Pulmonary rehabilitation: What, who, and when

Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health-care utilization, and may improve survival in patients with chronic respiratory disease. Improving functional capacity is the most important goal of a pulmonary rehabilitation program. This is classically achieved by lower and upper extremities exercise endurance training, which improves muscle composition, increases oxidative enzyme content, and improves mitochondrial function. After exercise training, there are beneficial changes in ventilatory demand, respiratory pattern, and dynamic hyperinflation, resulting in decreased dyspnea during activities of daily living. Complementary to the exercise training, most successful programs include patient education in multiple domains. A better understanding of the disease itself, improved medication control, optimization of vaccinations, and healthy life style habits provide the patient with tools to control acute events, e.g., exacerbations. Finally, well-structured psychological support can help the patients control the symptoms of anxiety and depression that characterize respiratory diseases. Most of the evidence that supports the benefit of pulmonary rehabilitation have been derived from studies of patients with chronic obstructive pulmonary disease (COPD). However, results obtained in patients with diseases different from COPD have provided evidence that the benefits from pulmonary rehabilitation are also observed in symptomatic patients with other respiratory diseases.