Pulmonary rehabilitation for chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) describes a chronic lung condition that prevents the air supply from getting to the lungs. Symptoms include breathlessness, coughing, tiredness and frequent chest infection. Worldwide, COPD is a major cause of ill health.
Pulmonary rehabilitation programmes include exercise as a key component; some programmes contain other interventions such as assessment, education, psychological support and dietary advice. Pulmonary rehabilitation is one of the key recommended approaches in the treatment of COPD. This review compared the impact of pulmonary rehabilitation versus usual care on the health-related quality of life of people with COPD. We included 65 studies involving 3822 participants. Participants were randomly assigned to receive pulmonary rehabilitation or usual care. The quality of the studies was generally good.
This review highlights that pulmonary rehabilitation improves the health-related quality of life of people with COPD. Results strongly support inclusion of pulmonary rehabilitation as part of the management and treatment of patients with COPD.
Future studies should concentrate on identifying the most important components of pulmonary rehabilitation, the ideal length of a programme, the intensity of training required and how long the benefits of the programme last.
Alison, J.A., McKeough, Z.J., Johnston, K., McNamara, R.J., Spencer, L.M., Jenkins, S.C., Hill, C.J., McDonald, V.M., Frith, P., Cafarella, P., Brooke, M., Cameron-Tucker, H.L., Candy, S., Cecins, N., Chan, A.S.L., Dale, M., Dowman, L.M., Granger, C., Halloran, S., Jung, P., Lee, A., Leung, R., Matulik, T., Osadnik, C., Roberts, M., Walsh, J., Wootton, S., Holland, A.E. On behalf of the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand (2017) Australian and New Zealand Pulmonary Rehabilitation Guidelines. Respirology, doi: 10.1111/resp.13025
Plain language summary of evidence:
Pulmonary rehabilitation (PR) that includes exercise training is considered to be a key component of the management of people with COPD and has been shown to reduce symptoms of breathlessness and fatigue, improve health-related quality of life (HRQoL), and may reduce hospital readmissions after an exacerbation. The Australian and New Zealand Pulmonary Rehabilitation Guidelines provide evidence-based recommendations for the practice of PR specific to Australian and New Zealand healthcare contexts.
Summary of Key Recommendations:
Who should access pulmonary rehabilitation?
- People with stable COPD of all severities i.e mild, moderate or severe.
- People with COPD after a hospitalisation for an exacerbation (ideally PR should be accessed within two weeks of hospital discharge).
- People with bronchiectasis, interstitial lung disease or pulmonary hypertension.
Yang IA, Brown JL, George J, Jenkins S, McDonald CF, McDonald V, Smith B, Zwar N, Dabscheck E. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2018. Version 2.54, June 2018.
O6.1 Pulmonary rehabilitation. Non-pharmacological strategies (such as pulmonary rehabilitation and regular exercise) should be provided to all patients with COPD [evidence level I, strong recommendation]
Pulmonary rehabilitation programs involve patient assessment, supervised exercise training, education, behaviour change, nutritional intervention and psychosocial support (Spruit 2013). The aim of pulmonary rehabilitation is to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviours (Spruit 2013). Exercise training is considered to be the cornerstone of pulmonary rehabilitation (Spruit 2013)