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.1–5 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 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 lung diseases, asthma, cystic fibrosis, bronchiectasis, pulmonary hypertension, and thoracic cage abnormalities.3,5–7 Also, among patients with lung cancer, rehabilitation prior to resectional surgery improves exercise capacity and may reduce perioperative complications and length of hospital stay.8 Following surgery, rehabilitation can mitigate the adverse effects of treatment and improve physical function and symptom control, especially if initiated early.9–12 Patients with advanced lung cancer can also experience improvements in exercise capacity with training.13
Pulmonary rehabilitation has been used successfully in the evaluation and preparation of patients for surgery, such as lung transplantation and lung volume reduction surgery, and in maximizing recovery after surgery.14–16 Pulmonary rehabilitation has also 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. The 2020 worldwide COVID-19 pandemic highlights the needs and potential benefits of pulmonary rehabilitation for the large number of patients recovering from lung injury.17
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. There is also discussion of key components of a pulmonary rehabilitation program, results and benefits of pulmonary rehabilitation, the use of pulmonary rehabilitation in various conditions and settings, and, finally, the role of rehabilitation as an adjunct to lung surgery.
In 2013, the American Thoracic Society and European Respiratory Society adopted the following definition:
“Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health-enhancing behaviors.”...