In late April 2010, the journal Nursing Times published a study review article that posed the question, “Do people with mild COPD benefit from early pulmonary rehabilitation programs?”
The study, conducted at a U.K. based outpatient medical services center known as a PCT (Primary Care Trust), involved a 3 week pre-pulmonary rehab program for 8 mild COPD patients. During the program, patients met twice a week for two hours to receive educational counseling from the researchers regarding exercise, breathlessness, relaxation techniques, smoking cessation, proper use of inhalers and nutrition among other topics. (Gulrajani R. Do people with mild COPD benefit from early pulmonary rehabilitation programmes? Nursing Times. 2010:106: 17, Epub ahead of print)
At the end of the program 50% of the patients in the study reported less dyspnea (shortness of breath episodes) and said they had more control over their condition. 25% of the study participants reported feeling less fatigued. 100% of the patients in the study felt the program was beneficial and would recommend it to other mild COPD patients.
While scientific researchers will likely discount the results of the study given its small size, construction, and duration, the article explores a critical question for both practitioners and patients – is there value in providing access to some of the core information provided in pulmonary rehabilitation programs for people who have yet to develop severe lung disease?
To fully appreciate this question, it is important to understand that today pulmonary rehabilitation is typically only offered to moderate to severe COPD patients in the U.K. (same is true in the U.S.), meaning mild COPD patients cannot gain access to such a program. Pulmonary rehabilitation is a treatment program which combines observed/managed aerobic and strength training exercise with counseling on nutrition, breathing techniques, airway clearing techniques, and proper use of medications among other topics. It has been proven time and time again as effective in improving COPD patient physical conditioning, reducing shortness of breath, reducing hospital admissions and improving overall patient quality of life.
According to the article author, people in the U.K. who visit a PCT complaining of chronic shortness of breath typically receive a spirometry test (to determine lung function quality). If mild COPD is suspected, a patient receives counseling on smoking cessation (if they smoke). They may also be prescribed rescue inhalers (which temporarily open airways during shortness of breath attacks) and provided instruction on the proper use of the inhalers. These counseling sessions typically last only 15 minutes and therefore a minimum of valuable information beyond these topics is communicated and, as mentioned above, pulmonary rehab is not offered. The same basic patient treatment scenario also occurs in U.S. medical practices.
To the researchers, this truncated practitioner/patient interaction leaves a lot to be desired especially when the practitioners know that pulmonary rehab has such a strong track record in improving symptoms and quality of life – even for those with mild COPD. So the researchers decided to investigate a novel approach to “try to prevent deteriorating lung function rather than wait until patients had moderate to severe disease and (then) could attend PRP (pulmonary rehabilitation program).”
Knowing it would not fly with their health care system administrators to simply offer a full scale pulmonary rehab program for mild COPD patients (pulmonary rehab services are only reimbursed for moderate to severe COPD patients), the U.K. based researchers sought to offer a mini-education program based on the core elements of pulmonary rehabilitation.
Intuition would suggest that offering a full scale pulmonary rehab as a treatment option earlier in the development of COPD might help slow or halt the progression of lung disease and reduce hospital admissions related to COPD exacerbation events. And indeed, there have been previously published studies that demonstrate efficacy of pulmonary rehab for those with mild COPD as well as more severe cases. However, despite the evidence that pulmonary rehab is helpful to people with mild COPD, it remains a treatment option largely only available to those with more advanced lung disease. And this reality is frustrating for the on the ground physicians, therapists and nurses who work in pulmonary rehab settings who believe they could make a bigger difference if they were given the opportunity to work with less severe COPD patients. This study attempts to fill the frustrating void with a mini-pre-rehab program and its results seem to demonstrate value in their approach (understanding that more rigorous follow on research is warranted).
This state of affairs is the primary reason we created the Breathe Better for Life guide and companion CD. We desired to expand awareness of pulmonary rehab and provide people who would otherwise have no access to its proven efficacy the opportunity to undertake a rehab-style program based on the principles of this powerful treatment option (in consultation with their doctor). For those interested in learning more about the guide and CD, visit http://www.breathebetterforlife.com./
We would encourage those who suffer from chronic shortness of breath to engage your physician (primary care or pulmonologist) about pulmonary rehab and whether it is appropriate to your situation. If the only weapons in your arsenal to manage your lung disease are rescue inhalers, antibiotics prescriptions, and/or supplemental oxygen, you are dramatically selling yourself short. These treatments do relieve short-term symptoms, but none of them improve physical conditioning, reduce shortness of breath on an ongoing basis, or improve long-term sense of quality of life like pulmonary rehabilitation.
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