Clinics in chest medicine
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Numerous barriers exist to the timely introduction of palliative care in patients with advanced chronic obstructive pulmonary disease (COPD). The complex needs of patients with advanced COPD require the integration of curative-restorative care and palliative care. ⋯ Pulmonary rehabilitation provides the opportunity to introduce palliative care by implementing education about advance care planning. Education about advance care planning addresses the information needs of patients and can be an effective strategy to promote patient-physician discussion about these issues.
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Exercise training remains a cornerstone of pulmonary rehabilitation (PR) in patients with chronic respiratory disease. The choice of type of exercise training depends on the physiologic requirements and goals of the individual patient as well as the available equipment at the PR center. Current evidence suggests that, at ground walking exercise training, Nordic walking exercise training, resistance training, water-based exercise training, tai chi, and nonlinear periodized exercise are all feasible and effective in (subgroups) of patients with chronic obstructive pulmonary disease. In turn, these exercise training modalities can be considered as part of a comprehensive, interdisciplinary PR program.
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Pulmonary rehabilitation is now an established standard of care for patients with chronic obstructive pulmonary disease (COPD). Although pulmonary rehabilitation has no appreciable direct effect on static measurements of lung function, it arguably provides the greatest benefit of any available therapy across multiple outcome areas important to the patient with respiratory disease, including dyspnea, exercise performance, and health-related quality of life. It also appears to be a potent intervention that reduces COPD hospitalizations, especially when given in the periexacerbation period. The role of pulmonary rehabilitation within the larger schema of integrated care represents a fruitful area for further research.