Pulmonary rehabilitation in chronic obstructive pulmonary disease

Careful review of the currently available literature clearly shows the benefit of pulmonary rehabilitation in COPD. More evidence has become available concerning the magnitude and mechanisms of the obtained benefits. In addition, it has become clearer that patients at both ends of the disease spectrum can be good candidates for properly designed rehabilitation programs. We attempted to summarize the available evidence and added some clinical practice advice in our attempt to define the present state of the art. Rehabilitation programs should be part of a larger decision tree including optimal medical therapy and nonpharmacologic treatment options, such as surgery, not discussed in the present review. Future research in rehabilitation should focus on further fine-tuning the rehabilitation programs for individual patients. However, the overwhelming evidence currently available is clearly sufficient for regulatory authorities to conclude that there is an evidence base for reimbursement for pulmonary rehabilitation. The current programs improve health-related quality of life and exercise tolerance to a greater extent than any other intervention currently available for patients with COPD. Pulmonary rehabilitation reduces health care use in patients with excessive use of health care resources. Tailoring programs to make these benefits as large and as long-lasting as possible remains a major challenge.