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The Nonpharmacologic Treatment of Chronic Obstructive Pulmonary Disease

Advances in Our Understanding of Pulmonary Rehabilitation

¹ Section of Pulmonary and Critical Care, St. Francis Hospital and Medical Center, Hartford, Connecticut; and ² University of Connecticut School of Medicine, Farmington, Connecticut

Correspondence and requests for reprints should be addressed to Richard ZuWallack, M.D., Pulmonary and Critical Care, St. Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105. E-mail: rzuwalla{at}stfranciscare.org

ABSTRACT

The optimal care of patients with chronic obstructive pulmonary disease generally requires combining pharmacologic and nonpharmacologic therapies. The latter include smoking cessation, the encouragement of physical activity and exercise, influenza and pneumonia vaccinations, education on adherence to medical therapy, collaborative self-management strategies, such as a plan to manage exacerbations, and advance directives. Although each of these is a component of good medical practice, they can be given together in the form of a comprehensive outpatient pulmonary rehabilitation program. Pulmonary rehabilitation, which includes exercise training, education, psychosocial support, and nutritional intervention, has demonstrated effectiveness over multiple outcome areas, despite the fact that it has virtually no direct effect on the underlying pathophysiology of the lung. This intervention works primarily through its beneficial effects on associated morbidity, such as physical deconditioning. Pulmonary rehabilitation is indicated when respiratory symptoms or functional limitations persist despite otherwise standard medical therapy. Combining optimal bronchodilator therapy and/or supplemental oxygen therapy with exercise training will enhance the effectiveness of the latter.

Key Words: activity • chronic obstructive pulmonary disease • exercise • pulmonary rehabilitation

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