Pulmonary rehabilitation in chronic obstructive pulmonary disease

Abstract

The aim of the present review is to cover various aspects of pulmonary rehabilitation (PR) in patients with stable chronic obstructive pulmonary disease (COPD): definition and rationale, outcome measures and patient selection, practical organization and program content. For the articles and reviews about pulmonary rehabilitation were searched in HINARI and MedLine. The keywords were: pulmonary rehabilitation, COPD management, COPD outcomes, chronic bronchitis, exercise training, muscle, health care resources, dyspnoea, health-related quality of life and multidisciplinary approach. Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide and an important worldwide cause of disability and handicap. Centred at exercise training, PR is global, multidisciplinary, individualized and comprehensive approach acting on the patient as a whole and not only on the pulmonary component of the disease. PR is now well recognized as an effective key intervention in the management of several respiratory diseases particularly in COPD. For patients with chronic obstructive pulmonary disease, PR is now considered to be the standard of care for those with at least moderate COPD as well as for those patients with COPD of mild severity (as determined by spyrometry) who, follow maximal medical care and remain symptom-limited in exercise capacity or functional status. The goal of PR is for the patient to become more physically active and maintain independence a longer period of time. The benefits of PR extend far beyond physical endurance and reduced dyspnoea, and include improved adherence, reduced health care utilization and costs, more patient involvement in disease management, and improved patient outlook. In the recent years, the beneficial effects of a comprehensive and multidisciplinary pulmonary rehabilitation program have been so well documented in COPD that this therapy has gained a prominent position in most guidelines on diagnosis and treatment of this disorder. The magnitude of the effects resulting from pulmonary rehabilitation compare favourably with the available drug therapies in COPD, and the evidence for reducing use of health care resources is increasing. The successful effects of pulmonary rehabilitation in COPD can be largely attributed to the systemic component of the disease, with peripheral muscle dysfunction the best documented.