Abstract
Pulmonary rehabilitation (PR) is a non-pharmacological intervention addressed to chronic obstructive pulmonary disease (COPD) and non-COPD chronic respiratory patients, a key management strategy scientifically demonstrated to improve exercise capacity, dyspnoea, health status and psychological wellbeing. The main body of literature comes from COPD patients, as they provide the core evidence for PR programmes. PR is recommended even to severe patients having chronic respiratory failure; their significant psychological impairment and potential for greater instability during the PR programme will be carefully considered by the multidisciplinary team. Optimizing medical management (e g, inhaled bronchodilators, oxygen therapy, non- invasive ventilation) may enhance the results of exercise training. Patients who already receive long-term domiciliary non- invasive ventilation (NIV) for chronic respiratory failure might exercise with NIV during exercise training if acceptable and tolerable to the patient. It is not advisable to offer long-term domiciliary NIV with the only aim to improve outcomes during PR course. There are different attempts to use both negative and positive NIV in limited clinical studies. Long-term adherence to exercise is an important goal of PR programmes and teams, targeting to translate all-domain gains of PR into increased physical activity and participation to real life. Being a reliable alternative for the future, studies should focus on pressure regimens, type of devices, acceptability and portability for everyday activities.
Highlights
Pulmonary rehabilitation (PR) is a non-pharmacological intervention addressed to chronic obstructive pulmonary disease (COPD) and non-COPD chronic respiratory patients, a key management strategy scientifically demonstrated to improve exercise capacity, dyspnoea, health status and psychological wellbeing
The results provided evidence that noninvasive positive pressure ventilation (NPPV) addition in a group of stable COPD patients reduces hypercapnia, improves overall survival, exercise capacity and health-related quality of life (HRQoL) over 1 year when comparing with guideline-oriented COPD treatment without NPPV [18]
Long-term oxygen therapy (LTOT) and non-invasive ventilation (NIV) are potentially valuable therapeutic options, especially in COPD patients with severe lung hyperinflation and exercise-induced desaturation noticed during exercise training as part of a comprehensive PR programme [16]
Summary
Pulmonary rehabilitation is described as a “comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behaviour change, designed to improve the physical and psychological condition of people with chronic respiratory disease, and to promote the long-term adherence to health-enhancing behaviours” [1]. Multidisciplinary PR is a key component in the management of COPD [5], and has proved to be beneficial in patients with COPD in terms of improving exercise capacity, symptoms (as breathlessness, fatigue, and mood) and HRQoL [14, 15]; it reduces health care utilization, being one of the most cost-effective therapeutic strategies [5, 12]. The results provided evidence that NPPV addition in a group of stable COPD patients reduces hypercapnia, improves overall survival, exercise capacity and HRQoL over 1 year when comparing with guideline-oriented COPD treatment without NPPV [18]. To low-intensity NPPV using an inspiratory pressure of 15 mBAR in controlling nocturnal hypoventilation in this population of patients [21] It is advantageous in improving dyspnoea during physical activity, lung function and HRQoL [21]. They have been reported two disadvantages of high-intensity NPPV: patients need more days in hospital to acclimatise and there is an increased expiratory leakage comparing to low-intensity NPPV [21]
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