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Pulmonary rehabilitation

Pulmonary rehabilitation is a multidisciplinary intervention designed to optimize the physical and social performance of individuals with chronic respiratory diseases.
The pathophysiology of pulmonary rehabilitation centers on addressing the impairments associated with chronic respiratory conditions. These include skeletal muscle dysfunction, exercise intolerance, and deconditioning. Risk factors such as smoking, occupational exposure, and age contribute to the development of these conditions. Pulmonary rehabilitation, through its components of exercise training, education, and behavioral intervention, can effectively manage these impairments and improve patient outcomes.
The epidemiology of pulmonary rehabilitation is closely tied to the prevalence and incidence of chronic respiratory conditions, particularly COPD and asthma.
Disease course
The primary objectives of pulmonary rehabilitation are to reduce symptoms, improve functional capacity, and increase the patient's participation in everyday activities. Key components of pulmonary rehabilitation include exercise training, education, and behavior change support.
Prognosis and risk of recurrence
Patient-related factors play a significant role in the prognosis of pulmonary rehabilitation. These include age, comorbidities, and baseline lung function. Adherence to the program is a key determinant of the success of pulmonary rehabilitation.
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).


1.Diagnostic investigations

Evaluation for comorbidities: 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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2.Medical management

Indications, stable outpatients: 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

3.Nonpharmacologic interventions

Smoking cessation: 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

4.Therapeutic procedures

Neuromuscular electrical stimulation: 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.

5.Specific circumstances

Patients with asthma: 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

6.Patient education

General counseling: 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.

7.Follow-up and surveillance

Indications for specialist referral: 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