Pulmonary rehabilitation is a medically supervised self-management programme lasting 6 to 12 weeks to help people who have chronic breathing problems.
It is one of the few treatments options proven to be effective in improving the quality of life and reducing hospital admissions of people with chronic obstructive pulmonary disease (COPD).
Pulmonary rehabilitation classes are run by physiotherapists and respiratory teams and are often held at local hospitals or community centres 2 or 3 times per week. Topics usually include:
exercise training — tailored for you
nutritional counselling
education on your lung disease or condition and how to manage it
energy-conserving techniques
breathing strategies
psychological counselling and/or group support.
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 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
“..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:
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
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.
