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Pulmonary Rehabilitation

Pulmonary rehabilitation is a multidisciplinary program that is designed to maximize physical function and improve quality of life of people with chronic obstructive pulmonary disease (COPD). It is recommended for patients with COPD whose symptoms become worse upon exertion as well as for patients who experience frequence acute exacerbations of COPD symptoms. There are three major components of pulmonary rehabilitation:

• Exercise training - Usually involves a 2-month program of supervised exercise sessions (2 or 3 sessions per week) on an outpatient basis. In between formal, supervised sessions, patients are encouraged to exercise at home.

• Patient education - Teaching COPD patients methods of breathing control, relaxation techniques, the benefits of exercise, and the importance of smoking cessation is a major goal of the patient education aspect of pulmonary rehabilitation. Patient education may be done on an individual basis or in a group setting.

• Nutritional advice - For reasons that are not well understood, many COPD patients are underweight initially, however, over time, they tend to become overweight due to a lack of physical activity and overeating. Nutritional advice regarding eating a well-balanced, low-fat diet to maintain appropriate body weight is also a major objective of a multidisciplinary pulmonary rehabilitation program.

Supplemental Oxygen Therapy

Patients with chronic obstructive pulmonary disease (COPD) who develop hypoxemia (low levels of oxygen in the bloodstream) will usually require supplemental oxygen therapy to increase the levels of oxygen in the bloodstream. For patients with stable COPD, supplemental oxygen therapy is done in the home setting. Studies have shown that supplemental oxygen therapy can substantially improve exercise tolerance in people with COPD and can also reduce mortality.

Patients who experience frequent acute exacerbation of COPD symptoms (e.g., cough; increased sputum production; worsening shortness of breath)that may lead to respiratory failure will usually require non-invasive ventilation. In non-invasive ventilation, the patient receives respiratory support in the hospital through a face mask or a nose mask that is connected to a portable ventilator. Non-invasive ventilation is indicated for patients with acute exacerbations of COPD who develop respiratory acidosis where the pH of the blood drops to 7.35 or lower and who have an elevated arterial carbon dioxide pressure (PaCO2) level.

The Role of Surgery in Severe Emphysema

Emphysema is a lung disease characterized by breathing difficulty that is caused by an enlargement of the air sacs (alveoli) in the lungs. Surgery is a treatment option for people with advanced emphysema whose symptoms can no longer be controlled with medical therapy. In general, there are three surgical procedures that may be considered for people with advanced emphysema:

Bullectomy

Some people with severe emphysema develop large air spaces in teh lungs called giant bullae that can not only interfere with breathing but can also cause other complications such as lung absesses or a collapsed lung. Surgical removal of these giant bullae, a procedure known as a bullectomy, can help patients breathe more easily and prevent further complications. In general, a bullectomy may be considered for patients with severe emphysema in the following situations: