The importance of components of pulmonary rehabilitation, other than exercise training, in COPD
Comprehensive pulmonary rehabilitation is an important component in the clinical management of people with chronic obstructive pulmonary disease (COPD). Although supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation, there are many other components that should be considered to manage the impairments and symptom burden, as well as the psychosocial and lifestyle changes imposed by COPD. As physiotherapists are part of the multidisciplinary team and spend large amounts of time with their patients, they are central in facilitating chronic disease self-management.
These include approaches designed to:
1) facilitate smoking cessation (intensive counselling therapy and nicotine replacement therapy are most effective when embedded in pulmonary rehab)
2) optimise pharmacotherapy (correct inhaler technique, review adherence, vaccination, proper oxygen therapy)
3) assist with early identification and treatment of acute exacerbations (education, written action plan when first symptoms noticed)
4) manage acute dyspnoea (pursed lip breathing, forward-lean position, use of rollator (facilitating accessory muscles of respiration, reducing metabolic cost).
5) increase physical activity (frequent, short activities, goal setting, motivational interviewing)
6) improve body composition (maintain FFM and healthy BMI, nutritional support)
7) promote mental health (treat anxiety and depression, cognitive behaviour therapy)
8) facilitate advance care planning (end-of-life care, discuss unwanted interventions)
9) establish social support networks (peer support in rehab, patient support groups, involving caregivers).
Consideration should be given to incorporating these approaches within the framework of a pulmonary rehab programme. A multidisciplinary team can provide a tailor-made intervention, with the patient having access to those healthcare professionals with expertise that is relevant for their specific situation. Regular team meetings may help healthcare professionals to provide a coordinated approach to patient care. > From: Hill et al., Eur Respir Rev 22 (2013) 405-413. All rights reserved to the European Respiratory Society.