Pulmonary Rehabilitation

COPD is the only major disease with an increasing death rate.

While working through the AAFPs METRIC Module on COPD last year, I was reacquainted with the importance of Pulmonary Rehabiliation...

From eMedicine:

Consequences of respiratory disease

• Peripheral muscle dysfunction
• Respiratory muscle dysfunction
• Nutritional abnormalities
• Cardiac impairment
• Skeletal disease
• Sensory deficits
• Psychosocial dysfunction

Pulmonary rehabilitation has been defined in the following terms:

A multidimensional continuum of services directed to persons with pulmonary disease and their families, usually by an interdisciplinary team of specialists, with the goal of achieving and maintaining the individual's maximum level of independence and functioning in the community.

Comprehensive pulmonary rehabilitation programs generally have the following 4 major components:

• Exercise training
• Education
• Psychosocial/behavioral intervention
• Outcome assessment

 

From the AAFPs METRIC Module on COPD: (http://www.aafp.org/online/en/home/cme/selfstudy/metric/buy/copd.html)

Recommendation: Pulmonary rehabilitation should be considered for patients with COPD who have dyspnea or other respiratory symptoms, reduced exercise tolerance, a restriction in activities because of their disease, or impaired health status.¹

Level of Evidence: Based on opinion of the American Thoracic Society and the European Respiratory Society.

Pulmonary rehabilitation is an individualized treatment program that uses education, exercise training, nutrition and behavior counseling, and outcome assessment components to improve a patient’s quality of life and reduce COPD symptoms. A summary of the wide range of benefits resulting from pulmonary rehabilitation are shown below.

Benefits of Pulmonary Rehabilitation in COPD²

• Improves exercise capacity (Evidence A).
• Reduces the perceived intensity of breathlessness (Evidence A).
• Can improve health-related quality of life (Evidence A).
• Reduces the number of hospitalizations and days in the hospital (Evidence A).
• Reduces anxiety and depression associated with COPD (Evidence A).
• Strength and endurance training of the upper limbs improves arm function (Evidence B).
• Benefits extend well beyond the immediate period of training (Evidence B).
• Improves survival (Evidence B).
• Respiratory muscle training is beneficial, especially when combined with general exercise training (Evidence C).
• Psychosocial intervention is helpful (Evidence C).

These benefits occur despite the fact that pulmonary rehabilitation has little effect on static pulmonary function measurements.¹

Most effective pulmonary rehabilitation programs last at least two months, though the longer a program lasts, the more effective it is (Evidence B).² Sadly, the benefits are short-term as no program has been shown to maintain these effects over time.^1,2

When recommending a patient, there are several possible selection criteria, including functional status. In general, however, most patients see the benefits of pulmonary rehabilitation at any stage of disease progression, though those who are chair-bound are not likely to benefit even from home-visiting programs.² Other criteria for consideration can include severity of dyspnea or other respiratory symptoms, reduced exercise tolerance, restriction in activities because of the disease, impaired health status, the patient’s general motivation and his or her smoking status.^1,2

References

1. American Thoracic Society and European Respiratory Society. Standards for the diagnosis and management of patients with COPD. Retrieved from the World Wide Web January 9, 2007 at:http://www.ersnet.org/ers/default.aspx?id=98 .
2. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2005. Retrieved from the World Wide Web on January 9, 2007 at:http://goldcopd.com/GuidelinesResources.asp?l1=2&l2=0 .