Pulmonary rehabilitation (PR) is a multidisciplinary approach to reducing symptoms and improving quality of life in patients with compromised lung function. The approach can be used in patients with chronic pulmonary disease and as preoperative conditioning before lung surgery.
The American Thoracic Society (ATS) and the European Respiratory Society (ERS) define pulmonary rehabilitation (PR) as “an evidence-based, multidisciplinary, 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, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease. Comprehensive pulmonary rehabilitation programs include patient assessment, exercise training, and psychosocial support.” (1)
Pulmonary rehabilitation programs are intended to improve the patient’s functioning and quality of life. The vast majority of study has focused on patients with chronic obstructive pulmonary disease (COPD), although there has been some interest in PR in patients with asthma, cystic fibrosis, or bronchiectasis. According to a joint ATS/ERS (American Thoracic Society/European Respiratory Society) statement issued in 2006, pulmonary rehabilitation may be of value for conditions other than COPD in cases in which respiratory symptoms are associated with diminished functional capacity or reduced health-related quality of life.
Pulmonary rehabilitation is also routinely offered to patients awaiting lung transplantation and lung volume reduction surgery (LVRS). PR before lung surgery may stabilize or improve patients’ exercise tolerance, teach patients techniques that will help them recover after the procedure, and allow healthcare providers to identify individuals who might be suboptimal surgical candidates due to non-compliance, poor health, or other reasons.
A pulmonary rehabilitation outpatient program is a comprehensive program that generally includes team assessment, patient training, psychosocial intervention, exercise training, and follow-up. The overall length of the program and the total number of visits for each component may vary from program to program.
- Team assessment includes input from a physician, respiratory care practitioner, nurse, and psychologist, among others.
- Patient training includes breathing retraining, bronchial hygiene, medications, and proper nutrition.
- Psychosocial intervention addresses support system and dependency issues.
- Exercise training includes strengthening and conditioning and may include stair climbing, inspiratory muscle training, treadmill walking, cycle training (with or without ergometer), and supported and unsupported arm exercise training. Exercise conditioning is an essential component of pulmonary rehabilitation. Education in disease management techniques without exercise conditioning does not improve health outcomes of patients who have chronic obstructive pulmonary disease.
- Follow-up to a comprehensive outpatient pulmonary rehabilitation program may include supervised home exercise conditioning.
Candidates for pulmonary rehabilitation should be medically stable and not limited by another serious or unstable medical condition. Contraindications to pulmonary rehabilitation include severe psychiatric disturbance (e.g., dementia, organic brain syndrome), and significant or unstable medical conditions (e.g., heart failure, acute cor pulmonale, substance abuse, significant liver dysfunction, metastatic cancer, disabling stroke).