TY - JOUR T1 - Whither pulmonary rehabilitation? Will alternative modes help or hurt? JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01678-2018 VL - 52 IS - 4 SP - 1801678 AU - Richard Casaburi Y1 - 2018/10/01 UR - http://erj.ersjournals.com/content/52/4/1801678.abstract N2 - Chronic obstructive pulmonary disease (COPD) causes great misery to those afflicted. While it would be nice to think that a cure is near at hand, this remains only a distant dream. Symptom relief is the best we can do for the time being. We look for therapies to provide important patient-centred benefits such as improved exercise tolerance, reduced dyspnoea and better health-related quality of life. When we consider available therapies, we might consider comparing the magnitude of benefits of bronchodilators with those of pulmonary rehabilitation. A recent informal comparison of these benefits gleaned from meta-analyses in the literature reveals that, for exercise tolerance, dyspnoea and quality of life, the yield of pulmonary rehabilitation is several-fold greater than for bronchodilators [1]. In this analysis, pulmonary rehabilitation benefits well exceed thresholds of clinical importance in all three of these domains. Moreover, over the past 25 years, pulmonary rehabilitation has gained a bulletproof physiological basis [2, 3]; the strategies employed, especially in the area of exercise training, are highly evidence-based.Pulmonary rehabilitation is available to only a sliver of COPD patients. Studies have explored less resource intensive approaches. Unless they prove to be at least as effective, traditional pulmonary rehabilitation availability may be further reduced. http://ow.ly/fyh930lYFo2 ER -