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Pulmonary rehabilitation

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of pulmonary rehabilitation are prepared by our editorial team based on guidelines from the British Thoracic Society (BTS 2013).
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Diagnostic investigations

Evaluation for comorbidities: as per BTS 2013 guidelines, consider initial assessment for pulmonary rehabilitation as it provides an opportunity to assess and refer for treatment of comorbidities prior to commencing.
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Medical management

Indications, stable outpatients: as per BTS 2013 guidelines, refer patients with a Medical Research Council (MRC) dyspnea score of 3-5 who are functionally limited by breathlessness for outpatient pulmonary rehabilitation.
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  • Indications, post COPD exacerbation

  • Goals of pulmonary rehabilitation

  • Duration of pulmonary rehabilitation programs

  • Bronchodilators

  • Noninvasive ventilation

  • Supplemental oxygen

  • Supplemental heliox

Nonpharmacologic interventions

Smoking cessation: as per BTS 2013 guidelines, refer patients with COPD for pulmonary rehabilitation regardless of their smoking status.
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  • Hormonal and nutritional supplements

  • Nature of exercise training

  • Frequency of exercise training

  • Interval and continuous aerobic training

  • Inspiratory muscle training

  • Supervision of pulmonary rehabilitation

Therapeutic procedures

Neuromuscular electrical stimulation: as per BTS 2013 guidelines, consider neuromuscular electrical stimulation in selected patients with low BMI and evidence of quadriceps weakness who are unable or unwilling to participate in pulmonary rehabilitation.
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Specific circumstances

Patients with asthma: as per BTS 2013 guidelines, avoid routinely referring patients with asthma for pulmonary rehabilitation.
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  • Patients with COPD

  • Patients with CVD

  • Patients with psychiatric conditions

  • Patients with non-cystic fibrosis bronchiectasis

  • Patients with ILDs

  • Patients with other chronic respiratory diseases

Patient education

General counseling: as per BTS 2013 guidelines, acquire basic knowledge about what pulmonary rehabilitation programs entail and about their effectiveness. Present pulmonary rehabilitation programs as a fundamental treatment for COPD, rather than an optional add-on.
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Follow-up and surveillance

Indications for specialist referral: as per BTS 2013 guidelines, consider the setting of pulmonary rehabilitation, skill mix of the team and other comorbidities in the risk assessment of patients entering a rehabilitation programme.
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  • Repeat pulmonary rehabilitation