Pulmonary Rehab for Acute COPD Exacerbations

An afternoon scientific symposium today will address the impact of acute exacerbations on patients with COPD, allowing participants to consider the benefits and challenges of providing pulmonary rehabilitation in the post-exacerbation period.

Carolyn Rochester

“Acute exacerbations of disease are a major cause of morbidity and mortality for patients with COPD. Exacerbations are associated with further decline in lung function, increased symptoms of dyspnea and fatigue, reduced functional mobility, and worse quality of life, and they are a major contributor to COPD-related healthcare costs,” says Carolyn Rochester, MD, associate professor of medicine, medical director of the Pulmonary Rehabilitation Program at the Veterans Affairs Connecticut Healthcare System, and medical director of the Yale Clinical COPD Program, at the Yale University School of Medicine, New Haven, CT.

Dr. Rochester and Roger Goldstein, MD, professor of medicine and physical therapy at the University of Toronto, and head of the Respiratory Division at West Park Healthcare Centre, are co-chairs of “Managing an Acute Exacerbation of COPD: Is Pulmonary Rehabilitation the Solution?” which will be from 2:15 to 4:15 p.m. today in Bellco Theatre Section 3 (Street Level) Colorado Convention Center.

Dr. Rochester notes that periods of immobility related to exacerbations, particularly those requiring hospitalizations, lead to increased muscle weakness and atrophy, often requiring re-hospitalization and increasing the risk for mortality. Pharmacotherapies can assist, but when used alone often do not succeed in preventing subsequent exacerbations or hospitalizations, says Dr. Rochester, adding that strategies to reduce exacerbations are needed.

“Pulmonary rehabilitation is an essential component of the integrated care of the COPD patient,” Dr. Rochester says. “It improves skeletal muscle function and exercise capacity, reduces dyspnea, improves quality of life, can improve physical activity levels, and reduces urgent healthcare use for medically stable patients. Pulmonary rehabilitation adds to the benefits of pharmacotherapies by addressing exercise capacity, functional mobility, and symptom management. It also affords an opportunity for further patient assessment and provides education geared toward collaborative self-management and health-promoting behavior change.

The majority of available published evidence, including randomized controlled trials and a Cochrane systematic review, has demonstrated that supervised pulmonary rehabilitation provided early (e.g., within three weeks) after hospitalizations for acute exacerbations of COPD is feasible, safe, and effective; leads to gains in exercise tolerance, reduced symptoms, and improved quality of life; and reduces risk of hospital readmissions.”