Pulmonary Rehabilitation

Rehabilitation programs for patients with chronic obstructive pulmonary disease (COPD) have existed for more than 30 years. The American College of Chest Physicians in 1974 defined pulmonary rehabilitation and described aspects of care for patients with respiratory impairments. The American Thoracic Society incorporated these into an official position statement in 1981. More recently, the 2006 American Thoracic Society and the European Respiratory Society Statement on Pulmonary Rehabilitation stated, “Pulmonary rehabilitation is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease.” Most of the research available has addressed the benefits of rehabilitation for patients with COPD while neglecting rehabilitation outcomes for patients with other chronic respiratory diseases such as restrictive lung diseases, spinal and chest deformities, neuromuscular conditions that lead to respiratory failure, pulmonary vascular diseases, and those that affect the very obese. Early research in the area of pulmonary rehabilitation focused on the lack of improvement, as documented by pulmonary function testing, or the failure to reverse the natural progression of the disease process. Today, many successful pulmonary rehabilitation programs exist and the need for early detection and treatment of respiratory dysfunction is widely accepted. Rehabilitation research now emphasizes symptom improvement, functional and exerChoosing Goals and Outcomes in Pulmonary Rehabilitation Structure of the Pulmonary Rehabilitation Program The Pulmonary Rehabilitation Team Program Components Patient Candidacy Physical Therapy Management Patient Evaluation Procedures Chart Review Patient Interview Patient Examination Treatment Intervention Airway Clearance Functional Training Physical Conditioning Endurance Training Strength Training Flexibility Respiratory Muscle Exercise Exercise Considerations for Different Stages of Lung Diseases Case Study Summary References