PULMONARY REHABILITATION

Pulmonary rehab has been shown to improve quality of life and reduce risk of exacerbation in certain patients with COPD.


The content below is courtesy of American Thoracic Society.  Original authors are Suzanne C. Lareau RN, MS and Bonnie Fahy RN, MN.  For a PDF version please click here.


If you have shortness of breath because of lung problems, you may have asked yourself:

• Can I exercise or should I avoid exercise because it makes me  short of breath?

• How can I get in better shape and have more energy if I am short of breath every time I try to exercise?

• What medications do I really need to take?

Pulmonary rehabilitation can help answer these and other questions. Enrolling in a pulmonary rehabilitation program may reduce your shortness of breath and increase your ability to exercise. You may have heard that pulmonary rehabilitation is only for people with COPD (chronic obstructive pulmonary disease). We now know that people with other lung conditions such as pulmonary hypertension and interstitial lung disease can benefit as well.

What is Pulmonary Rehabilitation?

Pulmonary rehabilitation is a program of education and exercise that helps you manage your breathing problem, increase your stamina (energy) and decrease your breathlessness. The education part of the program teaches you to be “in charge” of your breathing instead of your breathing being in charge of you. You will learn how to pace your breathing with your activities, how to take your medicines and even how to talk with your health care provider.

The exercise sessions are supervised by pulmonary rehabilitation staff that prepares an exercise program just for you. The exercises start at a level that you can handle (some people start exercising while sitting and others on a treadmill). The amount of time you exercise will be increased in time and the level of difficulty will change based on your ability. As your muscles get stronger, you will be more active with less breathlessness and be less tired.

How much time does a Pulmonary Rehabilitation Program take?

The amount of time it takes to complete a pulmonary rehabilitation program will vary depending on your needs. Because the program staff are constantly monitoring your progress and increasing your exercises as you are able, attending every session is important. Most programs meet two to three times a week and programs can last 4 to 12 weeks or more.

How will I know if Pulmonary Rehabilitation is right for me?

Your health care provider will determine if you qualify for pulmonary rehabilitation by:

• Evaluating your current state of health and lung function test results

• Discussing your current activity level and your ability to do the things you want to do

• Determining your willingness and ability to attend.

Pulmonary rehabilitation programs are limited in the number of people who can attend so that you get close supervision. You will be evaluated before you begin the program to make sure you do not have health issues that would limit your ability to join. This evaluation may take place at the rehabilitation site or in a clinic by a physician, advanced practice nurse or physician assistant.

Once the program begins, a team of health care professionals (nurses, respiratory therapists, physical therapists, occupational therapists, psychologists, dieticians, social workers, spiritual advisors such as a chaplain and others) will work with you to put you in charge of your breathing.

What will I learn in Pulmonary Rehabilitation?

The education part of the program happens both in a classroom, one-on-one with the professional staff, and during each exercise session. During group meetings, you will learn new ways to breathe during stressful times and while being active. You will practice these new breathing techniques during your exercise sessions. You will learn about your medications; what the medications do and how to use your inhalers to get the most benefit from them. During the program, you may be given an Action Plan that outlines what you should do when you are having a lung flare-up (exacerbation).

Some people with breathing problems need to use oxygen. During pulmonary rehabilitation you will be tested at rest and with exercise to see if oxygen may help you. You will learn the reasons why some people with shortness of breath use oxygen

and others do not need it.

If you smoke, the program will provide support for you to quit or get you a referral to a program that can help you to quit. You will also learn how and when to call you health care provider, including what key points to share with them and what questions to ask. Also during the program, you can expect to meet others that also have breathing problems. You will have the time to share concerns and successes with others living with lung disease.

What will I do in the exercise sessions?

You may not think that you can exercise when just walking across the room makes you breathless. There are however, standard exercises that have been found to work well for people with breathing problems. The type and amount of exercise you will do will depend on what you can do now and as you get stronger, your exercises will increase. Exercise sessions begin with stretching exercises or warm ups, followed by exercises for your arms and legs. Usually you will do both exercises to build your strength and exercises to build your endurance (stamina). To build your strength, generally weights and lifting devices are used. For endurance, activities might include walking on a treadmill or in a corridor and using a stationary cycle. The amount of time you exercise depends on what you can handle. After attending pulmonary rehabilitation, patients are frequently amazed at how much they can exercise and how much less short of breath they are.

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How can I find a Pulmonary Rehabilitation Program and what will it cost?

Ask your health care provider for a referral to a qualified program. Programs are often offered in an outpatient department of a hospital, including Veterans Administration hospitals. Some programs are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation. These programs can be found on the AACVPR website listed below in the Resources Section. The American Lung Association can also help you to locate a program in your area.

The cost to you and insurance coverage of pulmonary rehabilitation can vary greatly depending on where you live and what program you choose. Medicare covers pulmonary rehabilitation for COPD, providing you meet certain requirements. Medicare may also cover rehabilitation for other lung conditions, but this varies with different regions of the country. The pulmonary rehabilitation program coordinator can tell you if you qualify and what the cost to you will be.

What happens after I finish a Pulmonary Rehabilitation program?

It is so very important that you continue to exercise after finishing your rehabilitation program or you will lose all of the benefit you have gained. Before you “graduate”, the pulmonary rehabilitation staff will design for you a long-term plan of exercise for you. Many programs offer a “maintenance” plan so that you can continue to exercise with others with breathing problems.


Authors: Suzanne C. Lareau RN, MS, Bonnie Fahy RN, MN

Reviewers: Richard ZuWallack MD, Linda Nici MD


Resources:

American Lung Association Lung http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/diagnosing-and-treating/pulmonary-rehabilitation.html or call Help Line at 1-800-586-4872.

American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) http://www.aacvpr.org/Resources/SearchableProgramDirectory/tabid/ 113/Default.aspx


The ATS Patient Information Series is a public service of the American Thoracic Society and its journal, the AJRCCM. The information appearing in this series is for educational purposes only and should not be used as a substitute for the medical advice of one’s personal health care provider. For further information about this series, contact J.Corn at jcorn@thoracic.org.




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