Photo Credit: Nutthaseth Vanchaichana
Pulmonary rehabilitation in COPD that includes exercise training is an effective way to decrease disease severity due to exacerbations.
Exacerbations are important events in the disease trajectory of patients with chronic obstructive pulmonary disease (COPD). They are the main drivers of cost, impair patients’ function and health-related QOL, and speed up the deterioration of patients with COPD.
Pulmonary rehabilitation that includes exercise training is an effective way to interrupt the downward spiral of increasing disease severity due to exacerbations. Most guidelines include the prescription of rehabilitation after exacerbations. Unfortunately, uptake of these programs is low as programs may not be available, and the logistics of center-based rehabilitation may not fit with the needs of patients who have a rather severe chronic disease. Making programs more accessible and closer to patients’ homes is an important task we tried to do in our study.
We worked together with primary care physical therapists, general practitioners, chest physicians, and patients to develop a program that would be feasible to implement in a primary care physical therapy (PT) practice. In Belgium, we found that such PT practices are available within a few kilometers of the houses of our patients. Appointments can be made more flexibly than in center-based rehabilitation. A possible drawback is the lack of multidisciplinary support.
We developed a practical program for primary care physiotherapists, which is described in detail in the paper. The program offers progressively more difficult exercises for patients after exacerbations and requires limited infrastructure. Patients referred to the program thought it was feasible, and physiotherapists could follow the guidance. A randomized controlled study on the effectiveness of the program is currently underway.
The program is free to adopt and can be used by colleagues in primary care to train their patients after acute exacerbations. For many physical therapists, it is new that the emphasis is not on breathing exercises but rather on reconditioning, with resistance training for the lower limbs and whole-body exercise training (after a few weeks). The program is freely available online and includes YouTube clips for the exercises. It can be progressed as patients improve.
More patients should be offered the opportunity to engage in exercise training after an acute exacerbation of COPD. Patients lose their confidence to engage in physical activity and ultimately become much more disabled than needed based on their lung problems.
General practitioners and chest physicians should have a plan for referring th eir patients to a training program. With this program, we hope to inspire primary care physiotherapists to set up such programs as a care package in their practices.
We are currently evaluating the program’s effectiveness in a larger patient population and hope to share those results soon. Obviously, the short and long-term effects of such programs need to be investigated. These programs are no substitute for center-based rehabilitation but may provide options for patients for whom center-based rehabilitation is not possible.
Please do not discharge a patient with a COPD exacerbation from your service without an operational plan for exercise training adapted to the capabilities of your patient. This needs to be restored as quickly as possible; otherwise, patients will quickly experience their next respiratory exacerbation.
