Pulmonary rehabilitation.

Pulmonary rehabilitation programs use multidisciplinary teams to optimize physical and social functioning of patients with chronic respiratory impairment. These programs provide rehabilitation in inpatient, outpatient, or home settings, using at least three sessions weekly (one may be unsupervised) for at least 6 wk. The programs usually consist of exercise training, education, and psychosocial/behavioral components. Upper extremity exercises and instruction on breathing technique are included in most rehabilitation programs and reduce dyspnea, but the contribution of these to improved functional capacity remains unproven. Decreases in the sensation of dyspnea, increased functional exercise capacity, and enhanced quality of life of patients with chronic obstructive pulmonary disease (COPD) are established benefits of pulmonary rehabilitation. Evidence is lacking for the efficacy of rehabilitation for patients with non-COPD causes of pulmonary impairment, but many of these patients probably benefit. Despite the availability of strong evidence to support the efficacy of pulmonary rehabilitation programs in patients with severe COPD, third-party reimbursement policies have been inconsistent. Nonetheless, enrollment in a pulmonary rehabilitation program is encouraged for all appropriate candidates with chronic respiratory impairment, particularly for those with severe COPD.