Ν. Κουλούρης, Καθηγητής Ιατρικής Σχολής ΕΚΠΑ
Ι. Βογιατζής, Αν. Καθηγητής ΣΕΦΑΑ ΕΚΠΑ
Δ. Μπούρος, Καθηγητής Ιατρικής Σχολής ΕΚΠΑ
Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease which is characterized by progressive deterioration in lung function and exercise capacity.
Pulmonary rehabilitation is defined as a “comprehensive intervention” based on thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, self-management intervention aiming at behavior change.
Pulmonary rehabilitation programmes use multidisciplinary teams to optimize physical and social functioning of patients with chronic respiratory impairment. These programmes provide rehabilitation in inpatient, outpatient, or home settings, using at least three sessions weekly (one may be unsupervised) for at least 6 weeks.
Decreases in the sensation of dyspnea, increased functional exercise capacity, and enhanced quality of life of patients with chronic obstructive pulmonary disease (COPD) are established benefits of pulmonary rehabilitation (evidence A). Moreover, reduces hospitalizations among patients who had a recent exacerbation (≤ 4 weeks from prior hospitalization) (evidence B).
Despite the availability of strong evidence to support the efficacy of pulmonary rehabilitation programmes in patients with severe COPD, third-party reimbursement policies have been inconsistent. Nonetheless, enrollment in a pulmonary rehabilitation programme is encouraged for all appropriate candidates with chronic respiratory impairment, particularly for those with severe COPD.
There is little information regarding the benefit of pulmonary rehabilitation at home. What there is differs with respect to many factors: supervision provided, severity of disease, training modalities, intensity of the programme and environment defined as ‘home’.
When compared to hospital programmes, home rehabilitation may result in smaller changes in exercise tolerance and quality of life, unless provided for a longer time with adequate supervision. However, home rehabilitation may be related to better adherence to an exercise programme and longer-term maintenance of improvements.
Applying the principles of energy conservation with respect to activities of daily living is more appropriate at home and patients will benefit from ease of access. Cost effectiveness has not been adequately researched but a group approach run at a local hospital or community center will probably be more cost effective than individual home based treatments.
Where patients are able, the best approach in terms of effective treatment is attendance at out-patient based programmes. For patients too ill to attend, however, a comprehensive home care approach can reduce hospitalisation and emergency department visits.
Overall, pulmonary rehabilitation has been designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors.
Pulmonary Rehabilitation, COPD, Quality of life, Exercise