PULMONARY REHABILITATION
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.
