Personalised pulmonary rehabilitation in COPD

Abstract

This review summarises ongoing developments in personalised medicine and individualised medicine in chronic obstructive pulmonary disease (COPD). Currently applied classification systems largely ignore the complexity and heterogeneity of the COPD syndrome. Personalised medicine has to consider the influence of unique circumstances of the person, which contribute to this heterogeneity and complexity. Pulmonary rehabilitation is described as a comprehensive, individualised intervention based on thorough assessment of identifiable treatable traits. Partnership in care will become a crucial factor to improve and maintain health. Tolerating uncertainty and unpredictability will enrich future doctor-patient relationships.

Patient assessment and selection for pulmonary rehabilitation

“…Additional factors such as medical co‐morbidities, anxiety, depression, coping strategies, disease knowledge and general health literacy, self‐efficacy, disease exacerbations, complex medication regimens, supplemental oxygen and/or NIV (where needed), hospitalizations and healthcare costs all influence the ultimate impact of the disease on the patient. PR is, indeed, an opportunity to provide individualized, personalized treatment to address many of these issues . As such, where possible, assessment and outcomes measurement regarding these and/or other additional patient features are desirable.…”

“…Importantly, patients have a wide spectrum of needs from PR. Some may principally require exercise training and symptom management, whereas others who are medically complex with multi‐morbidity may require a PR programme with multidisciplinary staff as well as the ability to assess a broader base of patient characteristics, undertake a more comprehensive set of rehabilitation interventions and measure a broader range of PR outcomes . In general, however, patient assessment and outcomes measurement are necessary to assess and monitor patients' progress, ensure patients' safety, ensure quality and safety of the PR programme, enable quality improvement initiatives and ensure payer/insurance reimbursement for PR services .…”

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

“…However, several gaps in our knowledge remain and need to be addressed in future research. While PR assessment and interventions are aimed to provide a comprehensive and individualised treatment91 and recent meta-analysis and guidelines confirmed the overall benefits of PR,1 92 93 not all patients improve as a result of this intervention 94 95. Similarly, systematic reviews of palliative care interventions suggest benefit, but work is needed to identify the best intervention for individual patients 96.…”

Add‐on interventions during pulmonary rehabilitation

“…The ultimate goal of phenotyping in medicine is to allow the identification of patient groups with unique prognostic or therapeutic perspectives . This concept also addresses PR programmes as it is a unique example of personalized medicine . ‘Treatable traits’ refers to a label‐free, precision medicine approach to the diagnosis and management of chronic airway diseases in general and can be applied to the concepts of PR to guide building a modular personalized PR programme tailored to the patient.…”