For those of you who need evidence base research to believe that recomending an activity called “Pulmonary Rehabilation” is benefical for those with chronic lung conditions, here you go. It is also proof that you have to keep moving, if you are going to “live with it.”
CHEST. 2007,131(5_suppl):1S-3S doi:10.1378/chest.07-0892
Pulmonary diseases are becoming more important causes of morbidity and mortality in the modern world, with COPD being the most common and a major cause of lung-related death and disability. 1 Pulmonary rehabilitation has emerged as a recommended standard of care for patients with chronic lung disease based on a growing body of scientific evidence. In 1997, the American College of Chest Physicians and the American Association of Cardiovascular and Pulmonary Rehabilitation published evidence-based guidelines. 2 3 Because of the increase in the published literature on pulmonary rehabilitation, the purpose of this document is to update the 1997 guidelines with a systematic, evidence-based review of the literature.
In the United States, COPD accounted for 119,000 deaths in 2000, ranking it the fourth-leading cause of death and the only major disease among the top 10 that continues to increase. 4 5 6 7 Mortality data tend to underestimate the impact of COPD because it is more likely to be listed as contributory rather than the underlying cause of death, and is often not listed at all. 8 9 Between 1980 and 2000, death rates for COPD increased 282% for women compared to 13% for men. Also in 2000, the number of women dying from COPD exceeded the number of men. 4
COPD develops insidiously over decades and, because of the large reserve in lung function, there is a long preclinical period. Affected individuals have few symptoms, and the disease remains undiagnosed until it is at a relatively advanced stage. In a population survey, Burrows 10 reported that only 34% of persons with COPD had ever consulted a physician, 36% denied having any respiratory symptoms, and 30% denied dyspnea on exertion, which is the primary symptom of COPD. National Health and Nutrition Examination Survey III data estimate that 24 million US adults have impaired lung function, 4 while only 10 million report a physician diagnosis of COPD. Worldwide, the burden of COPD is projected to increase substantially, paralleling the rise in tobacco use, particularly in developing countries. An analysis by the World Bank and World Health Organization ranked COPD 12th in 1990 in disease burden reflected in disability-adjusted years of life lost. 8
For consistency throughout the guideline, the Panel used the description of severity of COPD as recommended by the Global Initiative for Chronic Obstructive Lung Desease 11 and American Thoracic Society/European Respiratory Society 12 guidelines based on FEV1, as follows: stage I, mild, FEV1 ≥ 80% of predicted; stage II, moderate, FEV1 50 to 80% of predicted; stage III, severe, FEV1 30 to 50% of predicted; and stage IV, very severe, FEV1 30% of predicted.
The American Thoracic Society and the European Respiratory Society recently adopted the following definition of pulmonary rehabilitation 13 :
Pulmonary rehabilitation is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease.
This definition focuses on three important features of successful rehabilitation: (1) a multidisciplinary approach, (2) an individualized program tailored to the patient needs, and (3) attention to physical and social function.
Rehabilitation programs for patients with chronic lung disease are well established as a means of enhancing standard therapy in order to control and alleviate symptoms and optimize functional capacity. 2 13 14 15 The primary goal is to restore the patient to the highest possible level of independent function, which is accomplished by helping patients learn more about their disease, treatments, and coping strategies.
Pulmonary rehabilitation is appropriate for any patient with stable chronic lung disease who is disabled by respiratory symptoms. Programs typically include components such as patient assessment, exercise training, education, nutritional intervention, and psychosocial support. These programs have been successfully applied to patients with diseases other than COPD such as interstitial diseases, cystic fibrosis, bronchiectasis, and thoracic cage abnormalities. 16
Through a thorough and systematic review of the literature, the Panel developed the following recommendations on rehabilitation for patients with chronic lung disease: