Pulmonary Rehabilitation for Respiratory Disorders Other than Chronic Obstructive Pulmonary Disease

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Key points

  • A strong scientific rationale exists for providing pulmonary rehabilitation (PR) to persons with many forms of respiratory disease other than chronic obstructive pulmonary disease.

  • Nearly all published clinical trials have shown beneficial effects of PR for such patients.

  • Evidence to date shows that PR for patients with disorders other than chronic obstructive pulmonary disease is feasible, safe, and effective.

  • PR should be provided according to a disease-relevant approach to ensure patient safety

Rationale for PR in non-COPD disorders

The scientific rationale for PR for persons with COPD is that it can stabilize or reverse many systemic manifestations of the disease, including skeletal muscle dysfunction.4, 5 Participation in PR also improves exercise capacity, reduces knowledge deficits, promotes use of long-term health-enhancing behaviors, reduces depression and anxiety,6 helps patients manage complex medical regimens and exacerbations, reduces hospitalizations,7, 8 improves patients’ QOL,1, 9 and can improve physical

Asthma

Asthma affects all age groups and is a leading cause of chronic illness in children and adults. As a result of airflow obstruction, increased work of breathing and symptom exacerbation (including exercise-induced bronchoconstriction [EIB] for some persons), patients with asthma often experience dyspnea, show less tolerance for exercise despite optimized pharmacologic therapy, and have low physical activity levels.21, 22 Poor asthma control is associated with a greater prevalence of functional

ILD/Pulmonary Fibrosis

ILD (diffuse parenchymal lung disease) is a heterogeneous group of disorders in which the lung interstitium and/or alveolar spaces are involved with varying degrees (and differing histopathologic patterns) of inflammation or fibrosis. Typical symptoms of ILD include disabling exertional dyspnea,77, 78 nonproductive cough, and fatigue, and other symptoms may also be present when the ILD is part of a systemic disease.

Patients with ILD also have reduced exercise tolerance79 and low physical

Pulmonary Hypertension (PH)

PH, defined as an elevation in mean pulmonary artery pressure above 25 mm Hg at rest or higher than 30 mm Hg with exercise, arises from a wide variety of conditions.113 Pulmonary arterial hypertension (PAH) is a condition that results from structural remodeling of pulmonary arteries and endothelial dysfunction in the absence of underlying left-sided cardiac disease, parenchymal lung disease or direct involvement of the pulmonary venous circulation. Currently available pharmacologic therapies

Practical challenges of providing PR to persons with respiratory disorders other than COPD

Provision of PR to persons with disorders other than COPD poses several practical challenges. First, it requires PR care providers to be familiar with the anatomic, physiologic, and clinical features of, as well as treatment options for, these diverse disorders. This in turn poses the challenge of providing educational sessions and reading materials to and assessing competencies of staff members whose clinical experience may have been limited largely to caring for patients with COPD. Second,

Summary

PR is an important therapeutic intervention that should no longer be considered suitable only for patients with COPD. A strong rationale exists for providing PR to persons with a broad range of respiratory disorders other than COPD. Evidence shows that PR for these patients is feasible, safe, and effective. A disease-relevant approach should be undertaken based on individuals' needs. Further research is needed to better understand the optimal program content, duration, and outcomes measures, to

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