Chapter 43: Rehabilitation in Chronic Obstructive Pulmonary Disease and Other Respiratory Disorders

Introduction

Rehabilitation for patients with chronic lung diseases is well established as a means of enhancing standard pharmacologic and other therapies in controlling and alleviating symptoms and optimizing functional capacity.^1–4 The primary goal of any rehabilitation program is to restore the patient to the highest possible level of independent function. This goal is accomplished by helping patients and significant others learn more about the underlying disease, treatment options, and coping strategies. Patients are encouraged to participate actively in providing their own health care, become more independent in daily activities, and be less dependent on health professionals and expensive medical resources. Rather than addressing solely reversal of the disease process, rehabilitation focuses on improving disability from disease.

Historically, pulmonary rehabilitation strategies were developed and have been used primarily for patients with chronic obstructive pulmonary disease (COPD). However, pulmonary rehabilitation has also been applied successfully to patients with other chronic lung conditions, including interstitial diseases, cystic fibrosis, bronchiectasis, and thoracic cage abnormalities.^3,5–7 It has been used successfully in the evaluation and preparation of patients for surgery, such as lung transplantation and volume reduction lung surgery, and in maximizing recovery after surgery.^8–11 Pulmonary rehabilitation has been used to facilitate patient recovery from acute processes such as acute lung injury, or exacerbations of chronic lung disease requiring mechanical ventilation or acute hospital care. Pulmonary rehabilitation is appropriate for any patient with stable lung disease who is disabled by respiratory symptoms. Even patients with advanced disease may benefit if they are selected appropriately and realistic goals are set.

This chapter defines pulmonary rehabilitation and outlines issues related to patient selection and evaluation. Key components of a pulmonary rehabilitation program are described and results of rehabilitation programs reviewed. Finally, the role of rehabilitation prior to and following lung surgery is reviewed.

Definition

In 2006, the American Thoracic Society and European Respiratory Society adopted the following definition:

Pulmonary rehabilitation is 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 healthcare costs through stabilizing or reversing systemic manifestations of the disease.²

This definition focuses on three important features of successful rehabilitation. First, the program is multidisciplinary. Pulmonary rehabilitation programs utilize expertise from various healthcare disciplines that is integrated into a comprehensive, cohesive program tailored to the needs of each patient. Second, the program is tailored to the individual. Patients with disabling lung disease require individual assessment of needs, individual attention, and a program designed to meet realistic individual goals. Third, the program addresses multidimensional outcomes that include physical, psychological, and social function as well as healthcare utilization.

The interdisciplinary team ...