Chest
Special ReportPulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Guidelines
Section snippets
EPIDEMIOLOGY OF COPD
In the United States, the overall prevalence of COPD in adult white populations is 4 to 6%; in men and 1 to 3%; in women. In persons older than 55 years, COPD is recognized in approximately 10 to 15%;.1, 2 As of 1985, the prevalence rates of COPD in adults 65 years and older was 167/1,000 in men and 126/1,000 in women.3 Recent trends suggest that disease prevalence is stable to decreasing in men, but increasing among women. The 1993 National Health Interview Survey estimated that 14 million
Background
Rehabilitation for patients with chronic lung diseases is well established and widely accepted as a means of enhancing standard therapy in order to alleviate symptoms and optimize function.7, 8, 9, 10, 11, 12, 13 The primary goal of rehabilitation is to restore the patient to the highest possible level of independent function. This goal is accomplished by helping patients to increase their activity through exercise training and to reduce and gain control of their symptoms. Patients and
DEFINITIONS
In 1974, the American College of Chest Physicians (ACCP) Committee on Pulmonary Rehabilitation adopted the following definition quoted in an ATS statement:
“Pulmonary rehabilitation may be defined as an art of medical practice wherein an individually tailored, multidisciplinary program is formulated which through accurate diagnosis, therapy, emotional support, and education, stabilizes or reverses both the physio- and psychopathology of pulmonary diseases and attempts to return the patient to
METHOD FOR THE GUIDELINES PANEL
The Guidelines Panel was organized under the joint sponsorship of the ACCP and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). In addition to the Chair (Dr. Ries), each organization appointed four representatives: Drs. Casaburi, Celli, Mahler, and Make represented the ACCP; Drs. Carlin, Carrieri-Kohlman, Emery, and Hodgkin represented the AACVPR. Dr. Judah Skolnick served as the Liaison from the ACCP Health and Science Policy Committee.
The primary purpose of
Recommendation
Pulmonary rehabilitation may improve survival in patients with COPD.
Strength of Evidence=C Scientific Evidence
Six studies have assessed the effect of comprehensive pulmonary rehabilitation on survival in patients with COPD. One
FUTURE RECOMMENDATIONS FOR RESEARCH
As the field of pulmonary rehabilitation has matured over the past several decades, much has been learned about the effectiveness and benefits of such programs. The practice of rehabilitation for persons with chronic lung diseases was founded in the physiology and pathophysiology of pulmonary medicine but has grown to encompass also the behavioral and social consequences that are important in understanding the impairments, disabilities, and handicaps of individuals with chronic disease.
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Cited by (412)
Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD: An Historical Cohort Study Using Electronic Health Records
2017, ChestCitation Excerpt :There may be unobserved confounding despite propensity matching. Reductions in LOS following rehabilitation have also been reported in some RCTs24,25 and observational studies,26 whereas a reduction in LOS was not observed in this cohort. Reasons for this finding may include the fact that patients in our analysis were older and frailer and possibly had more comorbidities than those who participated in the RCTs.
Effect of pulmonary rehabilitation on tidal expiratory flow limitation at rest and during exercise in COPD patients
2017, Respiratory Physiology and NeurobiologyWhat means pulmonary rehabilitation in 2015?
2015, Revue des Maladies RespiratoiresSerial changes in exercise capacity, quality of life and cardiopulmonary responses after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease
2018, Heart and LungCitation Excerpt :We therefore suggest patients receive 16 to 24 sessions of PR. Our suggestion is consistent with the current guideline, which suggests 20 sessions for these patients.20 Similar to other studies, we found that exercise training did not improve airflow limitation.18
Reprint requests: Andrew L. Ries, MD, MPH, UCSD Rehabilitation Program, 269 Washington Street (West), San Diego, CA 92103-8377