Pulmonary rehabilitation is an evidence-based, multi-disciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, and reduce health care costs through stabilizing or reversing the manifestations of the disease.
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. In addition to impairing survival, COPD causes dyspnea that limits patients’ daily function. Exercise intolerance is limited not only by lung function (including ventilatory and gas exchange abnormalities) but also by cardiac and skeletal muscle dysfunction. Exercise capacity, shortness of breath, and health status (disease-speciﬁc health-related quality of life) can be improved with pulmonary rehabilitation. The most important component of pulmonary rehabilitation is exercise training, including a lower extremity aerobic exercise program such as walking or stationary cycling. Strengthening and stretching programs are also incorporated. Supervised programs are usually 6 to 8 weeks in duration at least three times a week, but longer programs may be more effective. The goal is for the patient to continue exercising independently lifelong.
Other components of pulmonary rehabilitation include patient education, psychosocial counseling, and nutritional counseling. The goal of patient education is to assist the patient in incorporating health-enhancing behaviors such as adherence to prescribed medications and exercise. Use of inhaled medications is unique to patients with lung disease, and education should include teaching patients the skills of self-administration of such medications. Classes in anatomy and physiology of lung disease, respiratory medications, and oxygen therapy focus on improving patient understanding of their condition and its treatment. Other issues addressed include end-of-life considerations when appropriate and sexual counseling to assist patients in leading full lives.
Periods of increased respiratory symptoms (COPD exacerbations) are associated with impaired quality of life, worsening lung function, and urgent health care visits and hospitalizations. Education about COPD exacerbations incorporate timely recognition of changes in symptoms, how to contact health care professionals, and appropriate use of action plans for treatment. Collaborative self-management programs have been demonstrated to reduce hospitalizations.
Many patients with COPD demonstrate depressive symptoms, even if not clinical depression. Anxiety, partly related to the fear invoked by dyspnea, is also common. Psychosocial evaluation, including screening for depression and anxiety along with medications and counseling when appropriate, is incorporated in comprehensive pulmonary rehabilitation programs.
Weight loss can bee seen in patients with more severe COPD, and low body weight is a risk factor for mortality in COPD. In such patients, nutritional counseling, including intake of foods to maintain body weight and nutritional status, is of obvious importance. Patients with COPD may also present with weight gain caused by inactivity, and lowering body weight can improve exercise capacity.
Although most commonly applied to patients with COPD, patients with other respiratory disorders, including cystic ﬁbrosis, asthma, bronchiectasis, and interstitial lung disease may also be candidates for pulmonary rehabilitation.