The PuRe trial evaluates the effectiveness, cost effectiveness and sustainability of pulmonary rehabilitation for people with chronic respiratory diseases in low-resource settings across Bangladesh, India, and Malaysia, comparing Centre-based and Home-based approaches with Usual Care. Summary People with lung diseases are often breathless and easily feel tired. They avoid exercise which means they become ‘unfit’ making it even harder to stay active. Pulmonary rehabilitation (PR) is a programme of exercise and education to reduce breathless and improve quality-of-life. Therapists assess how much exercise a person can do, then develops an individual exercise programme to improve that their fitness. We know PR works in high-income countries, but in low resource settings there may be less equipment, medication may be expensive, and travel to PR centres may be difficult. The PuRe trial is testing PR delivered in four low resource centres (in Bangladesh, India and Malaysia). We discussed the PR intervention with people from the local communities who helped us adapt the programme to local culture and healthcare services. We are recruiting 465 adults with breathlessness due to lung disease and allocating them by chance to centre-based PR or home-based PR or usual care. To find out if P is effective, we will compare changes in exercise capacity and quality-of-life in the people given PR with people who received usual care. We will also add up the cost of care so we can tell healthcare manages how much the service costs. We will ask patients, PR therapists and clinicians what they think of the PR service, and how they think PR services could be rolled out in the four different settings.The full title of the study is: PuRe: Pulmonary rehabilitation delivered in low resource settings for people with chronic respiratory disease: a 3-arm assessor-blind randomised implementation trial. Key People NameRoleInstitutionHilary Pinnock Principal InvestigatorUniversity of EdinburghEe Ming Khoo Co-Principal InvestigatorUniversity Malaya, Kuala Lumpur, Malaysia Roberto RabinovichCo-Principal InvestigatorUniversity of Edinburgh University of Edinburgh NameRoleVicky Hammersley Trial manager Christopher Weir Trial statistician Andy Stoddart Health economist Ruth McQuillan Capacity building Siân Williams Stakeholder engagement lead Genevie Fernandez Stakeholder engagement Tracy Jackson Co-Investigator, Community Engagement & Involvement (CEI) Purva Abhyankar Process evaluation lead Emily Healy Administrator Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh NameRoleMonsur HabibLocal Principal InvestigatorNazim Uzzaman Co-Investigator & local trial manager Asadur Rahman Health economist Jawed Banu CEI Selina Ahmed Researcher (process evaluation) Sumaiya Akhter PR therapist Keya Biswas PR therapist Mohasin Ali PR therapist (blinded assessor) Christian Medical College Vellore, Tamil Nadu, India NameRoleBiswajit Paul Local Principal Investigator Richa Gupta Co-Investigator, Pulmonologist Manoj Jacob Dhinagar Co-Investigator Udhaya Kumar Co-Investigator Paul Jebaraj Local trial manager Tarun George Health economist Dharani Kamarajan Researcher (process evaluation) Santhosh Vianrenatus Researcher (field research) Shadrack Ravindra Reddy PR therapist Asha Pichai PR therapist (blinded assessor) Rakesh Kumar PR therapist (blinded assessor) Ms Ruby PR therapist (blinded assessor) Jeffers Jayachandar Raj PR therapist (blinded assessor) Charles Ramesh PR therapist (blinded assessor) Sara Teresa PR therapist (blinded assessor) University Malaya, Kuala Lumpur, Malaysia NameRoleJulia Engkasan Local Principal Investigator Nik Sherina Hanafi Co-Investigator Munirah Rosli Local trial manager Jayakayatri Jeevajothi Nathan Research Manager Aniza Ismail Health economist Mohd Izzudin Md Ansari Researcher Norita Hussien Researcher (process evaluation lead) Nursyuhada Syukri Researcher (process evaluation) Sheron Goh Sir Loon Researcher (process evaluation) Ng Wei Leik Researcher (process