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INTRODUCTION

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Chronic pulmonary disease has a negative effect on several patient-centered outcomes. Among these, exercise capacity, dyspnea, and quality of life are the most relevant. Analysis of factors that contribute to exercise limitation, exercise-induced dyspnea, reduced quality of life, and pathophysiologic changes in patients with chronic pulmonary disease underlies research efforts to identify effective interventions for this patient population.

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As defined by the American Thoracic Society and the European Respiratory Society, pulmonary rehabilitation is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have a decreased ability to participate in daily life activities. Integrated into the individualized treatment of such patients, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs by stabilizing or reversing systemic manifestations of the disease. Comprehensive pulmonary rehabilitation programs include patient assessment, exercise training, education, nutritional support, and psychosocial support.

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This treatment approach has clearly demonstrated favorable and long-lasting effects on all patient-centered outcomes. In addition, pulmonary rehabilitation appears to have positive effects on other important outcomes (eg, number and severity of exacerbations, health care resource utilization, and survival) in patients with chronic pulmonary conditions, particularly those with chronic obstructive pulmonary disease (COPD). Although the evidence for the efficacy of pulmonary rehabilitation is strong and it is highly recommended by current guidelines, only a minority of eligible patients with chronic pulmonary disease are included in rehabilitation programs. This discrepancy may derive from lack of belief in the efficacy of such programs, lack of local access, or concerns about cost. The first of these impediments can be addressed by intensified promotion of the beneficial effects of pulmonary rehabilitation in the medical community; the other two, however, may require the design of simple and locally available programs using a minimum amount of resources that still produce clinically relevant effects.

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American Thoracic Society Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories: ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111–117.
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Glaab  T, Vogelmeier  C, Hellmann  A, Buhl  R: Guideline-based survey of outpatient COPD management by pulmonary specialists in Germany. Int J Chron Obstruct Pulmon Dis 2012;7:101–108.
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Nici  L, Donner  C, Wouters  E  et al.: American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006;173:1390–1413.
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Polverino  F, Cosio  BG: Subphenotypes: The many faces of chronic obstructive pulmonary disease. Therapy 2009;6:771–773.

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OVERVIEW OF THE NORMAL LUNG

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Structural & Functional Anatomy

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The primary function of the lung is ventilation–perfusion matching to maximize delivery of oxygen to and removal of carbon dioxide from the tissues. Air enters the respiratory system through the trachea, which then subdivides into the cartilaginous primary bronchi. These bronchi ...

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