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

Pulmonary rehabilitation has been established as the standard of care for patients with symptomatic chronic obstructive pulmonary disease (COPD). Benefits include improvements in exercise tolerance, dyspnoea 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 chronic obstructive pulmonary disease (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. Although efforts are underway to organize such a trial, even in a best-case scenario it will be a number of years before the results are available.