RT Journal Article
SR Electronic
T1 Pulmonary rehabilitation and severe exacerbations of COPD: solution or white elephant?
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00050-2015
DO 10.1183/23120541.00050-2015
VO 1
IS 2
A1 William D-C. Man
A1 Milo A. Puhan
A1 Samantha L. Harrison
A1 Rachel E. Jordan
A1 Jennifer K. Quint
A1 Sally J. Singh
YR 2015
UL http://openres.ersjournals.com/content/1/2/00050-2015.abstract
AB Hospitalisations for severe exacerbations of chronic obstructive pulmonary disease are associated with significant physical and psychological consequences including an increase in symptom severity, severe reductions in physical activity, a deleterious effect on skeletal muscle, impaired exercise tolerance/ability to self-care, decline in quality of life, and increased anxiety and depression. As these consequences are potentially amenable to exercise training, there is a clear rationale for pulmonary rehabilitation in the peri/post-exacerbation setting. Although a 2011 Cochrane review was overwhelmingly positive, subsequent trials have shown less benefit and real-life observational studies have revealed poor acceptability. Qualitative studies have demonstrated that the patient experience is a determining factor while the presence of comorbidities may influence referral, adherence and response to pulmonary rehabilitation. Systematic reviews of less supervised interventions, such as self-management, have shown limited benefits in the post-exacerbation setting. The recent update of the Cochrane review of peri-exacerbation pulmonary rehabilitation showed that benefits were associated with the “comprehensive” nature of the intervention (the number of sessions received, the intensity of exercise training and education delivered, and the degree of supervision) but implementation is demanding. The challenge is to develop interventions that are deliverable and acceptable around the time of an acute exacerbation but also deliver the desired clinical impact.Pulmonary rehabilitation after severe exacerbation of #COPD is effective but implementation is challenging http://ow.ly/QOmyg