O6.4 Pulmonary rehabilitation

Pulmonary rehabilitation reduces dyspnoea, fatigue, anxiety and depression, improves exercise capacity, emotional function and health-related quality of life and enhances patients’ sense of control over their condition [evidence level I]

Pulmonary rehabilitation reduces hospitalisation and has been shown to be cost-effective [evidence level II]

Pulmonary rehabilitation programs involve patient assessment, exercise training, education, nutritional intervention and psychosocial support. (Nici et al., 2006) An online toolkit is available to assist health professionals to implement a Pulmonary Rehabilitation Program. See www.pulmonaryrehab.com.au

Pulmonary rehabilitation is one of the most effective inter­ventions in COPD(Lacasse et al., 2006),(Ries et al., 2007) and has been shown to reduce symptoms, disability and handicap, reduce hospitalisation (Griffiths et al., 2000), (Griffiths et al., 2001) and to improve function by:

• improving peripheral muscle function, cardiovascular fitness, muscle function and exercise endurance (Lacasse et al., 2006),(Ries et al., 2007), (Troosters et al., 2005);
• enhancing the patient’s emotional function, self-confidence and coping strate­gies, and improving adherence with medications (Morgan et al., 2001), (Lacasse et al., 2006);
• improving mood by controlling anxiety and panic, decreas­ing depression, and reducing social impediments (Ries et al., 2007).

Pulmonary rehabilitation should be offered to patients with moderate to severe COPD, but can be relevant for people with any long-term respiratory disorder character­ised by dyspnoea. (Nici et al., 2006), (Ries et al., 2007) Exercise programs alone have clear benefits,(Lacasse et al., 2006) while the benefits of education or psychosocial support without exercise training are less well documen­ted. (Ries et al., 2007), (Nici et al., 2006) Comprehensive programs incorporating all three interventions have the greatest benefits (see below).

Most research has been undertaken with hospital-based programs, but there is also evidence of benefit from rehabilitation provided to in-patients and in the community and home settings.(Nici et al., 2006), (Wijkstra et al., 1994),(Wijkstra et al., 1995), (Ries et al., 2007), (Maltais et al., 2008) The minimum length of an effective rehabilitation program that includes exercise training is six weeks; however, there is some evidence of dose response-effect with longer programs producing greater and more sustained benefits in exercise tolerance (Ries et al., 2007) [evidence level II].

A list of pulmonary rehabilitation programs known to The Australian Lung Foundation can be accessed at http://www.lungfoundation.com.au/professional-resources/pulmonary-rehabilitation-co-ordinators/programs. The individual contact details can be obtained by calling the Lung Foundation’s Information and Support Centre (free-call 1800 654 301)