Resp Care
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Pulmonary rehabilitation has emerged as a standard of care for patients with chronic lung disease, based on a growing body of scientific evidence. Over recent decades, several organizations have championed pulmonary rehabilitation and developed comprehensive statements, practice guidelines, and evidence-based guidelines. Documenting the scientific evidence underlying clinical practice has been important in overcoming skepticism and convincing health professionals, health-care institutions, third-party payers, and regulatory agencies to support pulmonary rehabilitation programs. ⋯ Recommendations were given for outcomes of comprehensive pulmonary rehabilitation programs, including lower-extremity exercise training, dyspnea, health-related quality of life, health-care utilization, survival, psychosocial outcomes, and long-term benefits. Additional topics include the duration of pulmonary rehabilitation, post-rehabilitation maintenance strategies, intensity of aerobic exercise training, strength training, anabolic drugs, upper-extremity training, inspiratory-muscle training, education, psychological and behavioral components, oxygen supplementation, noninvasive ventilation, nutrition supplementation, rehabilitation for patients with disorders other than chronic obstructive pulmonary disease, and future pulmonary rehabilitation research. These guidelines provide an excellent summary of the recent literature and further strengthen the scientific basis of pulmonary rehabilitation.
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Lightweight portable oxygen systems are commonly preferred by patients over compressed-oxygen systems that use E-size cylinders. However, cost is often perceived as a barrier to the prescription of lightweight portable oxygen systems. ⋯ The type of oxygen system used did not significantly affect overall cost of care in patients with COPD on long-term oxygen therapy.
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Pulmonary rehabilitation is widely accepted as effective therapy for patients with chronic obstructive pulmonary disease (COPD). This paper presents a brief (and somewhat subjective) history of pulmonary rehabilitation, and stresses the development of the exercise component. Until the middle of the 20th century, patients with COPD were advised to avoid the dyspnea that activity brings. ⋯ In the 1960s Petty created the multi-disciplinary team that was found to be effective in delivering pulmonary rehabilitation. In the 1980s doubts surfaced as to the ability of rehabilitative exercise to improve muscle function in COPD, but in the 1990s studies showed that well-designed exercise programs caused beneficial physiologic adaptations. The current decade has yielded studies that exploited those insights to design interventions that boost the effectiveness of rehabilitative exercise.