GUEST EDITORIAL Pulmonary rehabilitation: The critical outcomes

Chronic obstructive pulmonary disease (COPD), the only major chronic disease with increasing mortality [1], poses significant health care burden and resource use [2]. Pulmonary rehabilitation—a multidisciplinary, 6 to 8 week outpatient intervention that combines exercise with educational, behavioral, and psychosocial support—has emerged over the past decade as the gold standard for COPD care. National and international guidelines for COPD recommend pulmonary rehabilitation for its proven efficacy. The purpose of this Journal of Rehabilitation Research and Development special edition is to highlight three critical outcomes of a comprehensive pulmonary rehabilitation program: smoking cessation, symptom relief, and improved functional performance. Smoking cessation is the only intervention to slow COPD long-term decline in lung function. Sherman, Lanto, Nield, and Yano, in “Smoking cessation care received by veterans with chronic obstructive pulmonary disease,” compared tobacco cessation outcomes between smokers with and without COPD in 18 VA primary care clinics. They found that even though smokers with COPD reported receiving more smoking cessation services than smokers without COPD, the smoking quit rate was the same. Smokers who reported they were not even interested in quitting had actually received the most cessation services, which suggests the need for more creative approaches to motivate these smokers not interested in quitting. Dyspnea (shortness of breath) and fatigue are closely related symptoms in chronic lung disease that are consistently encountered in the clinical arena. Their presence negatively impacts health-related quality of life. Meek and Lareau describe methods for their assessment and outcome evaluation in “Assessment and evaluation of dyspnea and fatigue.” Chronic dyspnea may be relieved by both pharmacologic and nonpharmacologic methods. The focus of “Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD),” by Gosselink, is breathing techniques traditionally used in pulmonary rehabilitation. Recommendations for practice, based on a critical review of the literature, are pursed-lips breathing, forward leaning position, and inspiratory muscle training. An innovative approach for examining dyspnea relief strategies is presented by Collins and colleagues in “Effect of ventilation-feedback training on endurance and perceived breathlessness during constant work-rate leg cycle exercise in patients with COPD.” The findings of decreased breathing frequency and prolonged expiratory time suggest that dynamic hyperinflation, one reason for dyspnea during exercise for COPD patients, may be reduced when ventilation feedback with exercise is used during pulmonary rehabilitation. Margaret Nield, PhD, RN Rehabilitation Research Advanced Career Development Award Fellow, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, West Los Angeles, Pulmonary and Critical Care. Associate Investigator, VA Health Services Research and Development Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, CA