Pulmonary rehabilitation for patients with advanced lung disease

Pulmonary rehabilitation is increasingly recognized as an important component of the comprehensive management of patients with severe symptomatic lung disease. A somewhat nihilistic approach to the concept of pulmonary rehabilitation became widespread when multiple studies evaluating that therapeutic tool in patients with advanced lung disease failed to show any improvement in conventional pulmonary function tests. Fortunately, the perseverance of many investigators from multiple disciplines has provided firm evidence that pulmonary rehabilitation offers an effective treatment option for patients with symptomatic advanced lung disease. The outcomes that have been evaluated in multiple trials are summarized in Table 1. This article reviews the fundamental concepts of pulmonary rehabilitation, its different components, and the effect on several outcome parameters.(69) The review concentrates on data obtained from studies involving patients with chronic obstructive pulmonary disease (COPD) because that is the entity affecting the majority of candidates for this therapeutic modality, and COPD patients are the population in whom most of the important studies have been completed. Nonetheless, many of the principles are applicable to patients with other advanced respiratory diseases.