Pulmonary rehabilitation

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the most important chronic lung diseases seen by physicians in the Asian region. There have been estimates of the burden of chronic obstructive pulmonary disease in the Asia-Pacific region in 12 countries for those aged > 30 year; and the overall prevalence in these countries was estimated to be 6.3% (1). The experiences of healthcare professionals taking care of these patients show the profound medical, social and economic impact of the disease. In the recent years, despite significant improvement of pharmacologic therapy, the most that can be achieved is temporary relief of symptoms in the majority of patients suffering from moderate to severe disease. This is perhaps the most significant reason for the increasing interest in establishing pulmonary rehabilitation programmes that started in the late 1980s in this region. Historically, application of rehabilitation in patients with chronic lung diseases had been applied primarily to COPD. This led to the first definition of pulmonary rehabilitation by the American College of Chest Physicians in 1974. The definition is as follows: Pulmonary rehabilitation is an art of medical practice wherein an individually tailored multidisciplinary programme is formulated through accurate diagnosis, therapy, emotional support and education, stabilizes or reverses both the physio and psycho-pathology of pulmonary diseases and attempts to return the patient to the highest possible functional capacity allowed by his pulmonary handicap and over all life situation (2). This definition concentrates on the essentials of a successful pulmonary rehabilitation programme which are: 1. the patient, 2. multidisciplinary approach and 3. directed to physiopathology and psychopathology. The American Thoracic Society has adopted the following definition: "pulmonary rehabilitation as a multidisciplinary programme of care for patients with chronic respiratory impairment that is individually failured and designed to optimize physical and social performance and autonomy (3)'. These programmes are established means of enhancing medical treatment to alleviate symptoms of these patients (4-9). Treatment targets are set both by the patient and the members of the rehabilitation team. The major objectives of the programme are (10-12): 1. Control the symptoms and possible Complications 2. Restore the patients to their highest level of independent function 3. Improve performance of activities of daily living 4. Improve exercise tolerance 5. Reduce the number of exacerbations and hospital confinements 6. Improve the overall "quality of life". © 2005 Hong Kong University Press, HKU. All righrts reserved.