Pulmonary rehabilitation: a focus on COPD in primary care

In 2007, the American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) published updated guidelines on pulmonary rehabilitation (PR). For patients with chronic obstructive pulmonary disease (COPD), PR is now considered to be the standard of care for those with at least moderately severe COPD as well as those patients with COPD of mild severity (as determined by spirometry) who, following maximal medical care, remain symptom-limited in exercise capacity or functional status. The goal of PR is for the patient to become more physically active and maintain independence longer. The benefits of PR extend far beyond physical endurance and reduced dyspnea, and include improved adherence, reduced health care utilization and costs, more patient involvement in disease management, and improved patient outlook. Pulmonary rehabilitation is more than "just an exercise program;" it is a multidisciplinary, comprehensive intervention that is ideally performed in formal programs by a team of health care professionals, in partnership with the primary care physician. In reality, primary care physicians perform most of the long-term management of COPD patients and thus are left to create ad hoc PR programs in their own communities. This article outlines each of the ACCP/AACVPR recommendations for PR and provides commentary on how these recommendations apply to COPD management in primary care. A discussion of reimbursement issues and future directions for PR guidelines is also provided.