Pulmonary rehabilitation

Depending on local availability, consider referring all COPD patients—irrespective of age, functional limitation, and smoking status—for pulmonary rehabilitation. This is “a multidisciplinary programme of care for patients with chronic respiratory impairment that is individually tailored and designed to optimise physical and social performance and autonomy.” A suitable programme is important in breaking the vicious cycle of worsening breathlessness, reduced physical activity, and deconditioning that many patients experience, and pulmonary rehabilitation plays a major role in restoring patients to an optimally functioning state. For example, early intervention after an acute exacerbation of COPD can produce clinically significant improvements in exercise capacity and health. The ideal programme should consist of several components, including exercise training, education, and nutritional support.

Exercise training—Outpatient pulmonary rehabilitation programmes typically run for two months, with two or three sessions of supervised exercise each week. Patients are encouraged to exercise at home and record their achievements, so that progress can be monitored. Studies have shown that physiological changes provided by endurance training take place at the level of skeletal muscle, even during sub-maximal exercise. Exercise training can improve exercise tolerance, symptoms, quality of life, peak oxygen uptake, endurance time during sub-maximal exercise, functional walking distance, and peripheral and respiratory muscle strength.

Education—This generally comprises various forms of goal directed and systematically applied communication aimed at improving …