Marian Benjamin

Pulmonary rehabilitation experts have been hard at work updating guidelines that have not been revised in 10 years. Andrew L. Ries, MD, MPH, and colleagues from the ACCP and AACVPR reviewed literature published between 1996 and 2004 and have come up with new recommendations as well as support for existing guidelines.

The new evidence supports the benefits of longer-term rehabilitation, maintenance strategies following rehabilitation, incorporating education and strength training into pulmonary rehabilitation, and the use of supplemental oxygen.

What the evidence does not support is inspiratory muscle training, anabolic drugs, or nutritional supplementation.

According to Ries, pulmonary rehabilitation “has emerged as a recommended standard of care for patients with chronic lung disease based on a growing body of scientific evidence.” He adds that since 1997 the published literature in pulmonary rehabilitation has increased substantially.

Editor’s note: For more on Pulmonary Rehab, read “Patients Win, Health Care Wins, Taxpayers Save” from the February 2005 issue of RT.

Some of the panel’s findings are:

COPD patients will benefit from a program of exercise training of the muscles of ambulation, and although low and high-intensity training produce clinical results, higher exercise intensity is associated with greater physiologic improvement, compared with lower intensity training.

In patients with COPD, pulmonary rehabilitation improves the symptoms of dyspnea, improves health-related quality of life, and reduces the number of hospital days and other types of health care utilization. Rehabilitation has also been shown to improve symptoms of depression that often accompany COPD.

What pulmonary rehabilitation cannot promise is improved survival among patients with COPD.

But while they are alive, patients can enjoy a fuller, healthier life both physically and psychologically.

Merely updating and revising pulmonary rehabilitation guidelines isn’t enough, however, because although patients do improve when in a structured rehabilitation program, its benefits are often lost when they leave the program. They do not keep up with their exercise regimen or employ other strategies to prevent exacerbations that they learned while in a program. This is where maintenance comes in. Encourage your patients to to form an action plan and continue using the strategies they have learned in their pulmonary rehabilitation programs. Tell them to join a better breathers club, take a brisk walk, lift some weights. Not only will they breathe better, they will feel better and have a shot at a full, active life.

—Marian Benjamin
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