Advances in Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease and Associated Conditions

Abstract

Pulmonary rehabilitation (PR) is an evidenced-based, proven treatment as mentioned recent guidelines in patients with chronic obstructive pulmonary disease (COPD). Exercise training is a cornerstone of PR programs, Inspiratory muscle training, neuromuscular electrical stimulation (NMES) are effective in selected patients. Water-based rehabilitation and tai chi are well tolerated recent modalities. Although there is an absence of a specific PR protocol for special conditions, PR is recommended before and also after endobronchial volume reduction (EBVR), lung volume reduction surgery (LVRS), both before and after lung transplantation periods, before, after surgery, during the intensive care unit (ICU) period, the chemotherapy period and as a component of palliative care. After COPD exacerbation, it is recommended within 3 weeks of hospital discharge. Modifying PR programs while considering comorbidities might lead to greater improvement in outcomes. After PR, the important points are to follow prescribed home exercise programs, control programs in the PR center/unit, and being more active in daily living life for the purpose of preserving improvements. Tele-PR is an alternative to conventional modalities due to similar improvements. Although PR is effective, it is an underutilized resource. The awareness of PR should be increased in patients and among health professionals.

Is there enough room for non-invasive ventilation in pulmonary rehabilitation?

“…COPD exacerbations are known to deteriorate life quality, to enhance disease progression and increase mortality [12]. Acute respiratory failure leading to acute or acute-on-chronic respiratory acidosis, develops when the respiratory muscles fall to achieve adequate alveolar ventilation despite high levels of diaphragmatic activity [28] and when appear alterations in central ventilatory control [18].…”

“…After successfully completing a course of PR, the only way to maintain the achieved improvements is to continue with a home-based exercise programme and participate to follow-up visits in the PR centre. The scope is to make chronic respiratory patients to become more active in daily living life and to preserve endurance capacity, psychological and cognitive benefits [12]. NIV can be used for long-term treatment of chronic respiratory failure at home.…”

“…Multidisciplinary PR is a key component in the management of COPD [5], and has proved to be beneficial in patients with COPD in terms of improving exercise capacity, symptoms (as breathlessness, fatigue, and mood) and HRQoL [14,15]; it reduces health care utilization, being one of the most cost-effective therapeutic strategies [5,12]. PR is addressed to stable patients especially with moderate-to-severe disease, after an acute exacerbation, in intensive care unit, in perioperative period after a lung transplantation, before and after lung cancer surgery, and before endobronchial lung volume reduction [12]. It can be offered in a hospitalbased outpatient setting, in an inpatient setting, a community-based setting and at the patient's home [4].…”

“…Exercise training is the cornerstone in PR programmes and the best approach for increasing muscle strength, decreasing symptoms, reducing mood abnormalities, improving cardiovascular function and the motivation for physical activity [12]. The target training intensity in the PR exercise setting is critically dependent on baseline exercise testing, which is associated with a learning effect [16].…”

“…The target training intensity in the PR exercise setting is critically dependent on baseline exercise testing, which is associated with a learning effect [16]. The main components of exercise training programmes are endurance and resistance training that should be practised supervised at least twice weekly, more than 60% to 80% of the maximal work rate, delivered as high-intensity and dynamic, interval and continuous training [9,12,13,17]; in parallel with these supervised sessions, there are recommended five unsupervised sessions of 30 min of PA per week, in line with standard healthy living advice [17]. Typical modes of aerobic exercise are walking or cycling [13].…”