Carolyn L. Rochester, M.D., Martijn A. Spruit, PT, Ph.D., and Anne Holland, PT, Ph.D., recently published a concise, 1.5 page review article in about the current status of pulmonary rehabilitation programs for patients with chronic respiratory diseases in JAMA. Here are five takeaways from their article:
- Only a small percentage of patients who would benefit from pulmonary rehabilitation take advantage of it. People who might benefit from pulmonary rehabilitation are those with chronic respiratory disease who have physical limitations and impaired quality of life despite taking the appropriate medication, according to Rochester, Spruit and Holland. Yet less than 5% of eligible patients take advantage of pulmonary rehabilitation services. The impediments include lack of knowledge about the benefits and the absence of metrics that would require or encourage clinicians to make referrals.
- Self-management is a key component. Programs typically begin an assessment of the patient and a review of their medications. Walking, cycling, free weights and stair climbing are among the activities included in a typical prescribed exercise program, and the exercise needs to extend patients beyond what they are doing in their day-to-day lives. But there is also self-management to the programs that include smoking cessation (if relevant) and advice on proper use of medications, healthy nutrition, and establishing an exercise routine.
- The evidence suggests that pulmonary rehabilitation is effective. Lung function does not necessarily improve but pulmonary rehabilitation programs are associated with improved physical, emotional and social function and quality-of-life improvements, according to Rochester, Spruit, and Holland. They referenced a 2015 Cochrane review that included 65 trials showed that pulmonary rehabilitation resulted in improvements in the 6-minute walk test and quality of life. They also mentioned a 2016 Cochrane of 20 trials that showed that pulmonary rehabilitation reduced the chances of rehospitalization among patients with chronic obstructive pulmonary disease. The benefits of the programs last for eight to 12 months, according to the trio of authors, and longer programs may lead to gains in exercise capacity and quality of life.
- A program usually lasts 8-12 weeks. Most programs are done on an outpatient basis for 8-12 weeks with 2-3 sessions per week. The authors say in-patients are available in some countries and are well suited for patients with severe lung disease and multiple comorbidities.
- Coverage varies. In the U.S., Medicare, Medicaid and private insurers will cover up to a lifetime total of 72 sessions if they are prescribed by a physician and are deemed as being medically necessary, according to Rochester and her co-authors.