Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases

Spruit, Martijn A.; Wouters, Emiel F.M.

doi:10.1111/resp.13512

Cited by 55 publications

(57 citation statements)

References 59 publications

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“…Current guidelines state that the degree of clinical complexity should determine the types of (pharmacological and non-pharmacological) interventions provided, ranging from healthy lifestyle advise combined with recommended drug therapy [16,17], up to a comprehensive, inpatient, interdisciplinary PR program for patients with multiple physical, emotional and/or social treatable traits at the time of referral [10,18].…”

Section: Current Clinical Practicementioning

confidence: 99%

Profiling of Patients with COPD for Adequate Referral to Exercise-Based Care: The Dutch Model

et al. 2020

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A loss of physical functioning (i.e., a low physical capacity and/or a low physical activity) is a common feature in patients with chronic obstructive pulmonary disease (COPD). To date, the primary care physiotherapy and specialized pulmonary rehabilitation are clearly underused, and limited to patients with a moderate to very severe degree of airflow limitation (GOLD stage 2 or higher). However, improved referral rates are a necessity to lower the burden for patients with COPD and for society. Therefore, a multidisciplinary group of healthcare professionals and scientists proposes a new model for referral of patients with COPD to the right type of exercise-based care, irrespective of the degree of airflow limitation. Indeed, disease instability (recent hospitalization, yes/no), the burden of disease (no/low, mild/moderate or high), physical capacity (low or preserved) and physical activity (low or preserved) need to be used to allocate patients to one of the six distinct patient profiles. Patients with profile 1 or 2 will not be referred for physiotherapy; patients with profiles 3-5 will be referred for primary care physiotherapy; and patients with profile 6 will be referred for screening for specialized pulmonary rehabilitation. The proposed Dutch model has the intention to get the right patient with COPD allocated to the right type of exercise-based care and at the right moment.

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Section: Current Clinical Practicementioning

confidence: 99%

Profiling of Patients with COPD for Adequate Referral to Exercise-Based Care: The Dutch Model

et al. 2020

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“…Choice of setting may aid compliance with rehabilitation; however, some review authors expressed concern that some settings (e.g. home‐based rehabilitation) may lead to variations in the amount of individual tailoring possible and may reduce the ability to address the specific needs of some patients . This has led to controversies over what can be termed ‘pulmonary rehabilitation’.…”

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“…This has led to controversies over what can be termed ‘pulmonary rehabilitation’. The review by Spruit and Wouters highlights the complex conditions that can be addressed in a sophisticated PR programme and provides food for thought about the unanswered questions relating to the potential limitations of home programmes. Troosters et al .…”

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confidence: 99%

Optimizing health in chronic lung diseases: What did we learn from the experts in pulmonary rehabilitation?

Alison

Franssen

2019

Respirology

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“…For targeted intervention strategies aiming to reduce dyspnoea through pulmonary rehabilitation or lung volume reduction procedures, understanding the pathophysiological mechanisms underlying patients' disability is paramount to mitigating symptom burden and improving health status in these patients [16]. Such targeted intervention requires an interdisciplinary cardiorespiratory approach.…”

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The Medusa faces of dyspnoea in COPD

Wouters

2019

Eur Respir J

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Exercise limitation and exertional dyspnoea are common problems in patients with a variety of chronic lung diseases, as well as with heart failure. In chronic obstructive pulmonary disease (COPD) patients, the level of patient-reported dyspnoea is used as a parameter to assess COPD, currently leading to a "one size fits all" approach, largely based on pharmacological recommendations [1]. As exertional symptoms poorly correlate even with resting measurement lung function clusters [2], a more accurate estimate of functional capacity by cardiopulmonary exercise testing (CPET) can provide information about the influences of the cardiac, respiratory, musculoskeletal and haematological systems [3]. Such assessment of the integrated cardiopulmonary response to exercise remains largely underutilised in the personalised assessment and management of patients with exercise limitation and breathlessness.The collaboration of two expert teams on exercise pathophysiology has extended our understanding considerably of this disabling problem, through a set of studies on exercise limitation in COPD patients and those with COPD and heart failure overlap. Their report is published in this issue of the European Respiratory Journal [4].

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Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases

Cited by 55 publications

References 59 publications

Profiling of Patients with COPD for Adequate Referral to Exercise-Based Care: The Dutch Model

Profiling of Patients with COPD for Adequate Referral to Exercise-Based Care: The Dutch Model

Optimizing health in chronic lung diseases: What did we learn from the experts in pulmonary rehabilitation?

The Medusa faces of dyspnoea in COPD

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