Pulmonary Rehabilitation: A Team Approach To Improving Quality of Life

COPD and You

Chronic obstructive pulmonary diseases (COPD) are the most common chronic lung diseases. They include chronic bronchitis and emphysema. In 1993 it was estimated that 14 million adults had some form of COPD. On average, 15 percent of adults over age 55 have COPD, many of them women. Since 1990, COPD has been the fourth leading cause of death in the United States.

Pulmonary rehabilitation has become an important way to reduce the impact of COPD and other chronic lung diseases. If you have a pulmonary disease, you may have been told that you need pulmonary rehabilitation.This brochure has been designed to provide you with information about pulmonary rehabilitation.

What is Pulmonary Rehabilitation?

Pulmonary rehabilitation combines exercise training and behavioral and educational programs designed to help patients with COPD control symptoms and improve day-to-day activities. It is a team approach—patients work closely with their doctors; nurses; respiratory, physical, and occupational therapists; psychologists, exercise specialists; and dietitians.

The main goals of pulmonary rehabilitation are to help patients improve their day-to-day lives and restore their ability to function independently. If your illness has affected your daily living, pulmonary rehabilitation can help you:

Reduce and control breathing difficulties and other symptoms.
Learn more about your disease, treatment options, and coping strategies.
Learn to manage your disease and reduce your dependence on health professionals and costly medical resources.
Maintain healthy behaviors such as smoking cessation, good nutrition, and exercise.

In addition, pulmonary rehabilitation can help reduce the number and length of hospital stays and increase your chances of living longer.

Who benefits?

In the past, pulmonary rehabilitation was used primarily for patients with COPD. However, it can also be helpful to people with other chronic lung conditions such as:

Interstitial diseases.
Cystic fibrosis.
Bronchiectasis.
Thoracic cage abnormalities.
Neuromuscular disorders.

Pulmonary rehabilitation can also be helpful to those who need lung transplants or other lung surgeries. Whether you have a chronic respiratory system disease or are experiencing disabling symptoms, such as shortness of breath, cough, and/or mucus production, pulmonary rehabilitation can help. Even patients with severe disease can benefit.

What is involved?

Pulmonary rehabilitation involves these components:

Exercise training: lower body, upper body, ventilatory muscle training (for some patients).

Psychosocial support.

Educational programs.

Lower body training

Lower body exercises like walking or riding a stationary bicycle will help strengthen your leg muscles and increase muscle tone and flexibility. These exercises will help you move about more easily, often for longer periods of time. They can also make certain tasks, like walking up stairs, easier to do.

Many patients find that as their technique improves, their motivation to continue with the exercise program increases as well. As a result, many patients report feeling better about themselves and their ability to control symptoms such as breathing difficulties.

Upper body training

Upper body training increases the strength and endurance of arm and shoulder muscles. Strengthening these muscles is important because they provide support to the ribcage and can improve breathing. These exercises can also help in tasks that require arm work such as carrying groceries, cooking dinner, lifting items, making the bed and vacuuming, taking a bath or shower, and combing hair. They can also decrease the amount of oxygen needed for these activities. This may be due to less worry about breathing difficulties and better coordination of the muscles involved in raising the arms.

Many patients with lung diseases are not in very good physical condition or have never exercised on a regular basis. Don't worry. Your pulmonary rehabilitation team will meet with you to assess your needs and will work with you to develop an exercise program designed specifically for you. They will advise you about which exercises will give you the best results, how often you should do them, for how long, and at what level. They will give you information on how to maintain your exercise abilities on a regular basis.

Ventilatory muscle training

Weakness of the respiratory muscles can contri-bute to breathing problems and make exercising difficult. For some patients, ventilatory muscle training (VMT) may improve respiratory muscle function, help reduce the severity of breathlessness, and improve the ability to exercise.

Research at this time does not support the use of VMT for everyone. However, it may be helpful for some patients with COPD who have respiratory muscle weakness and breathlessness. Your pulmonary rehabilitation team will let you know if you are a candidate for VMT.

Psychosocial support and education

In addition to exercise training, many pulmonary rehabilitation programs provide help with the em-otional stresses common to COPD. Some patients never experience any significant emotional distress as a result of their disease. But for many, COPD can cause depression, anxiety, or other emotional problems. These might include concerns about:

Body image.
Increased loneliness.
Relationships with family and friends.
Lack of social support.
Negative self-concept and low self-esteem.

Support may be provided through patient education programs, or as part of support or stress management groups. Patients are counseled about depression and anxiety, taught relaxation skills, encouraged to talk about their feelings, and learn the importance of giving and receiving emotional support from others.

It is important to remember that support for psychological or emotional difficulties is most beneficial over a longer period of time—there is no such thing as a "quick fix." If you are experiencing any of the above feelings, make sure you discuss them with your pulmonary rehabilitation team.

Since smoking is well known to be the primary risk factor for the onset and working of COPD, many pulmonary rehabilitation programs provide educational sessions and counseling to help patients stop smoking. Most patients with COPD have quit smoking by the time they begin a pulmonary rehabilitation program. Others may continue to smoke as a way to cope with depression, anxiety, and loneliness.

Other patient education classes often cover a wide variety of topics. These might include:

How the lungs work.
Information about COPD and other chronic lung diseases.
Information about medications, including drug action, side effects, using an inhaler, and self-care techniques.
Understanding and using oxygen therapy.
Diet, nutrition, and weight management.
Breathing retraining.
Importance of exercise.
Strategies for managing breathing problems.
Symptom assessment and knowledge about when to seek medical treatment.
Travel.

Information may be provided through lectures, printed hand-outs, demonstrations, or one-on-one instruction.

In summary, much has been learned about the effectiveness and benefits of pulmonary rehabilitation. Patients with COPD greatly benefit from the combination of physical training and behavioral and emotional support. Pulmonary rehabilitation helps patients with COPD improve their quality of life and their ability to function independently. Talk to your physician about pulmonary rehabilitation and how it can help you.

For a list of programs in your area, you may contact the American Association of Cardiovascular and Pulmonary Rehabilitation (608-831-6989) or your local chapter of the American Lung Association.

The American College of Chest Physicians is the leading resource for the improvement of cardiopulmonary health and critical care worldwide. Its mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication.

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) is a multidisciplinary association comprised of health-care practitioners who in their professional endeavors are regularly involved in some aspect of cardiovascular and/or pulmonary rehabilitation. AACVPR is dedicated to the improvement of clinical practice, promotion of scientific inquiry, and advancement of education for the benefit of health-care professionals and the public.