Pulmonary rehabilitation for chronic obstructive pulmonary disease

Cochrane: Chronic obstructive pulmonary disease (COPD) describes a chronic lung condition that prevents the air supply from getting to the lungs. Symptoms include breathlessness, coughing, tiredness and frequent chest infection. Worldwide, COPD is a major cause of ill health.

Pulmonary rehabilitation programmes include exercise as a key component; some programmes contain other interventions such as assessment, education, psychological support and dietary advice. Pulmonary rehabilitation is one of the key recommended approaches in the treatment of COPD. This review compared the impact of pulmonary rehabilitation versus usual care on the health-related quality of life of people with COPD. We included 65 studies involving 3822 participants. Participants were randomly assigned to receive pulmonary rehabilitation or usual care. The quality of the studies was generally good.
This review highlights that pulmonary rehabilitation improves the health-related quality of life of people with COPD. Results strongly support inclusion of pulmonary rehabilitation as part of the management and treatment of patients with COPD.
Future studies should concentrate on identifying the most important components of pulmonary rehabilitation, the ideal length of a programme, the intensity of training required and how long the benefits of the programme last.

 

Authors' conclusions: 

Pulmonary rehabilitation relieves dyspnoea and fatigue, improves emotional function and enhances the sense of control that individuals have over their condition. These improvements are moderately large and clinically significant. Rehabilitation serves as an important component of the management of COPD and is beneficial in improving health-related quality of life and exercise capacity. It is our opinion that additional RCTs comparing pulmonary rehabilitation and conventional care in COPD are not warranted. Future research studies should focus on identifying which components of pulmonary rehabilitation are essential, its ideal length and location, the degree of supervision and intensity of training required and how long treatment effects persist. This endeavour is important in the light of the new subgroup analysis, which showed a difference in treatment effect on the CRQ between hospital-based and community-based programmes but no difference between exercise only and more complex pulmonary rehabilitation programmes.