Low-cost pulmonary rehabilitation for chronic respiratory diseases: a narrative review.

This is a narrative review, not a systematic review or meta-analysis. It did not formally assess risk of bias, and its conclusions are the authors' interpretation of 20 heterogeneous publications. Most evidence was in COPD, so it gives little guidance for asthma, interstitial lung disease, pulmonary hypertension, post-tuberculosis disease, bronchiectasis or post-COVID respiratory problems. Many included studies had small samples, single-centre designs, short intervention periods and unavoidable difficulty blinding participants and therapists in exercise programmes. Home-based or community-based delivery is not automatically feasible. Unsafe walking spaces, overcrowded housing, limited privacy, low health literacy, family responsibilities, pollution, climate extremes and socioeconomic constraints can reduce participation. Long-term maintenance, cost-effectiveness and sustainability were poorly studied. Some programmes did not sustain benefits at 12 months, and the review had limited primary-care and implementation-outcome evidence. Low-cost pulmonary rehabilitation is a bundle of adapted components, so the contribution of any single component cannot be separated.

The authors declared that no financial support was received for the work or its publication.

Do not conclude that low-cost pulmonary rehabilitation is proven for every chronic respiratory disease. The reviewed evidence was mainly in COPD, and the authors did not formally assess risk of bias. Do not treat low-cost as unsupervised or as a single exercise item. Programmes combined walking, resistance, education, monitoring and support, so the effect of any one component cannot be separated.