Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient. Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient's needs, and may or may not include pharmacologic intervention.
Medical uses
The NICE clinical guideline on chronic obstructive pulmonary disease states that “pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD ”. It is indicated not only in patients with COPD, but also in:
*Average reduction in quadriceps strength decreased by 20-30% in moderate to severe COPD
*Reduction in the proportion of type I muscle fibres and an increase in the proportion of type II fibres compared to age matched normal subjects
*Reduction in capillary to fibre ratio and peak oxygen consumption
*Reduction in oxidative enzyme capacity and increased blood lactate levels at lower work rates compared to normal subjects
*Prolonged periods of under nutrition which results in a reduction in strength and endurance
Respiratory muscle dysfunction
Background
Pulmonary rehabilitation is generally specific to the individual patient, with the objective of meeting the needs of the patient. It is a broad program and may benefit patients with lung diseases such as chronic obstructive pulmonary disease, sarcoidosis, idiopathic pulmonary fibrosis and cystic fibrosis, among others. Although the process is focused on the rehabilitation of the patient him/herself, the family is also involved. The process typically does not begin until a medical exam of the patient has been performed by a licensed physician. The setting of pulmonary rehabilitation varies by patient; settings may include inpatient care, outpatient care, the office of a physician, or the patient's home. Although there are no universally accepted procedure codes for pulmonary rehabilitation, providers usually use codes for general therapeutic processes. The goal of pulmonary rehabilitation is to help improve the well-being and quality of life of the patient and their families. Accordingly, programs typically focus on several aspects of the patient's recovery and can include medication management, exercise training, breathing retraining, education about the patient's lung disease and how to manage it, nutrition counseling, and emotional support.
Exercise is the cornerstone of pulmonary rehabilitation programs. Although, exercise training does not directly improve lung function, it causes several physiological adaptations to exercise which can improve physical condition. There are three basic types of exercises to be considered. Aerobic exercise tends to improve the body's ability to use oxygen by decreasing the heart rate and blood pressure. Strengthening or resistance exercises can help build strength in the respiratory muscles. Stretching and flexibility exercises like yoga and Pilates can enhance breathing coordination. As exercise can trigger shortness of breath, it is important to build up the level of exercise gradually under the supervision of health care professionals. Additionally pursed lip breathing can be used to increase oxygen level in patient's body. Breathing games can be used to motivate patients to learn pursed lip breathing technique.
Guidelines
have been issued by various regulatory authorities.
