ABSTRACT
There has been growing realization that chronic obstructive pulmonary disease (COPD) severity and prognosis are determined only partially by lung function impairment; indeed once forced expiratory volume (FEV1) is less than 50% predicted, it yields no prognostic value (1). This may explain the limited benefits of pulmonary pharmacological therapies and the rapidly expanding interest in therapies designed to treat the systemic consequences of COPD. Despite initial skepticism that COPD patients (with their pulmonary impairment) could achieve exercise levels necessary to produce a true physiological training effect (2), pulmonary rehabilitation (PR) has emerged as arguably the most effective nonpharmacological intervention in improving exercise capacity and health status in COPD patients, supported by a number of randomized-controlled trials and meta-analyses (3). However, the health-economic consequences of PR and its effects on acute exacerbation rate are less well established. Furthermore, most data have been obtained in stable chronic patients (free from recent exacerbation), and only in recent times have investigators begun studying the role of PR in the multidisciplinary management of the COPD patient with acute exacerbation.
