Long-term efficacy of pulmonary rehabilitation: a state-of-the-art review

Abstract

Purpose: While the short-term efficacy of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) is well documented, less is known about its sustainability and long-term effects in non-COPD patients, as well as secondary effects on exacerbation rates and the use of health care resources.

Methods: We conducted a MEDLINE literature search on studies of pulmonary rehabilitation from the years 2000 to 2010. For each study, design, modalities, and outcomes were tabulated.

Results: Design, group size, and duration of followup varied considerably between studies. Fifteen studies assessed physical performance, quality of life, or dyspnea in patients with COPD up to 24 months after rehabilitation. Six studies conducted followup evaluations in patients with interstitial lung disease, and 1 study considered asthma. Exacerbation rates and the use of health care resources were assessed in 20 studies in COPD and in 1 study in asthma. Results indicated the maintenance of the primary effects up to 1 year after pulmonary rehabilitation in COPD, while such effects were less pronounced in patients with interstitial lung disease. Secondary improvements regarding exacerbation rates and the use of health care resources were not consistent throughout studies and diseases.

Conclusions: Pulmonary rehabilitation has positive short- and long-term functional effects in COPD and more recent research supports improvements of exacerbation rates and the use of health care resources as secondary outcomes of pulmonary rehabilitation. Additional research on long-term efficacy regarding secondary effects and non-COPD patients is essential.