Pulmonary Rehabilitation: Role and Advances

Pulmonary rehabilitation is an integral part of the comprehensive management of patients with chronic respiratory disease. This intervention, which consists of exercise, self-management education, and nutritional and psychosocial support, improves symptoms, exercise capacity, functional status, and quality of life by targeting the multisystemic affects of chronic respiratory disease. Although the scientific evidence is strongest for its role in the treatment of stable chronic obstructive pulmonary disease (COPD), there is an increasing evidence base for its role in other diseases and settings.

The ability of pulmonary rehabilitation to impact on the systemic manifestations of chronic disease and to affect disease progression and mortality is a subject of active investigation and great clinical importance. The current issue of Seminars in Respiratory and Critical Care Medicine examines the growing evidence for pulmonary rehabilitation in nontraditional settings. The articles included in this issue are state-of-the-art reviews by leading experts in the field. Our common purpose is to apply this successful treatment strategy to situations where impairments may be similar and there is opportunity to positively impact on disability and disease.

The introductory article by Dr. Carlin provides an excellent historical perspective on the growth and application of pulmonary rehabilitation and allows the reader to appreciate the evolution of our understanding of what limits patients with chronic respiratory disease and how we can address these limitations. The article by Drs. Varadi and Goldstein examines the use and application of pharmacotherapy to extend the benefits of exercise-based pulmonary rehabilitation. Four articles in this issue examine the role of pulmonary rehabilitation in novel or nontraditional settings such as the acute COPD exacerbation (Drs. Mikelsons and Wedzicha); during critical illness (Dr. Rochester); in lung cancer patients (Dr. Nici); and as part of palliative and/or end of life care (Dr. McCormick). Although these settings are diverse, they all provide opportunity to address and optimize function such that further deterioration can be prevented or ameliorated, life-saving procedures might be pursued, or treatment can be refocused on the patient’s goals when long-term survival is not an outcome that can be impacted on.

Three articles in this issue address some of the issues that complicate care of the complex patient with chronic illness. The article by Drs. Troosters and Van Remoortel focuses on pulmonary rehabilitation in the patient with both COPD and cardiovascular disease and ways to adapt the rehabilitation program to tackle the systemic manifestations that are common to these comorbidities. The article by Dr. Bourbeau helps define and describe self-management education, a crucial component of pulmonary rehabilitation that gives patients the tools needed to co-manage their illness. Dr. ZuWallack examines the important issue of how to increase activity and participation in chronic respiratory patients. Our last article by Drs. Wouters and Vanderhoven looks at pulmonary rehabilitation within the context of integrated care, a crucial paradigm shift as we encounter a much more complex and chronically ill patient in an increasingly fragmented health care system.

I thank each of the authors for their participation and their efforts to “push the envelope” in our understanding of the effects of chronic respiratory disease and how to adapt pulmonary rehabilitation to a broader population to elicit positive outcomes. I look forward to future research in these areas and wider application of this treatment modality. It has been my pleasure to serve as guest editor and a distinct honor to oversee such wonderful scholarly work.