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pulmonary rehabilitation

Indications: 1) disorders a) chronic obstructive pulmonary disease (COPD; chronic bronchitis &/or emphysema) - recommended for symptomatic patients with COPD & FEV1 < 50% of predicted - effective in patients with advanced COPD [3] - hospitalization for COPD exacerbation regardless of lung function [13] - reduces rate of rehospitalizations after COPD exacerbation [10] - repeated courses or continuous pulmonary rehabilitation of value [3] b) interstitial lung disease [13] - idiopathic pulmonary fibrosis* [11] c) pulmonary hypertension recommended but evidence of benefit is lacking [13] d) other indcations not specifically mention by the American Thoracic Society - asthma - bronchiectasis - cystic fibrosis - chest wall diseases - neuromuscular disorders 2) signs/symptoms a) dyspnea during rest or exertion b) hypoxemia; hypercapnia c) reduced exercise tolerance or a decline in ADLs d) worsening dyspnea with reduced but stable exercise tolerance e) chronic respiratory failure with need for mechanical ventilation f) ventilator dependency g) increasing emergency department visits, hospitalization, or unscheduled office visits 3) lung surgery for transplantation, volume reduction, or cancer * noncompletion or nonresponse predicts higher 1-year mortality in patients with idiopathic pulmonary fibrosis [11] Procedure: - 3-4 months - education - nutritional counseling - exercise training - exercise at least 3 times a week for the most benefit [NIH:NHBLI] - functional assessment - follow-up [3] - maintenance - reasonable to consider maintenance pulmonary rehabilitation [13] - evidence of sustained benefit is lacking - monthly supervised reinforcement sessions for 1 year [4] - weekly-session maintenance program for 1 year [6] - statistically significant benefit in exercise capacity for weekly-session maintenance program for 6 months, but not for 1 year [7] - regular walking of benefit [5] - in-person treatment & telerehabilitation have similar benefits

Related

pulmonary visual impairment

Specific

cardiopulmonary rehabilitation pulmonary rehabilitation for COPD

General

rehabilitation

References

  1. Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, Make B, Rochester CL, Zuwallack R, Herrerias C. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007 May;131(5 Suppl):4S-42S. Corresponding NGC guideline withdrawn Jan 2013 PMID: 17494825 http://www.chestjournal.org/content/vol131/5_suppl/index.shtml
  2. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
  4. Ries AL et al Maintenance after Pulmonary Rehabilitation in Chronic Lung Disease. A Randomized Trial. Am J Respir Crit Care Med. 2003. 167:880-888 PMID: 12505859 http://www.thoracic.org/assemblies/pr/resources/ries-maintenance-after-pr-in-copd.pdf
  5. Heppner PS1, Morgan C, Kaplan RM, Ries AL Regular walking and long-term maintenance of outcomes after pulmonary rehabilitation. J Cardiopulm Rehabil. 2006 Jan-Feb;26(1):44-53. PMID: 16617228 - Bauldoff GS1, Hoffman LA, Zullo TG, Sciurba FC. Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli. Chest. 2002 Sep;122(3):948-54. PMID: 12226037
  6. Roman M et al Efficacy of pulmonary rehabilitation in patients with moderate chronic obstructive pulmonary disease: a randomized controlled trial. BMC Family Practice 2013, 14:21 http://www.biomedcentral.com/1471-2296/14/21
  7. Beauchamp MK, Evans R, Janaudis-Ferreira T, et al. Systematic review of supervised exercise programs after pulmonary rehabilitation in individuals with COPD. Chest. 2013;144:1124-1133 PMID: 2342993
  8. Goldstein RS, Hill K, Brooks D, Dolmage TE. Pulmonary rehabilitation: a review of the recent literature Chest. 2012 Sep;142(3):738-49 PMID: 22948578
  9. Spruit MA, Singh SJ, Garvey C et al An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13-64 PMID: 24127811
  10. Stefan MS, Pekow PS, Priya A et al. Association between initiation of pulmonary rehabilitation and rehospitalizations in patients hospitalized with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2021 Nov 1; 204:1015. PMID: 34283694 https://www.atsjournals.org/doi/10.1164/rccm.202012-4389OC
  11. Nolan CM et al. Pulmonary rehabilitation in idiopathic pulmonary fibrosis and COPD: A propensity-matched real-world study. Chest 2022 Mar; 161:728 PMID: 34699771 PMCID: PMC8941605 Free PMC article https://journal.chestnet.org/article/S0012-3692(21)04208-2/fulltext
  12. NIH: National Heart, Lung and Blood Insitutue (NHLBI) Pulmonary Rehabilitation http://www.nhlbi.nih.gov/health/health-topics/topics/pulreh/
  13. Rochester CL et al. Pulmonary rehabilitation for adults with chronic respiratory disease: An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med 2023 Aug 15; 208:e7. PMID: 37581410 PMCID: PMC10449064 Free PMC article https://www.atsjournals.org/doi/10.1164/rccm.202306-1066ST