Pulmonary prehabilitation and smoking cessation

Abstract

Purpose of reviewThis review aims to summarize the current literature on pulmonary prehabilitation programs, their effects on postoperative pulmonary complications, and the financial implications of implementing these programs. Additionally, this review has discussed the current trends in pulmonary prehabilitation programs, techniques for improving rates of perioperative smoking cessation, and the optimal timing of these interventions. Recent findingsPrehabilitation is a series of personalized multimodal interventions tailored to individual needs, including lifestyle and behavioral measures. Pulmonary prehabilitation has shown to reduce postoperative pulmonary complications (PPCs).

Exercise Effects on Health-Related Quality of Life (HRQOL), Muscular Function, Cardiorespiratory Function, and Body Composition in Smokers: A Narrative Review

“…Smoking causes elevated carbon monoxide levels in the blood, which reduces the ability of haemoglobin to carry oxygen to tissues and impairs the oxygen extraction by tissues [39]. Smoking causes ventilatory limitations, which result in an increased airway resistance and expiratory flow limitation leading to an increased breathing rate [40]. Smokers suffering from COPD have difficulty in performing their normal activities of daily living (ADL), physical activities, self-care, and hobbies [39,40], with symptoms that limit exercise, including leg fatigue, dyspnoea, and intermittent claudication [31].…”

“…Smoking causes ventilatory limitations, which result in an increased airway resistance and expiratory flow limitation leading to an increased breathing rate [40]. Smokers suffering from COPD have difficulty in performing their normal activities of daily living (ADL), physical activities, self-care, and hobbies [39,40], with symptoms that limit exercise, including leg fatigue, dyspnoea, and intermittent claudication [31]. This results in a sedentary lifestyle leading to deconditioning that further increases respiratory work related to any given task [37][38][39][40].…”

“…During exercise, severe COPD or airflow obstruction can lead to higher end-expiratory lung volume and impaired lung emptying, which worsens during the presence of any other negative risk factor (e.g., anxiety) [41], and this response of hyperinflation increases limitations of the tidal volume (Vt) response to exercise [39][40][41]. Moreover, COPD increases the elastic load on the inspiratory muscles and alters the muscle length-tension relationship forcing them into a shortened position [11].…”

“…A prolonged duration of exercise training increases the exerted workload on respiratory muscles, which results in increases in breathing rate and ventilation rates [44], which sets a higher demand for an increase in blood flow to the working respiratory muscles [44]. Various studies have reported a demand for blood flow of about 10 to 15% by the respiratory muscles during heavy exertion [39][40][41][42]. CAT predisposes an individual to the early onset of respiratory muscle fatigue due to the recruitment of additional respiratory muscles [44].…”

How much does it cost to be fit for operation? The economics of prehabilitation

“…A prehabilitation programs can include a variety of physical exercises, nutritional support, and psychological strengthening. Optimization of preoperative clinical conditions contributes to minimize the periprocedural complications and optimization of short-term follow up after surgical procedures [3][4][5][6].…”