Pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD)

Treatment Overview

Pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) combines a number of different therapies to help reduce your symptoms, improve quality of life, and encourage your active participation in your treatment. It will not reverse the damage to your lungs already caused by COPD. Instead, it will help you improve your ability to carry out daily tasks, such as dressing, grocery shopping, and walking, within the limits of the disease.

Pulmonary rehabilitation programs vary in their scope, duration, and whether they are conducted in an inpatient or outpatient setting. Many types of medical personnel, including physicians, nurses, dietitians, physical and occupational therapists, and respiratory therapists, may be involved with these programs. All programs generally include education and counselling, exercise, nutritional guidance, techniques to improve breathing, and emotional support.

Pulmonary rehabilitation is usually supervised and structured. This means it will include:

• Medical evaluation and management. Evaluation of your symptoms and current medical treatment ensures that you can get the most out of the program. A medical evaluation also will pinpoint other concerns, such as heart problems, that might affect your ability to exercise.
• Short-term and long-term goals. After symptoms and other medical problems have been identified, short- and long-term goals are set that reflect specific needs. For instance, some people might want to be able to dress themselves every day while others might want to be able to walk 30 minutes every day. Your ability to exercise and to perform daily tasks is determined before starting the program.
• Therapy programs. Which therapy programs you participate in will depend on your needs and goals. For example, if you are a smoker, a smoking cessation program may be the most important short-term goal. See below for specific therapy programs.
• Evaluation of results. Each therapy program should be designed so that results can be measured. Measurable results may include easier breathing, the ability to exercise longer, and an improved quality of life.

All pulmonary rehabilitation programs generally include education for both you and your family on how the program affects your COPD symptoms, the importance of the program to your overall health, and how regular participation can help you meet your goals. Understanding COPD—how it progresses and is best treated—makes it easier to live with and manage the disease.

Support and encouragement from friends, family, and health professionals are crucial in helping you stick to your rehabilitation plan. Your health professional may recommend counselling for you and your family. Support groups are available in many cities. These groups can help you and your family cope with COPD and its possible complications.

One of the greatest benefits of a pulmonary rehabilitation program is the opportunity to meet other highly motivated people with COPD and exchange information about living with COPD.

Therapy programs

Therapy programs are tailored to meet your specific needs. If you still smoke, stopping is the most important therapy program. Other therapy programs include exercise, breath training, and nutritional guidance.

Exercise

Regular exercise can improve how active you can be and can decrease your shortness of breath. If you stay active, you may develop fewer complications, have a better attitude about your life and the disease, and be less likely to be depressed. Exercise training for COPD often includes aerobic exercise, such as walking or using a stationary bike, and muscle-strengthening exercises for your arms and legs.

Always consult with your health professional before starting an exercise program. People with COPD may have heart problems, such as coronary artery disease (CAD) or high blood pressure, that may limit exercise options. You may need medical supervision when you start the program.

For more information, see:

Exercises for chronic obstructive pulmonary disease.

Breath training

If you have severe COPD, you may find you take quick, small, shallow breaths. Breath training can help you take deeper breaths and reduce breathlessness. You must practise breath training regularly for you to do it well.

Three basic breath training methods are diaphragmatic breathing, pursed-lip breathing, and breathing while bending forward. They can be used to help you get through periods when you feel more short of breath.

• Diaphragmatic breathing helps your lungs expand so that they take in more air. (Your diaphragm is a muscle that helps draw air into your lungs as your breathe.) Lie on your back or prop yourself up on several pillows. With one hand on your abdomen and the other on your chest, breathe in, pushing the abdomen outward as far as possible. You should be able to feel the hand on your abdomen moving out, while the hand on your chest should not move. When you breathe out, you should be able to feel the hand on your abdomen moving in. After you can do diaphragmatic breathing well lying down, you can learn to do it sitting or standing. Many, but not all, people with COPD find this breathing method helpful. Diaphragmatic breathing should be practised for 20 minutes, 2 to 3 times a day.
• Pursed-lip breathing may help you breathe more air out so that your next breath can be deeper. In this type of breathing, you breathe in through the nose and out through the mouth while almost closing your lips. Breathe in for about 4 seconds and breathe out for 6 to 8 seconds. Pursed-lip breathing decreases shortness of breath and improves your ability to exercise.
• Breathing while bending forward at the waist may make it easier for you to breathe. Bending forward while breathing may decrease shortness of breath in those with severe COPD, both at rest and during exercise. This may be because bending forward allows the diaphragm to move more easily.

Nutritional guidance

Good nutrition is important to maintain your strength and health. Problems with muscle weakness and weight loss are frequent in COPD, and people with COPD who are profoundly underweight, especially those with emphysema, are at higher risk of death than are people with COPD who have a normal weight.¹ For more information, see:

Eating well when you have COPD.

Avoiding weight loss when you have COPD.

What To Expect After Treatment

An ongoing pulmonary rehabilitation program can help you function better over the long term. Each program should set short- and long-term goals to help you monitor change and success. This ensures that the program continues to meet your needs.

Why It Is Done

Pulmonary rehabilitation is recommended for people who have respiratory disorders such as COPD. Most people who have COPD can benefit from pulmonary rehabilitation, especially people who use oxygen therapy and have often had to go to the emergency room or hospital. Therapy is not limited to people who have mild or moderate COPD.

How Well It Works

Pulmonary rehabilitation improves quality of life. A review of research reports that participating in pulmonary rehabilitation:²

• Relieves shortness of breath and fatigue.
• Gives you more control over your condition.
• Results in greater improvement of quality of life than using other types of treatment, such as medication.
• Modestly improves how much you can exercise.

An effective pulmonary rehabilitation program should be at least 2 months long; the longer the program is, the more effective it is.³

Risks

There is little or no risk to these programs if they are well supervised.

What To Think About

The success of pulmonary rehabilitation relies on the relationship between you and your team of health professionals. This team must work with you to achieve goals. It is vital that you take an active role in the program and understand the importance of regular participation.

Although this therapy can improve your daily life, it does not reverse the effects that COPD has had on the lungs or other organs such as the heart. It does not cure COPD. It trains the mind, muscles, and heart to get the most out of damaged lungs.

Pulmonary rehabilitation provides the opportunity to interact with health professionals specializing in lung disease and to exchange information with others about living with COPD.

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Author:	Douglas Dana Robin Parks, MS	Last Updated: August 28, 2006
Medical Review:	Renée M. Crichlow, MD - Family Medicine Tom Bailey, MD - Family Medicine Ken Y. Yoneda, MD - Pulmonology
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