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Pulmonary rehabilitation

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


Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health care utilization in patients with chronic respiratory disease. Most of the evidence supporting the benefit of pulmonary rehabilitation has been derived from studies of patients with chronic obstructive pulmonary disease (COPD). However, results obtained in patients with respiratory diseases different from COPD have provided evidence that the benefits from pulmonary rehabilitation are also observed in symptomatic patients with other respiratory diseases.  

The indications, goals, and components of pulmonary rehabilitation and the potential benefits for patients with chronic lung disease will be reviewed here [1]. Other therapeutic modalities, such as smoking cessation, oxygen therapy, bronchodilators, antibiotics, nutritional support, respiratory muscle training and resting, and cardiac rehabilitation, 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" and "Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease".)


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" [2,3].


The indications for pulmonary rehabilitation have not been precisely defined. The Global Initiative for Chronic Obstructive Disease suggests that pulmonary rehabilitation be included in the management of patients with chronic obstructive pulmonary disease (COPD) categories B, C, and D (table 1) [4]. For respiratory diseases different from COPD, there have been no formal statements regarding patient selection, but it is common to consider pulmonary rehabilitation in symptomatic patients whose quality of life is impaired by their disease.

Frailty affects approximately one-fourth of patients with COPD and is a predictor of noncompletion of pulmonary rehabilitation. However, a study of 816 patients with stable COPD of whom 212 (26 percent) met criteria for frailty found that those who completed pulmonary rehabilitation experienced reduced dyspnea, improved exercise performance and physical activity level, and 61 percent no longer met criteria for frailty [5]. Thus, frailty is not necessarily a contraindication. Similarly, chronic hypercapnia due to advanced COPD is not a contraindication, as benefit has been demonstrated in these patients [6].

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Literature review current through: Nov 2017. | This topic last updated: Jul 13, 2017.
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