New evidence-based guidelines from the American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommend a comprehensive pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD), citing that pulmonary rehabilitation can help improve a patient's exercise tolerance, dyspnea, and health-related quality of life, as well as decrease hospital stay and health-care utilization. Guidelines also state that pulmonary rehabilitation can be beneficial for patients with other non-COPD-related respiratory diseases, including asthma, lung cancer, and pulmonary fibrosis. The guidelines are published in the May issue of CHEST, the peer-reviewed journal of ACCP.
"COPD partially blocks the airways, making it difficult to breathe and participate in simple, everyday activities," said Andrew Ries, MD, MPH, FCCP, chair of the pulmonary rehabilitation guidelines committee. "The primary goal of pulmonary rehabilitation is to restore the patient to the highest possible level of independent function. We want patients to become more physically active and to learn more about their disease, treatment options, and how to cope." Pulmonary rehabilitation can include exercise training, education, instruction in various respiratory techniques, and psychosocial support. Research shows that pulmonary rehabilitation is appropriate for any stable patient with COPD who is disabled by respiratory symptoms.
The new guidelines, developed by an expert panel from the ACCP and AACVPR, contain recommendations about specific interventions needed for pulmonary rehabilitation, duration of rehabilitation, and benefits of rehabilitation for patients with COPD and those with other chronic respiratory diseases. The guidelines consider exercise training a mandatory aspect of comprehensive rehabilitation, stating that both low- and high-intensity exercise training produce clinical benefits for patients with COPD. Furthermore, the guidelines stress that strength and endurance training, lower and upper extremity exercise training, as well as education about self-management of the disease are integral aspects of a comprehensive pulmonary rehabilitation program.
Regarding duration, guidelines state that 6 to 12 weeks of pulmonary rehabilitation will produce benefits in several outcomes, but these benefits will decline gradually over 12 to 18 months. Longer pulmonary rehabilitation programs (beyond 12 weeks) may produce greater benefits than shorter programs.
Pulmonary rehabilitation can result in significant physical and psychosocial benefits for patients with COPD. A comprehensive rehabilitation program can improve symptoms of dyspnea, improve health-related quality of life, and decrease hospital stay and health-care utilization. Patients may also experience improved cognitive function and reduced symptoms of anxiety and depression. Guidelines also state that pulmonary rehabilitation can benefit patients with non-COPD-related chronic respiratory diseases; however, experts suggest that pulmonary rehabilitation programs be modified to include treatment strategies specific to individual diseases and patients.
"With the increasing incidence of COPD, pulmonary rehabilitation is more important than ever before," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "Although no intervention has been shown to cure COPD, pulmonary rehabilitation can help patients manage their condition and improve their ability to lead active and productive lives."
For a complete listing of the ACCP/AACPR pulmonary rehabilitation guidelines, visit the ACCP Web site at www.chestnet.org.
COPD is the fourth leading cause of death in the United States and is primarily a result of smoking. More than 12 million people are diagnosed with the disease and an additional 12 million are likely to have the disease, but are undiagnosed. Worldwide, the burden of the COPD is projected to increase substantially, paralleling the rise in tobacco use, particularly in developing countries.
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. The journal's Web site also provides public access to thousands of archived studies, dating back to 1946--a newly added feature that is free of charge. The ACCP represents 16,600 members who provide clinical respiratory care, sleep medicine, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at www.chestnet.org.