Noninvasive Ventilation and Pulmonary Rehabilitation

Abstract

Reduced exercise tolerance and quality of life are commonly reported in chronic obstructive pulmonary disease (COPD) patients, and key elements of their pulmonary rehabilitation (PR) programmes are also represented from exercise training programmes that improve exercise tolerance (less fatigue and less dyspnoea) and quality of life of COPD patients [1] as well as reduction in healthcare use [3]. These well-proven and measurable effects have been demonstrated in stable COPD patients as well as in COPD during or after an acute exacerbation (AE) [4]. To date, publications attributable to such programmes unequivocally demonstrate the effectiveness of physical exercise in this patient population (Table 15.1). From these considerations and from the level of scientific publications, until now produced, exercise training programmes can be considered a cornerstone of PR in COPD. Exercise practice and prescription has nowadays different scopes justified from multiple complex and coexisting physiopathological backgrounds in COPD: cardiovascular and ventilatory limitation gas exchange dysfunctions, respiratory and peripheral muscle changes and not least a permanent oxidative stress status [2]. Furthermore comorbidities often present in COPD population (obesity, diabetes, neurological conditions) play a negative role in planning and then in reaching effective and long-term results [3]. Poor motivation anxiety and depression also can play an additional negative factor in the success of PR programmes. General accepted rules regarding the main outcomes for physical training in COPD patients (but also in healthy population) indicate that total training load must exceed the load encountered during daily life improving the aerobic capacity and muscle strength always reflecting the individual general features [5].