Pulmonary rehabilitation is a 6 to 12 week programme of education and exercise to help people with chronic breathing problems such as COPD, to manage breathing problems, increase stamina (energy) and decrease breathlessness.
Key points
- Pulmonary rehabilitation is proven to be effective in improving the quality of life and reducing hospital admissions of people with chronic obstructive pulmonary disease (COPD).
- Other chronic respiratory conditions it can be used for include sarcoidosis, bronchiectasis, idiopathic pulmonary fibrosis and cystic fibrosis.
- The programmes focus on education and exercise. They teach you how you can look after yourself with what you have learnt after the programme ends.
What does pulmonary rehabilitation involve?
Pulmonary rehabilitation classes are run by physiotherapists and respiratory teams. They are often held at local hospitals or community centres 2 or 3 times per week. The two main components of a pulmonary rehabilitation programme are exercise and education.
Exercise
An individual exercise programme is designed for you and takes into account your condition and any other illnesses you might have. The programme is gentle at first and as your fitness improves, you may be asked to do a little more each time. You also may be advised to follow a home exercise programme, so that when the programme ends you will know how to continue exercising at home to stay fit.
If you prefer not to exercise, the physiotherapist can discuss other activity options such as Sing your lungs out, a community-based singing group for people with lung disease.
Education
The education session covers information and tips on topics such as:
- your lung disease or condition and how to manage it
- how to eat a healthy and balanced diet
- energy-conserving techniques
- breathing strategies
- psychological counselling and/or group support.
What are the benefits of pulmonary rehabilitation?
Attending a programme can't cure your lung disease or completely ease your breathing problems, but it can help you function better in your daily life. Pulmonary rehabilitation is proven to be effective in improving the quality of life and reducing hospital admissions of people with COPD.
Taking part in pulmonary rehabilitation can improve your fitness so you feel more confident to do things. It can improve your muscle strength so you can use the oxygen you breathe more efficiently and help you cope better with feeling out of breath. It can also help you feel better mentally.
If you continue to smoke, you can still benefit from attending pulmonary rehabilitation, as the programme focuses on improving quality of life.
How do I find in a pulmonary rehabilitation programme?
Ask your GP or nurse about a pulmonary rehabilitation programme in your area. There are a range of programmes around the country, including some offered by local DHBs or branches of the Asthma & Respiratory Foundation that are tailored for Māori or Pasifika people.
Alternatively you can search for a service in your area here: Services (type the words pulmonary rehabilitation in the search box).
Learn more
The following links have more information about pulmonary rehabilitation. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Pulmonary rehabilitation NIH: National Heart, Lung, and Blood Institute
Pulmonary rehabilitation Australian Lung Foundation
References
- Pulmonary rehabilitation for people with COPD BPAC, NZ, 2017
Key practice points
- Pulmonary rehabilitation is an umbrella term for a structured programme which offers supervised exercise and education to patients with COPD, usually over a period of eight weeks
- Pulmonary rehabilitation is known to relieve dyspnoea and fatigue, improve mental health and quality of life, and increase the sense of control that patients with COPD have over their health while reducing their risk of hospitalisation
- All symptomatic patients with COPD will benefit from pulmonary rehabilitation, particularly:
- At diagnosis
- After discharge from hospital following an exacerbation
- When symptoms are progressively deteriorating
- Health professionals may need to use creative strategies to adapt the basic components of pulmonary rehabilitation for patients unable to attend formal programmes
|
| BPAC, Pulmonary rehabilitation May 2017 |
Resources for health professionals
Pulmonary rehabilitation for people with COPD BPAC, May 2017
Pulmonary rehabilitation toolkit Australian Lung Foundation
Pulmonary rehabilitation NIH: National Heart, Lung, and Blood Institute
Pulmonary rehabilitation Australian Lung Foundation
Definition of pulmonary rehabilitation
Pulmonary rehabilitation is defined as:
“..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 individualised treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimise functional status, increase participation, and reduce health care costs through stabilising or reversing systemic manifestations of the disease” (1).
PR is evidence-based for COPD
A Cochrane review 31 randomised controlled trials confirms the benefit of pulmonary rehabilitation. Statistically significant improvements were found for all the outcomes. In four important domains of QoL (dyspnea, fatigue, emotions and patients' control over disease), the effect was larger than the minimal clinically important difference. These results strongly support respiratory rehabilitation as part of the spectrum of management for patients with COPD. (2)
A further Cochrane review looked at whether pulmonary rehabilitation was safe after a hospital admission with a COPD exacerbation and concluded that pulmonary rehabilitation reduced hospital admissions and mortality compared with usual community care (no rehabilitation). Quality of life was also improved. Pulmonary rehabilitation appears to be a highly effective and safe intervention in COPD patients after suffering an exacerbation. (3)
Poor referral rates
Pulmonary rehabilitation is a proven self-management program that is effective in improving the quality of life and reducing hospital admissions of people with COPD. However, a recent study show that only 1% of COPD patients who could benefit from pulmonary rehabilitation have access to it each year in NZ. (4)
Making sure your patients attend a pulmonary rehabilitation programme is one of the most useful treatments you can offer your patients with COPD.
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
References
- Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med 2006; 173: 1390–1413
- Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2006, Issue 4. Abstract
- Puhan MA, Gimeno-Santos E, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD005305.
- Levack, WMM. Weatherall, M. et al. Uptake of pulmonary rehabilitation in New Zealand by people with chronic obstructive pulmonary disease in 2009. NZMJ 20 December 2012, Vol 125 No 1348.23-33.
