Rehabilitation nach stationärer COPD

Zusammenfassung

Eine pneumologische Rehabilitationsmaßnahme kann bei COPD-Patienten, insbesondere nach Exazerbationen, die Zahl der Rehospitalisierungen reduzieren und sogar die Mortalität verringern. Diese Effekte stehen jedoch in einem direkten Zusammenhang mit der Qualität der Rehabilitation, was diese komplex macht. Neben der Erfassung des medizinischen Status, der Leistungsfähigkeit sowie relevanter Komorbiditäten ist eine spezifische Diagnostik und zielgerichtete Therapie notwendig. Das schließt neben der medikamentösen Therapie, inklusive Training der Inhalationstechniken, unter Umständen auch endoskopische Therapien (z. B. Bronchialtoilette) ein. Auch die nicht-invasive Beatmung erhält eine wachsende Bedeutung im rehabilitativen Setting. Dies setzt neben der notwendigen fachlichen Expertise die Erfahrung und den Mut voraus, diese Patienten auch konkret in die Reha-Trainingsprogramme einzuschließen, die mit NIV durchgeführt werden können – wie Fahrradergometer-Therapien oder Laufbandtraining – mit dem Ziel, die Patienten einem höheren Trainingsstimulus zuzuführen, welcher die weitere Prognose des COPD-Patienten beeinflusst. Ein wichtiger Punkt in der Arzt-Patienten-Interaktion ist die Festlegung realistischer Patientenziele, um letztendlich zu einer dauerhaft aktiveren gesundheitsorientierteren Lebensweise zu gelangen.

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