chapter  30
Pulmonary rehabilitation
ByEFM Wouters
Pages 16

Chronic obstructive pulmonary disease is a devastating disorder that accounts for exorbitant human suffering. Impaired exercise tolerance and breathlessness are important features of the patient suffering from COPD. Despite the definition of COPD as a disease state characterized by the presence of a generally progressive and irreversible airflow limitation, the primary treatment was directed during many years on pharmacologic modulation of the airflow limitation by bronchodilating and anti-inflammatory agents. Despite the symptomatic relief after administration of bronchodilating agents, in most COPD patients a functional deficit persists after optimal pharmacologic treatment. Based on generally accepted treatment goals in COPD, pharmacologic treatment can therefore no longer be considered as sufficient in the state of the art management of patients with symptomatic COPD. Indeed, besides lessening of airflow limitation, reduction of symptoms and improvement in health status as well as prevention of secondary complications are also widely accepted management goals for COPD.1,2

The concept of rehabilitation, involving holistic efforts to restore patients with debilitating and disabling disease to an optimally functioning state, is a relatively recent practice in pulmonary medicine. In 1974 a committee of the American College of Chest Physicians defined pulmonary rehabilitation as ‘an art of medical practice wherein an individually tailored, multidisciplinary program is formulated which through accurate diagnosis, therapy, emotional support and education stabilises or

reverses both physio-pathologic and psycho-pathologic manifestations of pulmonary diseases and attempts to return the patient to the highest possible functional capacity allowed by his handicap and overall life situation’.3