Which patients should be included in pulmonary rehabilitation

Pulmonary rehabilitation is indicated for patients with a respiratory impairment who still are dyspnoeic despite optimal medical management, have reduced exercise tolerance, and have a handicap due to this pulmonary disorder. This means that all patients with complaints due to pulmonary diseases might be included in programmes. However, in this chapter we will focus on patients with COPD only. In the recent position paper of the American Thoracic Society (ATS), some indications were given for referral for pulmonary rehabilitation (Table 12.1) [1]. The problem with these indications is that they are general and therefore not easy to use in clinical practice. Only a few studies have focused on assessing which patients with COPD are ideal candidates for rehabilitation. Zu Wallack et al. included in their study patients with a mean FEVj of 1.0 L, and offered them a rehabilitation programme consisting of 12 3-h sessions given over 6weeks [19]. The patients were supervised by a team consisting of nurse, respiratory therapist, dietitian, physical therapist, and occupational therapist. The most important part of the programme was exercise training (treadmill, bicycle training, upper extremity training, breathing exercises). After 6 weeks, the patients with the lowest 12-min walking distance (12-MWD) and the best FEVj at baseline showed the largest improvement in walking distance (Fig. 12.1). The authors conclude that patients with less airflow obstruction can exercise on a higher workload, and thereby derive more

Table 12.1 Common indications for referral for Anxiety engaging in a«mties pulmonary rehabilitation [1]. Breathlessness with actmties

Limitations with: Social activities Leisure activities Indoor and/or outdoor chores Basic or instrumental activities of daily living Loss of independence

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Do Not Panic

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