Pulmonary Rehabilitation

Pulmonary Rehabilitation 101: How Can This Program Help With Lung Diseases?

Approximately 16 million Americans have COPD (chronic obstructive pulmonary disease). But, only 6% of patients take part in pulmonary rehabilitation (PR) programs. Just 50% of those who participate finish these programs. Although it can be a lifesaving treatment, a fraction of COPD patients receives it.

A PR program can help with the shortness of breath and boost a patient’s ability to exercise. Other than for COPD, pulmonary rehabilitation can prove useful for interstitial lung disease, pulmonary hypertension, post/pre-transplant, and cystic fibrosis. This is a detailed guideline of what pulmonary rehabilitation has to offer for different patients.

Table of Contents

How To Know If Pulmonary Rehab Is Right for Me?

Pulmonary rehab is a program meant for patients with chronic lung disease. The main goal is to use education, physical activity, and behavioral intervention to boost the patient’s quality of life. But, it also enhances their daily functioning and independence.

Rehabilitation can achieve that by:

  • Reducing the number of hospital visits
  • Promoting exercise tolerance
  • Improving sense of well-being
  • Decreasing shortness of breath

According to the latest statistics, 2 in 3 patients who take part in PR experience positive results. The treatment reduces the symptoms of lung disease, improves their emotional and physical state. Your healthcare provider will determine whether you qualify for treatment.

They will evaluate your current lung and health state, discuss your activity level, and determine your overall wellness. If you experience regular shortness of breath paired with lung disease, you can get treatment.

This type of approach is usually recommended to individuals who, despite taking daily medication, can’t perform their regular activities. That includes anyone with COPD, asthma, pulmonary fibrosis, and bronchiectasis.

The pulmonary rehabilitation team often consists of physical therapists, doctors, respiratory therapists, nurses, dietitians, and exercise specialists. They are a team of experts who work together to form an individualized treatment program. Each PR approach is tailored towards specific patient needs.

If you have trouble walking due to heart problems or you recently experienced a heart attack, pulmonary rehabilitation might not be a good choice for you. Contact your cardiologist or healthcare provider about getting cardiac rehabilitation instead.

Experts believe anyone with a recent myocardial infarction, unstable angina, or trouble walking shouldn’t do a PR. Their functional limitations can cause additional pressure from breathlessness. In cases such as these, it is best to consult with a GP.

What Does Pulmonary Rehab (PR) Offer?

According to a study from Respiratory Medicine, COPD patients who completed an outpatient 3 session PR, for 12 weeks, experienced a better exercise tolerance and health-related quality of life.

Most patients obtained a plateau in physical function (57%), walk test performance (75%), and emotional function (79%) after 8 weeks. Their condition became stable before the sixth week, allowing them to boost their quality of life.

Based on 2014 clinical reports, PR is a comprehensive approach that works with the patient as a whole. It doesn’t just target the major components of the disease. Focused on individualized treatment, the program reduces the symptoms, optimizes functional status, and reduces healthcare costs.

The way it achieves that is by revising and stabilizing the systemic manifestations of the disease. Even though countless components should be considered when managing a certain impairment, supervised exercise seems like the most viable approach.

To determine whether or not a patient needs pulmonary rehab, doctors will do an exercise stress test to measure the patient’s blood pressure, heart rate, and oxygen during exercise. This is followed by a pulmonary function test to check the breathing and a six-minute walk test to measure the walking distance a patient can accomplish.

During rehabilitation, the plan can include one or more of the following:

  • Exercise and breathing managementResearch shows that breathing techniques improve dyspnea (serious and lasting shortness of breath) in critically ill COPD patients. They are a low-cost, safe, and non-pharmacological method for managing lung disease. Patients learn unique techniques that will help them keep their breathing under control and remove the mucus from their lungs.
  • Nutritional support – Food plays a key role in lung function. With a healthy dose of nutrients, vitamins, and minerals, patients can maintain strong respiratory muscles. Nutritional counseling during PR will ensure patients stay on the right track. Experts can recommend nutritional supplements if necessary.
  • Interdisciplinary education – During individual or group sessions, patients will learn more about their lung diseases and ways to manage them. They get a detailed guideline of how their lungs work and the way medicine can help. In time, they will recognize the flare-ups and symptoms of the disease to find the most practical ways to control the illness.
  • Psychological counseling – Anxiety, stress, and depression are serious problems with COPD patients. Studies show that depression rates vary from 7% to 80% and anxiety from 2% to 80%. The more severe the disease is, the bigger the odds for mental unrest. Psychological counseling teaches patients self-management and maintenance strategies that can help overcome emotional problems. Patients take group or individual sessions to learn key stress control skills.

Oxygen administration and pharmacotherapy optimization – Those with severe lung disease typically take multiple drugs. These drugs, however, follow a complex and precise schedule. PR ensures that patients take their medicine at the right timing and with the proper dose. The first line of treatment for these patients is the NPPV (non-invasive positive-pressure ventilation). But, for more serious complications, IPPV (invasive positive-pressure ventilation) becomes necessary. The main indications for ventilation are acute respiratory acidosis, shock, recent diagnosis with neuromuscular disease, refractory hypoxemia, and short-term ICP (increased intracranial pressure). This type of oxygen administration is the only way to get the respiratory muscles back on track.

What Kind of Weaknesses Does Pulmonary Rehabilitation Address?

The central aspect of PR is to manage pulmonary diseases, prevent their progression, and relieve the symptoms. But most importantly, to avoid serious health complications, exacerbations and reduce the mortality rate. Sometimes, long-term oxygen therapy is necessary.

