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Pulmonary rehabilitation in COPD

Author
Bartolome R Celli, MD
Section Editor
James K Stoller, MD, MS
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

Pulmonary rehabilitation is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors [1-3].

The effects of pulmonary rehabilitation on quality of life and health care utilization will be reviewed here, focusing on the primary goals of rehabilitation — lower and upper extremity exercise conditioning, breathing retraining, education, and psychosocial support [4]. Other important therapeutic modalities that are stressed in many rehabilitation programs, including smoking cessation, oxygen therapy, bronchodilators, antibiotics, nutritional support, and respiratory muscle training and resting, are discussed separately. (See "Management of stable chronic obstructive pulmonary disease" and "Overview of smoking cessation management in adults" and "Long-term supplemental oxygen therapy" and "Nutritional support in advanced lung disease" and "Respiratory muscle training and resting in COPD".)

BENEFITS

Patients with chronic obstructive pulmonary disease (COPD) often decrease their physical activity because exercise can worsen dyspnea. The progressive deconditioning associated with inactivity initiates a vicious cycle, with dyspnea becoming problematic at ever lower physical demands. Pulmonary rehabilitation aims to break the cycle. Benefits of pulmonary rehabilitation include decreased dyspnea, improved health-related quality of life, fewer days of hospitalization, and decreased health-care utilization (table 1) [5-8]. Initiation of exercise rehabilitation during or immediately after admission for acute on chronic respiratory failure reduces the extent of functional decline and hastens recovery [9].

Mortality and exercise tolerance — The impact of rehabilitation on mortality is uncertain [5,10-13]. In a prospective observational study of 1218 patients, pulmonary rehabilitation did not confer a mortality benefit, but was associated with improved exercise capacity, dyspnea, and quality of life [10]. In contrast, another observational study that included patients with a wider range of airflow obstruction detected improved survival among patients whose exercise capacity and dyspnea improved after rehabilitation [11]. A meta-analysis demonstrated decreased hospital readmission and mortality among patients who received rehabilitation after an exacerbation of COPD [13].

A three-year prospective case control study of 80 patients with moderate to severe COPD showed improvements in body mass index (BMI), lung function, and health status with pulmonary rehabilitation compared with usual care [12]. Taken together, these studies emphasize the need for prospective randomized trials that are large enough to determine whether pulmonary rehabilitation impacts survival.

                    

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Literature review current through: Nov 2016. | This topic last updated: Mon Dec 14 00:00:00 GMT+00:00 2015.
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