Pulmonary rehabilitation--from guidelines to practice.

Pulmonary rehabilitation is an integral part of clinical management and health maintenance of patients with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical therapy. It is a spectrum of evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory problems. Most evidence for the efficacy of respiratory rehabilitation is for patients with chronic obstructive pulmonary disease but there are encouraging results for extending its indications. Current programs of pulmonary rehabilitation are based on guidelines which formally grade the level of scientific evidence and on practical recommendations developed by several prestigious societies. The main components of a pulmonary rehabilitation program are patient selection and assessment, exercise training, education and self-management of the disease, psychosocial and behavioral intervention, nutritional support, outcome assessment and enhancement of long-term adherence to the rehabilitation recommendations. Exercise training is the central component of respiratory rehabilitation, aiming at physical reconditioning, and upper and lower limb muscle training, using several strategies to optimize training. Outcome assessment is an integral part of the program including the measurement of several valid, interpretable and easy to administer parameters. The beneficial effects of pulmonary rehabilitation are the improvement of dyspnea and degree of physical and social disability, less hospitalizations and exacerbations, better overall quality of life by increasing independence.