Pulmonary rehabilitation and surgery for end-stage lung disease

Pulmonary rehabilitation is a multidisciplinary approach to the comprehensive management of patients with end-stage lung disease. Components of the pulmonary rehabilitation program include education, exercise, nutrition, and psychosocial support. Most of the information published on pulmonary rehabilitation has been from patients with COPD. There are some data on patients with cystic fibrosis but, unfortunately, there is a lack of information on other causes of end-stage lung disease. Published data almost invariably show improvements in functional capacity (i.e., walk distance) and quality of life. There are no objective physiologic changes in lung function. Because patients who attend programs regularly are a carefully selected subpopulation, conclusions from published reports may not apply to all patients with end-stage lung disease. The recommendation for pulmonary rehabilitation prior to lung volume reduction surgery or lung transplantation is based on assumptions that may not necessarily be true. No data exist that conclusively show that preoperative rehabilitation alters outcome. Nevertheless, given the relatively benign nature of pulmonary rehabilitation and the documented benefits, it is reasonable to recommend such a program to patients who are awaiting surgical intervention. Further research is required to define the role, nature, duration, intensity, and frequency of exercise training in the management of patients who are to undergo surgical treatment for advanced lung disease.