[Electrostimulation in the rehabilitation of patients with severe COPD: pertinent or not]

The degree of dyspnoea and muscular dysfunction during an exacerbation of COPD are so severe in some patients that they are unable to follow a traditional exercise training programme based on whole body activity (walking, cycling). Some alternative strategies like electrostimulation may be considered to initiate retraining as soon as possible, to break the vicious circle of exacerbations and improve the prognosis of these patients.

Five randomised studies with a control group have analysed the effects of electrostimulation in COPD. They show that this technique does not cause dyspnoea and is well tolerated by the patients regardless of their severity; that that it can improve peripheral muscular function, effort tolerance, dyspnoea and quality of life.

The preliminary results seem to indicate that electrostimulation probably has a place in respiratory rehabilitation. We think that it should be considered as an alternative to classical retraining in COPD patients with loss of independence during an exacerbation. However, further larger, standardised studies are necessary to confirm the clinical and functional benefits of this technique, to understand the underlying mechanisms and define the precise therapeutic indications.