New horizons for pulmonary rehabilitation

Abstract

Background: Pulmonary rehabilitation is a cornerstone of management for people with chronic obstructive pulmonary disease (COPD). Recent studies suggest that the traditional model for pulmonary rehabilitation, which focuses on centre-based programs for stable patients, could be broadened.Objectives: To examine evidence for inclusion of new patient populations, different settings and updated outcomes in pulmonary rehabilitation.Major findings: Pulmonary rehabilitation that is commenced early following an acute exacerbation of COPD results in fewer hospital readmissions and reduced mortality. This calls for program models that allow recovering patients to participate without delay. Patients with interstitial lung disease achieve modest benefits from pulmonary rehabilitation and participation should be encouraged in clinically stable patients. Advances in medical therapies for pulmonary arterial hypertension allow patients to achieve clinical stability, providing opportunity to safely engage in exercise training. These challenging groups require consideration of appropriate program content, exercise intensity and monitoring. Despite the known benefits, many patients with COPD do not participate in pulmonary rehabilitation. Increased understanding of the barriers to participation is required to ensure that pulmonary rehabilitation is accessible. Home-based rehabilitation achieves equivalent outcomes to centre-based rehabilitation and may provide new options for debilitated patients. The emergence of physical activity as an important marker of prognosis in COPD challenges clinicians to ensure that gains in exercise capacity are translated into increased daily life activity.Conclusions: The benefits of pulmonary rehabilitation extend to a wider group of patients than was previously understood. Flexible program models that facilitate participation for all those who can benefit are required.