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Benefits of Pulmonary Rehabilitation

The benefits of pulmonary rehabilitation are often observed even in irreversible respiratory disorders, because most of the handicap and disability results not from the pulmonary illness per se but instead from secondary co-morbidities that are treatable if diagnosed and recognized. Whereas the degree of hyperinflation or airway obstruction of chronic obstructive pulmonary disease (COPD) does not change noticeably with pulmonary rehab, reversal and improvement of muscle deconditioning and better exercise pacing enables patients to walk farther and with less shortness of breath.

Pulmonary rehabilitation programs include early recognition, prevention and treatment of morbidities, outpatient, inpatient and continued extended primary care of patients with chronic respiratory illness. The forecasted patient outcomes of a multidisciplinary pulmonary rehabilitation program include improved Quality of Life (QOL), increased independence as well as shorter hospitalization time and fewer hospitalizations.

Disease, disability, impairment and handicap

• Disease is a pathologic happening in the body with a unique set of signs and symptoms, often resulting in dysfunction or impairment. The dysfunction may lead to physical and social functional deficits.
• Impairment is any limitation, loss and/or abnormality of physical, psychological or anatomical function or structure.
• Disability is any limitation or lack of ability (as a result of impairment) in mind with performance of an activity within the range that is regarded normal for a human being. Dysfunction of activities of daily living (ADL) has an outcome on the ability of the person to live independently.
• A handicap is a hardship for a person, resulting from an disability or an impairment that prevents or limits the achievement of a role that is normal for that person.

For people with respiratory impairment, disability can be secondary to muscle deconditioning, poor exercise endurance, cardiopulmonary or primary skeletal pathology, or a combination of impairments. The patient can be handicapped further by inadequate family support or education and inadequate finances.

Benefits

A successful rehabilitation program differentiates and identifies the disease processes (impairments, disabilities, handicaps) so that primary strategies can be derived. The functional results of these impairments are labeled so that the patient with chronic pulmonary impairment is returned to the optimal mental, physical, economic and social independence. The performance of a multidisciplinary pulmonary rehabilitation program has been determined by controlled clinical trials.

Several impairments, for instance dysfunction of respiratory and peripheral muscles, weakness, abnormalities of nutrition and anxiety and depression, have shown clinical response to treatment. Overall progression with exertional dyspnea as well as improved QOL, have been documented. Compelling improvement in maximal exercise endurance, as measured during exercise testing (6-minute walk test) has been observed.
In the only randomized studies that have been conducted, survival betterment was not indicated, likely because of the inability to distinguish the difference. Controlled trials showed a lower use of health care resources after rehabilitation, evidenced by a reduced number of hospitalizations and physician office or emergency department visits.

Despite not conclusively proven the outcome of pulmonary rehabilitation in patients without COPD may be considerable. Retrospective examination has shown no substantial difference in improvement in QOL or exercise/endurance tolerance following pulmonary rehabilitation in non-COPD versus COPD patients. Consequently, pulmonary rehabilitation is beneficial for patients with impairment due to any chronic pulmonary disease, not just Chronic Obstructive Pulmonary Disease.

Pulmonary rehabilitation may improve prognosis in people who experience COPD exacerbation. Evidence from trials suggests that pulmonary rehabilitation is beneficial in COPD patients following acute exacerbation.