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What is COPD?
The World Health Organization describes Chronic obstructive pulmonary disease (COPD) as “a preventable and treatable lung disease characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. The symptoms of COPD include cough, sputum production, and dyspnoea (difficult or laboured breathing). COPD symptoms often don't appear until significant lung damage has occurred, which usually worsens over time (WHO).”
COPD refers to Emphysema or Chronic Bronchitis (not Asthma, this is a different type of lung condition).
What is pulmonary rehabilitation?
Pulmonary rehab is underutilized. It is estimated that less than 35% of people that can benefit from pulmonary rehab are referred (Lahham & Holland 2021).
Pulmonary rehab can be different depending on the patient's goals and presentation. It often includes some form of exercise, education and lifestyle modifications (Spruit et al., 2013).
What are the benefits?
Several Cochrane Reviews (often considered highest quality of evidence) found reasonable evidence to support the following benefits:
Improves dyspnoea in the long term (difficulty or labored breathing) (Dowman et al., 2021)
Improves walking capacity in the long term (Dowman et al., 2021)
Improves cardiorespiratory fitness in the long term (Dowman et al., 2021)(Puhan et al., 2016)
Improves general quality of life in the long term (Dowman et al., 2021)(Puhan et al., 2016)
Most importantly in all studies included, there were no adverse events, major side effects and it was considered safe).
Can you do it yourself?
Absolutely, the largest benefits from pulmonary rehab come from the exercise component, which is free and readily available to anyone.
However, there are some important considerations to make to ensure safety, appropriateness, and to be most effective. These include the following:
Frequency of exercise
Intensity of exercise
Type of exercise
Progression of exercise
Starting point for you
Exercise physiologists or physiotherapists are deemed the most qualified to set-up a safe and effective program (Alison et al., 2017).
Another consideration is long-term frequent engagement in exercise. For a lot of people this is not easy (75% of Australian adults do not meet the guidelines(AIHW 2023)). An exercise physiologist or physiotherapists can also guide and assist you here.
Resources
Further resources can be found here:
References
Australian Institute of Health and Welfare. (2023, May 19). Physical Activity. Retrieved from Australian Institute of Health and Welfare website: https://www.aihw.gov.au/reports/physical-activity/physical-activity
Alison, J. A., McKeough, Z. J., Johnston, K., McNamara, R. J., Spencer, L. M., Jenkins, S. C., Hill, C. J., McDonald, V. M., Frith, P., Cafarella, P., Brooke, M., Cameron-Tucker, H. L., Candy, S., Cecins, N., Chan, A. S., Dale, M. T., Dowman, L. M., Granger, C., Halloran, S., Jung, P., ... Lung Foundation Australia and the Thoracic Society of Australia and New Zealand (2017). Australian and New Zealand Pulmonary Rehabilitation Guidelines. Respirology (Carlton, Vic.), 22(4), 800–819. https://doi.org/10.1111/resp.13025
Dowman, L., Hill, C. J., May, A., & Holland, A. E. (2021). Pulmonary rehabilitation for interstitial lung disease. The Cochrane database of systematic reviews, 2(2), CD006322. https://doi.org/10.1002/14651858.CD006322.pub4
Lahham, A., & Holland, A. E. (2021). The Need for Expanding Pulmonary Rehabilitation Services. Life (Basel, Switzerland), 11(11), 1236. https://doi.org/10.3390/life11111236
Puhan, M. A., Gimeno-Santos, E., Cates, C. J., & Troosters, T. (2016). Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. The Cochrane database of systematic reviews, 12(12), CD005305. https://doi.org/10.1002/14651858.CD005305.pub4
Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., Hill, K., Holland, A. E., Lareau, S. C., Man, W. D., Pitta, F., Sewell, L., Raskin, J., Bourbeau, J., Crouch, R., Franssen, F. M., Casaburi, R., Vercoulen, J. H., Vogiatzis, I., Gosselink, R., ... ATS/ERS Task Force on Pulmonary Rehabilitation (2013). An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. American journal of respiratory and critical care medicine, 188(8), e13–e64. https://doi.org/10.1164/rccm.201309-1634ST
World Health Organization. (2023, March 16). Chronic obstructive pulmonary disease (COPD). Retrieved from World Health Organization: WHO website: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
This blog was written by Samuel Bulten
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