Although this is a relatively recent respiratory practice, pulmonary rehab can address multiple weaknesses. Since this is an individually designed multidisciplinary program, it can help with different degrees of respiratory impairment. Here is a detailed guideline of the weaknesses addressed.

Ventilatory Limitation

Constraint (ventilatory limitation) when exercising is determined by measuring how close the minute ventilation (ventilatory reserve) is while exercising. The type of breathing pattern a person adopts when exercising will affect their ventilatory constraint.

Pulmonary rehabilitation focuses on alleviating the impaired gas exchange and boosts dead space ventilation. Therefore, it can help with peripheral muscle dysfunction. To control the continuous breathing pattern, some patients need short-term ICP.

Ventilation can help with breathing problems. But, to reduce the risk of ventilator-induced lung damage, controlling the gas exchange becomes a key strategy. Ventilation helps patients ease the upper airway obstruction and helps the lungs function properly.

When the patient doesn’t need mechanical support anymore, then they go through the weaning program. Weaning liberates them from the endotracheal tube and restores their independence. Those who pass the objective and subjective assessment (like blood pressure, coughing, and heart status tests) are ready for weaning.

Heart Dysfunction

What most people don’t realize is that pulmonary diseases can also affect the heart. If the blood isn’t getting enough oxygen from the lungs, the cardiovascular system works harder to replenish its oxygen supply. This overworks the heart and can wear it out.

As a result, people with lung diseases are susceptible to heart problems. Based on research, COPD patients have a higher mortality risk due to myocardial infarction, arrhythmia, or congestive heart failure compared to healthy individuals.

Because of the better peripheral vascular resistance, pulmonary rehab boosts the right ventricular afterload. In other words, it strengthens the lungs and heart. If you do the monitored treatment and stick to the recommended guidelines, you can restore your health and enjoy a healthier lifestyle.

Gas Exchange Limitation

People with the pulmonary disease can have many health problems—some experience inspiratory muscle fatigue, impaired lung mechanics, malnutrition, ventricular dysfunction, and psychological issues. However, the impaired gas exchange can become a real health issue.

When there is a serious imbalance between oxygen demand and supply, you can experience restlessness, paleness, abnormal breathing, or cyanosis. This can take a toll on your daily life, research shows.

Pulmonary rehabilitation can address inspiratory muscle endurance and functional inspiratory muscle strength. That makes it a valuable component in managing pulmonary diseases.

Skeletal Muscle Dysfunction

COPD patients have weaker muscles and low endurance. Anyone with this chronic respiratory disease can experience skeletal muscle dysfunction. This is easy to recognize from the endurance and strength impairment.

Quadriceps strength tends to reduce in severe or moderately ill COPD patients. This will impact the patient’s quality of life. The reason for that is relatively simple. Because of the impaired skeletal muscle performance, people often have a low exercise capacity. They don’t have the energy to exercise, so they can’t take good care of their bodies.

Pulmonary rehab improves fatigue resistance, particularly the quadriceps muscle. It can help the muscles function better by boosting endurance, strength, muscle fiber, and managing fatigue. These are all key factors in improving exercise capacity.

Why Does PR Have High Drop-Out Rates?

Despite the countless benefits this program has to offer, a considerable amount of people drop out of treatment. Researchers decided to figure out the main reasons.

Based on the reports, it seems that most, or 36.4% of those evaluated, didn’t have the motivation to continue treatment. Whereas for 18.2%, the long distance from the hospital proved to be a serious problem.

If you really want to reap all the benefits, you should finish the entire program. Eventually, you can take advantage of all those results and get your health on the right path. The only way to achieve that is to remain dedicated and committed to the program. All your efforts can pay off in the long run.

How Long Does PR Take?

In most cases, PR features two or three sessions a week that last for a couple of weeks or months. In specific patients, it can last from 6-8 weeks to 1 year.  It usually depends on the severity of the disease. Some patients experience serious exacerbations (lung flare-ups), which forces them to require more oxygen. They can need additional support.

Most experts suggest 6-12 weeks with regular exercising sessions. PR can be based in the community, hospital, or both. For better outcomes, you should go to an inpatient facility. That way, you will always have supervision to keep the emotional function, fatigue, and dyspnoea in check.

When the program ends, the healthcare team will continue to assess your lung state and function. They will monitor the way your breathing has improved. You may have to do additional exercise tests just to see how the body is doing.

The key to a successful recovery is to continue with these exercises even after you finish rehab treatment. Otherwise, you can lose the benefits you’ve gained during PR. Your healthcare team will create a long-term strategic plan that will offer ideal maintenance for your breathing problems. As long as you stick to them, you can maximize the benefits.

Final Thoughts

Pulmonary rehab is a practical program for managing pulmonary diseases. It is a versatile approach that can boost the quality of life, mental and overall well-being in patients with a chronic lung condition. It can also be helpful for those with asthma, pulmonary fibrosis, and bronchiectasis. Now that you are familiar with its benefits, you can find the inspiration to finish the entire treatment.


Why CMRC?​

CMRC Hospital is the specialized provider for Long-term Care and rehabilitation services in Saudi Arabia. With one main facilities in Saudi Arabia, which are designed in a rehabilitation and long-term care hospital with a capacity of 66 beds.

CMRC provides an interdisciplinary clinical approach for Vent Rehabilitation Services which is customized for adults, adolescents, and children. The best rehabilitation services are not only our goal but our ultimate objective is to customize the care plan for each patient and make sure that the patient’s family and their members are integrated into the treatment plan.

When you joined Saudi Arabia hospital for any kind of our rehabilitation services or even for long-term care you will feel as if you are at #Your Second Home.