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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
REVIEWS ADVANCES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
Minerva Pneumologica 2009 March;48(1):73-84
Effectiveness of pulmonary rehabilitation in patients with asthma and chronic obstructive pulmonary disease (COPD)
Lusuardi M., Garuti G., Massobrio M., Spagnolatti L.
Unit of Pulmonary Rehabilitation AUSL Reggio Emilia S. Sebastiano Hospital, Correggio Reggio Emilia, Italy
According to the European Respiratory Society/ American Thoracic Society (ERS/ATS) definition “Pulmonary rehabilitation is 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 individualized treatment of the patient, PR is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease”. There is scientific evidence that PR improves dyspnea, exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) may be indicated also in other obstructive respiratory disorders such as bronchial asthma, cystic fibrosis, bronchiectasis, and conditions such as pre- post surgical treatment in major thoracic and abdominal surgery, prevention of complications in the respiratory intensive care unit. Optimal drug treatment and smoking cessation are important prerequisites for starting PR. Physical training is the main component of any PR programme (A degree of evidence) with particular regard to exercise training of lower limbs. Interval training is preferable for patients with severe symptom limitation. Other important items of a PR programme are: upper extremity training, respiratory muscle training, breathing exercises, chest physiotherapy, health education, psychosocial support, occupational therapy, and nutrition. After a baseline functional assessment, a correct outcome measurement must compare end-of-programme versus baseline evaluation of exercise capacity with an ergometric test or a 6min walking test, evaluation of dyspnea during exercise (Borg or Visual Analogue Scale [VAS]) or in daily life activities (MRC, BDI/TDI) and quality of life with a specific questionnaire such as the Saint George’s Respiratory Questionnaire (SGRQ).