Pulmonary rehabilitation and the COPD exacerbation

Patients who experience frequent exacerbations of chronic obstructive pulmonary disease (COPD) are known to have a higher mortality, reduced exercise capacity, and muscle atrophy. The next key challenges for the implementation of effective pulmonary rehabilitation are to reverse these changes and enable patients to recover from an exacerbation without serial decline in their functional capacity with each subsequent exacerbation. Current evidence suggests that early rehabilitation following an exacerbation may prove beneficial, although this has been described in a variety of guises and needs further evidence to identify the exact form that it should take. Other additional interventions such as the use of noninvasive ventilation, quadriceps muscle training, early ambulation with rollator frames, and inspiratory muscle training have been shown to demonstrate positive outcomes in these patients and may well complement outcomes achieved through early pulmonary rehabilitation programs. It is clear that further research into early pulmonary rehabilitation is required to identify the point at which it should start, what form it should take, how long programs should be to produce positive outcomes, and what the inclusion and exclusion criteria should be.