Approaches to rehabilitation of patients with ventilatory insufficiency

Multi-disciplinary rehabilitation programmes are popular in Europe and North America in the management of patients with chronic respiratory disease. Patients experience an increase in exercise tolerance, a decrease in dyspnoea and spend fewer days in hospital after completing the programme. Criteria for admission often include a well motivated nonsmoking patient with severe but stable disease of the ventilatory system. Although most patients have chronic airflow limitation, we have received a number of referrals concerning patients with non-obstructive ventilatory insufficiency, particularly thoracic restrictive disease and neuromuscular disease. Such patients frequently have hypercapnic respiratory failure, easily aggravated by increased activity or respiratory tract infection. Therefore, they cannot engage in a supervised exercise training programme unless we can stabilize their clinical state. We consider elective mechanical ventilatory support a valuable tool in their rehabilitation. Such support is often required only at night. By preventing the sleep-related alterations in arterial blood gases the clinical course of the disease is stabilized, functional level is increased and patients are then protected from episodes of acute respiratory failure which may be life-threatening.