Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient. Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient’s needs, and may or may not include pharmacologic intervention.
The NICE clinical guideline on chronic obstructive pulmonary disease states that “pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD (usually MRC [Medical Research Council] grade 3 and above)”.It is indicated not only in patients with COPD, but also in:
- Cystic fibrosis
- Idiopathic pulmonary fibrosis
- Before and after lung surgery
It appears not to be harmful and may be helpful for interstitial lung disease.
- To reduce symptoms
- To improve knowledge of lung condition and promote self-management
- To increase muscle strength and endurance (peripheral and respiratory)
- To increase the exercise tolerance
- To reduce length of hospital stay
- To help to function better in day-to-day life
- To help in managing anxiety and depression
- Reduction in number of days spent in hospital one year following pulmonary rehabilitation.
- Reduction in the number of exacerbation in patients who performed daily exercise when compared to those who did not exercise.
- Reduced exacerbation post pulmonary rehabilitation.
- Ventilatory limitation
- Increased dead space ventilation
- Impaired gas exchange
- Increased ventilatory demands due to peripheral muscle dysfunction
- Gas exchange limitation
- Compromised functional inspiratory muscle strength
- Compromised inspiratory muscle endurance
- Cardiac dysfunction
- Increase in right ventricular afterload due to increased peripheral vascular resistance.
- Skeletal muscle dysfunction
- Average reduction in quadriceps strength decreased by 20-30% in moderate to severe COPD
- Reduction in the proportion of type I muscle fibres and an increase in the proportion of type II fibres compared to age matched normal subjects
- Reduction in capillary to fibre ratio and peak oxygen consumption
- Reduction in oxidative enzyme capacity and increased blood lactate levels at lower work rates compared to normal subjects
- Prolonged periods of under nutrition which results in a reduction in strength and endurance
- Respiratory muscle dysfunction.