Pulmonary Rehabilitation Programs: Outcomes in Patients with Chronic Obstructive Pulmonary Disease
Effective management of chronic obstructive pulmonary disease (COPD) is aimed at prevention of disease progression, relief of symptoms, improvement in exercise tolerance, improvement in health status, prevention of complications, prevention of exacerbations and reduction in mortality. Pulmonary rehabilitation, aimed at restoring patients with disabling disease to an optimally functioning state, is a relatively recent practice in pulmonary medicine and is classically described as a multidisciplinary program of `care' for patients with chronic respiratory impairment. Health status assessment is a central feature of studies of COPD, since treatments for this condition, other than smoking cessation and long-term oxygen therapy, are largely symptomatic. Health status measurement quantifies the impact of disease on patients' daily life, health and well-being. General health- and disease-specific questionnaires have been designed to measure health status as well as health-related quality of life (HR-QOL). Published results provide a scientific basis for the overall pulmonary rehabilitation programs and, although with a lesser degree of evidence, for the specific components of these programs. The benefits of pulmonary rehabilitation include improvements in exercise tolerance, dyspnea and HR-QOL, and, to some extent, a decrease in healthcare usage. Pulmonary rehabilitation is effective in all settings including hospital inpatient, hospital outpatient, the community and home. However, more information is needed to ensure that the appropriate rehabilitation is given to the increasing number of patients with chronic respiratory diseases. Pulmonary rehabilitation is a costly process and patients should be carefully selected in order to save resources and obtain the maximum benefit. Although several questions remain unresolved, pulmonary rehabilitation programs should be included in the comprehensive treatment of patients with COPD.
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