evaluation) Nur Melissa Abdul Khalil Researcher (process evaluation) Bairave Shunnmugam Researcher (process evaluation) Anmol Singh PR therapist Kevin Ku CEI Faizah Jali PR therapist (blinded assessor) Koo Jui Geok PR therapist (blinded assessor) Ahamd Al Amin PR therapist (blinded assessor) Anmol Singh PR therapist Chan Soo Chin PhD student Universiti Teknologi MARA (UiTM), Selangor, Malaysia Fatim Tahirah Mirza Co-Investigator Contact Details Professor Hilary Pinnock | Principal Investigator | hilary.pinnock@ed.ac.uk Dr Vicky Hammersley | Trial Manager | vicky.hammersley@ed.ac.uk Key Collaborations Bangladesh Primary Care Respiratory Society Christian Medical College Vellore RUHSA Department KEM Hospital Research Centre Universiti Malaya Universiti Teknologi MARA (UiTM) International Primary Care Respiratory Group Funders Medical Research Council Global Health Research Programme Publications Jebaraj P, Paul B, Isaac R, Reddy SR, Kumar R, Vikas B, Das D, Norrie J, Weller D, Pinnock H. Optimising participation in a Pulmonary Rehabilitation Programme for people living with Chronic Respiratory Diseases in rural India: a feasibility study. J Glob Health 2025;15:04143. DOI: 10.7189/jogh.15.04143 https://jogh.org/2025/jogh-15-04143 Habib GMM, Uzzaman N, Rabinovich R, Akhter S, Sultana M, Ali M, Pinnock H. Delivering remote pulmonary rehabilitation in Bangladesh: a mixed methods feasibility study. J Glob Health 2025;15:04002. DOI: 10.7189/jogh.15.04002 https://jogh.org/2025/jogh-15-04002 Chan SC, Engkasan JP, Kaur J, Jayakayatri K, Hussein N, Suhainmi A, Hanafi NS, Kek PY, Yatim SM, Habib GMM, Pinnock H, Khoo EM. Home-Based Pulmonary Rehabilitation for Patients with Chronic Respiratory Diseases in Malaysia: A Mixed Method Feasibility Study. J Glob Health 2023;13:04099. DOI: 10.7189/jogh.13.04099 https://jogh.org/2023/jogh-13-04099 Chan SC, Beh HC, Jeevajothi Nathan J, Sahadeevan Y, Patrick Engkasan J, Chuah SY, Pek EW, Abdullah N, Wong CK, Hussein N, Suhaimi A, Hanafi NS, Mirza FT, Mohamad Yatim S, Pinnock H, William S, Khoo EM; RESPIRE Collaborators. Pulmonary rehabilitation capacity building through a teach-the-teacher programme: A Malaysian experience. J Glob Health. 2023 Aug 11;13:03047. DOI: 10.7189/jogh.13.03047 https://jogh.org/2023/jogh-13-03047 Singh D, Kaur H, Roy S, Juvekar S, Pinnock H, Agarwal D. Needs assessment for introducing Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease management in a rural Indian setting: a qualitative study. BMJ Open Respir Res 2023;10:e001696. DOI: 10.1136/bmjresp-2023-001696 https://bmjopenrespres.bmj.com/content/10/1/e001696 Adeloye D, Agarwal D, Barnes PJ, Bonay M, van Boven JF, Bryant J, Caramori G, Dockrell D, D'Urzo A, Ekström M, Erhabor G, Esteban C, Greene CM, Hurst J, Juvekar S, Khoo EM, Ko FW, Lipworth B, López-Campos JL, Maddocks M, Mannino DM, Martinez FJ, Martinez-Garcia MA, McNamara RJ, Miravitlles M, Pinnock H, Pooler A, Quint JK, Schwarz P, Slavich GM, Song P, Tai A, Watz H, Wedzicha JA, Williams MC, Campbell H, Sheikh A, Rudan I. Research priorities to address the global burden of chronic obstructive pulmonary disease (COPD) in the next decade. J Glob Health 2021;11:15003. DOI: 10.7189/jogh.11.15003 https://jogh.org/wp-content/uploads/2021/10/jogh-11-15003.pdf Chan SC, Sekhon JK, Engkasan JP, Jayakayatri K, Mirza FT, Liew S-M, Hussein N, Suhaimi A, Hanafi NS, Pang YK, Yatim SM, Jackson T, Fernandes G, Habib GMM, Pinnock H, Khoo EM. Barriers and challenges of implementing pulmonary rehabilitation in Malaysia: Stakeholders’ perspectives. J Glob Health 2021;11:02003. DOI: 10.7189/jogh.11.02003 https://jogh.org/documents/2021/jogh-11-02003.pdf Timeline Start date: March 2024End date: August 2027 Scientific themes Pulmonary rehabilitation; chronic respiratory disease; low- and middle-income countries; randomised controlled trial; health economic evaluation; process evaluation Methodology keywords Hybrid-1 implementation trial This article was published on Friday 15 November 2024
