Annals of Thoracic Medicine
EDITORIAL
Year
: 2006  |  Volume : 1  |  Issue : 2  |  Page : 65--66

Pulmonary rehabilitation: The standard practice… not yet standard


Mohamed S Al Moamary 
 College of Medicine, King Saud Bin Abdulaziz University for Health Sciences. King Abdulaziz Medical City. Riyadh, Saudi Arabia

Correspondence Address:
Mohamed S Al Moamary
College of Medicine, P.O. Box 84252 Riyadh - 11671
Saudi Arabia




How to cite this article:
Al Moamary MS. Pulmonary rehabilitation: The standard practice… not yet standard.Ann Thorac Med 2006;1:65-66


How to cite this URL:
Al Moamary MS. Pulmonary rehabilitation: The standard practice… not yet standard. Ann Thorac Med [serial online] 2006 [cited 2019 Aug 20 ];1:65-66
Available from: http://www.thoracicmedicine.org/text.asp?2006/1/2/65/27103


Full Text

Pulmonary rehabilitation (PR) is a multidisciplinary program for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance. The goals of PR are to reduce symptoms, improve activity and daily functioning and restore the highest level of independent functioning in patients with respiratory disease.[1] Typical candidates for PR are symptomatic patients with chronic lung disease who are aware of their disability and are motivated to participate actively in their health care. Therefore, PR is not limited to chronic bronchitis and emphysema but extended to other diseases, e.g., lung fibrosis, bronchiectasis, neuromuscular disease.[2]

Pulmonary rehabilitation benefits include improvements in dyspnea, exercise performance, improvement in health-related quality of life and reduction in health care utilization.[3] It is considered for patients with an FEV[1] of <80% of the predicted value and to be an essential part of the therapeutic options for the treatment of a patient with chronic lung disease. There are variations in the duration of PR; however, the latest update of the Global Initiative for Obstructive Lung Disease recommends duration of ³ 2 months.[4] There is no fixed format for PR with differences in terms of duration, number of sessions, training intensity. However, a reasonable PR should include exercise, education and psychosocial components.[5]

In addition to pulmonary function tests, health-related quality of life instruments have a definite role to assess severity and progression of the disease. Exercise capacity and quality of life are often impaired in proportion to lung function impairment.[6] The improvement of exercise tolerance has been estimated from incremental exercise tests, constant work rate tests or free walking tests. Therefore, it is not a surprise to know that PR improves endurance exercise time by an average of 87%.[7] Different pharmacological modalities are not the only methods of treatment; the addition of PR will lead to greater treatment effects as manifested by improvements in exercise performance, symptoms, health-related quality of life and health care expenditure.[8] These benefits were confirmed in a recent multicenter study that showed PR will lead to less utilization of health care services and the benefits will be sustained for over 18 months, though gradually declining.[9],[10] Moreover, patients undergoing lung volume reduction surgery in a multicenter study were able to perform exercise at higher intensity.[11]

All the available data clearly indicates that PR is an essential component of the management of patients with chronic lung diseases. Nevertheless, it is not yet widely utilized in many developing countries. A reasonable program can be initiated with treadmill machines, arm ergometers and stationary bicycles. A physiotherapist or respiratory therapist could serve as the key person in a multidisciplinary team. Launching such a program should be within the scope of an interested chest physician and a respiratory therapist or physiotherapist. Well-written PR guidelines are available online with the description of the procedure, contents and resources.[1],[2],[4],[12] A proposal to launch PR program should show the benefits, limitations, policy and procedure, space required, manpower and total costs. Documentation of the benefits and cost-saving to the health system would support the chances to get PR program approved.

References

1Pulmonary Rehabilitation Guidelines Panel, American College of Chest Physicians and American Association of Cardiovascular and Pulmonary Rehabilitation. Pulmonary rehabilitation: Joint ACCP/AACVPR evidence-based guidelines. Chest 1997;112:1363-96.
2Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease (State of the art). Am J Respir Crit Care Med 2005;172:19-38.
3Guell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, et al . Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest 2000;117:976-83.
4Fabbri LM, Hurd SS; GOLD Scientific Committee. Global strategy for the diagnosis, management and prevention of COPD: 2003 update. Eur Respir J 2003;22:1-2.
5British Thoracic Society, Standards of Care Subcommittee on Pulmonary Rehabilitation. Pulmonary rehabilitation. Thorax 2001;56:827-34.
6Hamilton AL, Killian KJ, Summers E, Jones NL. Symptom intensity and subjective limitation to exercise in patients with cardiorespiratory disorders. Chest 1996;110:1255-63.
7Lacasse Y, Brosseau L, Milne S, Martin S, Wong E, Guyatt GH, et al . Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2002;3:CD003793.
8Weiner P, Magadle R, Berar-Yanay N, Davidovich A, Weiner M. The cumulative effect of long-acting bronchodilators, exercise and inspiratory muscle training on the perception of dyspnea in patients with advanced COPD. Chest 2000;118:672-8.
9California Pulmonary Rehabilitation Collaborative Group. Effects of pulmonary rehabilitation on dyspnea, quality of life and healthcare costs in California. J Cardiopulm Rehabil 2004;24:52-62.
10Guell R, Casan P, Belda J, Sangenis M, Morante F, Guyatt GH, et al . Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest 2000;117:976-83.
11Ramsey SD, Berry K, Etzioni R, Kaplan RM, Sullivan SD, Wood DE, et al . Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema. N Engl J Med 2003;348:2092-102.
12Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, et al. American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med 2006;173:1390-413.