Pulmonary Rehabilitation: Where We've Succeeded and Where We've Failed

Abstract

Pulmonary rehabilitation has been established as the standard of care for patients with symptomatic COPD. Benefits include improvements in exercise tolerance, dyspnea and quality of life; magnitude of benefit is generally greater than for any other COPD therapy. A wide range of professional organizations and standards documents have recommended pulmonary rehabilitation; benefits accrue across the spectrum of disease severity.

However, pulmonary rehabilitation is provided to only a tiny fraction of those COPD patients who would benefit. International estimates posit that only 1-2% of COPD patients receive pulmonary rehabilitation. In contrast, other COPD therapies, bronchodilators and oxygen therapy in particular, are much more widely available. The costs of pulmonary rehabilitation should not be a major barrier, as costs are comparable to other therapies.

In seeking strategies to increase pulmonary rehabilitation availability, it can be argued that a demonstration of a life prolongation benefit would be of great help. Therapies that improve survival have a high priority for patients, for their health care providers and for payers. A well-designed survival study has never been performed. A group of investigators in the United States is attempting to get such a study underway; design features of such a study will be discussed.