The nonpharmacologic treatment of chronic obstructive pulmonary disease: advances in our understanding of pulmonary rehabilitation.
The optimal care of patients with chronic obstructive pulmonary disease generally requires combining pharmacologic and nonpharmacologic therapies. The latter include smoking cessation, the encouragement of physical activity and exercise, influenza and pneumonia vaccinations, education on adherence to medical therapy, collaborative self-management strategies, such as a plan to manage exacerbations, and advance directives. Although each of these is a component of good medical practice, they can be given together in the form of a comprehensive outpatient pulmonary rehabilitation program. Pulmonary rehabilitation, which includes exercise training, education, psychosocial support, and nutritional intervention, has demonstrated effectiveness over multiple outcome areas, despite the fact that it has virtually no direct effect on the underlying pathophysiology of the lung. This intervention works primarily through its beneficial effects on associated morbidity, such as physical deconditioning. Pulmonary rehabilitation is indicated when respiratory symptoms or functional limitations persist despite otherwise standard medical therapy. Combining optimal bronchodilator therapy and/or supplemental oxygen therapy with exercise training will enhance the effectiveness of the latter.
Zuwallack
Richard
R
Section of Pulmonary and Critical Care, St. Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105, USA. rzuwalla@stfranciscare.org
D001993:Bronchodilator Agents / Q000627:therapeutic use; D004417:Dyspnea / Q000534:rehabilitation; D015444:Exercise; D006801:Humans; D010102:Oxygen Inhalation Therapy; D010349:Patient Compliance; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D012648:Self Care
D001993:Bronchodilator Agents