuscript, and agreed to its submission for publication.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors thank all patients and their families for their participation. The authors also thank the multidisciplinary clinical team of Zigong Fourth People\\u0026rsquo;s Hospital for their support in delivering the integrated management programme.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eNopp S, Moik F, Klok FA et al (2022) Outpatient pulmonary rehabilitation in patients with long COVID improves exercise capacity, functional status, dyspnea, fatigue, and quality of life. 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J Cardiopulm Rehabil Prev 36(2):75\\u0026ndash;83. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1097/HCR.0000000000000171\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/HCR.0000000000000171\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLamberton CE, Mosher CL (2024) Review of the evidence for pulmonary rehabilitation in COPD: clinical benefits and cost-effectiveness. Respir Care 69(6):686\\u0026ndash;696. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.4187/respcare.11541\\u003c/span\\u003e\\u003cspan address=\\\"10.4187/respcare.11541\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCorhay JL, Nguyen Dang D, Van Cauwenberge H et al (2014) Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy. Int J Chron Obstruct Pulmon Dis 9:27\\u0026ndash;39. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.2147/COPD.S52012\\u003c/span\\u003e\\u003cspan address=\\\"10.2147/COPD.S52012\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEvans RA (2024) The rationale, evidence, and adaptations to pulmonary rehabilitation for chronic respiratory diseases other than COPD. Respir Care 69(6):697\\u0026ndash;712. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.4187/respcare.12089\\u003c/span\\u003e\\u003cspan address=\\\"10.4187/respcare.12089\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMenson KE, Dowman L (2024) Pulmonary rehabilitation for diseases other than COPD. 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Int J Chron Obstruct Pulmon Dis 16:379\\u0026ndash;391. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.2147/COPD.S263031\\u003c/span\\u003e\\u003cspan address=\\\"10.2147/COPD.S263031\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"the-egyptian-journal-of-bronchology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"\",\"sideBox\":\"Learn more about [The Egyptian Journal of Bronchology](https://ejb.springeropen.com/)\",\"snPcode\":\"43168\",\"submissionUrl\":\"https://submission.nature.com/new-submission/43168/3\",\"title\":\"The Egyptian Journal of Bronchology\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Open\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Post-COVID syndrome, chronic lung disease, pulmonary rehabilitation, multidisciplinary care pathway, psychological support, health-related quality of life, patient-reported outcomes\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9505042/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9505042/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003ePatients with chronic lung disease (CLD) and post-COVID syndrome suffer from multidimensional impairment that is often incompletely addressed by pharmacotherapy alone. We evaluated a ward-based multidisciplinary pathway integrating pharmacotherapy, psychological support, and pulmonary rehabilitation.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eIn this prospective controlled cohort study, 360 hospitalized patients with CLD and post-COVID syndrome received integrated multidisciplinary care (n\\u0026thinsp;=\\u0026thinsp;120) or usual care (n\\u0026thinsp;=\\u0026thinsp;240). The primary outcomes were changes in PaCO₂, FEV₁% predicted, and CT abnormality extent. Patient-reported outcomes, functional capacity, inflammation, and 6-month follow-up data were also assessed. Analyses used adjusted regression and IPTW.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eIntegrated care was associated with greater improvements in gas exchange, lung function, radiological resolution, quality of life, anxiety, exercise capacity, and inflammation (all P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). The composite early clinical benefit rate was higher (51.7% vs 37.5%, P\\u0026thinsp;=\\u0026thinsp;0.011). At 6 months, sleep quality was better and symptom-related medication use was lower, while rehospitalization and exacerbation rates were similar between groups.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eA ward-based multidisciplinary pulmonary rehabilitation pathway improves short-term physiological, functional, and patient-reported outcomes in high-risk patients with CLD and post-COVID syndrome, and reduces long-term symptom-related treatment burden.\\u003c/p\\u003e\",\"manuscriptTitle\":\"A multidisciplinary pulmonary rehabilitation pathway for hospitalized patients with chronic lung disease and post-COVID syndrome: a prospective controlled cohort study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-05-11 07:04:28\",\"doi\":\"10.21203/rs.3.rs-9505042/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-05-12T06:20:52+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-12T04:45:33+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-04T19:11:40+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"327851287031320462844838536219897156893\",\"date\":\"2026-04-30T06:27:11+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"252022393171770591899257994150667328096\",\"date\":\"2026-04-28T06:04:12+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-04-28T05:54:27+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-04-28T03:15:22+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-04-27T13:56:48+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"The Egyptian Journal of Bronchology\",\"date\":\"2026-04-23T09:30:19+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"the-egyptian-journal-of-bronchology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"\",\"sideBox\":\"Learn more about [The Egyptian Journal of Bronchology](https://ejb.springeropen.com/)\",\"snPcode\":\"43168\",\"submissionUrl\":\"https://submission.nature.com/new-submission/43168/3\",\"title\":\"The Egyptian Journal of Bronchology\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Open\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ff97040a-e2bc-47f9-adc7-b67653ed5384\",\"owner\":[],\"postedDate\":\"May 11th, 2026\",\"published\":true,\"recentEditorialEvents\":[{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-05-12T06:20:52+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-12T04:45:33+00:00\",\"index\":9,\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-04T19:11:40+00:00\",\"index\":8,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"327851287031320462844838536219897156893\",\"date\":\"2026-04-30T06:27:11+00:00\",\"index\":7,\"fulltext\":\"\"}],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-18T06:25:03+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-05-11 07:04:28\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9505042\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9505042\",\"identity\":\"rs-9505042\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}