Pulmonary rehabilitation and palliative care.

Pulmonary rehabilitation has been demonstrated to improve symptoms and quality of life of patients with chronic respiratory diseases. These benefits are not necessarily associated with physiological improvement and have not been shown to improve mortality. In this sense, its goals are palliative. Rehabilitation programs assess patients' knowledge of their diseases, degree of symptoms such as dyspnea and fatigue, understanding of common therapies, and capacity for exercise. The exercise component of pulmonary rehabilitation improves function within the rehabilitation setting and may translate to increased activity at home for some patients. The programs also offer additional opportunities to identify for referring providers potentially undetected underlying comorbidities such as sleep disturbances, anxiety, and depression, which contribute to a poor quality of life for many patients. In addition, patients and their caregivers can be encouraged to ask questions about interventions during exacerbations, the meaning of advance care planning, and goals for end of life care with the intent that these dialogues will lead to further discussions with their doctors and families.