[Value and costs of pulmonary rehabilitation]

Pulmonary rehabilitation (PR) is nowadays a recognized discipline for stabilisation and improvement of chronic pulmonary diseases. According to epidemiologic data the number of patients with chronic obstructive bronchitis and asthma is on the rise. Aim and components of a modern stationary PR-program are defined and benefit and costs discussed according to data from recent publications. Necessity of an individual, stepwise, multidisciplinary and holistic approach to physical and psychic symptoms based on an exact diagnostic workup is shown. Data from selected studies on benefits of PR such as reduced frequency and/or cost of hospitalisations, improved quality of life or reduced symptoms, improvement of pulmonary function and effects on mortality and working capacity are discussed. Since controlled studies are unavailable from Switzerland so far, data from American and European literature are used. In the most severe terminal stages of pulmonary failure individual complementary surgical measures have to be evaluated, i.e. volume-reducing surgery for emphysema or transplantation of the lung. The peri- and postoperative risks and arising costs have to be weighted against the expected improvement of pulmonary function and quality of life by exhaustive conservative measures.