Clinical Connection: UR Medicine Launches Pulmonary Rehab progam
December 3rd, 2015 | Archiveby Anthony Pietropaoli, MD
UR Medicine is pleased to announce the opening of a new Pulmonary Rehabilitation program (PR) for patients with chronic obstructive pulmonary disease (COPD). This new program is conveniently located in the existing cardiac rehabilitation space at Clinton Crossings, Building H.
Pulmonary rehabilitation is defined as “a comprehensive intervention based on thorough patient assessment followed by patient-tailored therapies including exercise training, education, and behavior change designed to improve the physical and psychological condition of patients with chronic respiratory disease and promote the long-term adherence to health-enhancing behaviors”(1).
Pulmonary rehabilitation has a number of proven benefits for patients with COPD. For patients with stable COPD, PR significantly improves symptoms and exercise tolerance (2). For patients with recent acute COPD exacerbations, PR not only improves symptoms and exercise tolerance, it also reduces the risk of hospital admissions (3). For this important clinical outcome, the Cochrane collaborators compiled the evidence from available clinical trials and estimated a number needed to treat (NNT) of four. That is, four COPD patients must be treated with PR in order to avoid one hospital admission. Clinical interventions with such a powerful treatment effect are indeed hard to find! More astounding, in this analysis the NNT to save one life was six, though this estimate was based on a few small studies so may be less reliable.
The Cochrane collaborators summarized their recent reviews with the following powerful endorsements (2, 3):
• “Pulmonary rehabilitation is now accepted within the scientific community as an essential strategy in the ongoing management of people with COPD.”
• “Pulmonary rehabilitation has long been underused in patients with COPD.”
• “Pulmonary rehabilitation is likely to reduce the risk for future admissions and leads to large and clinically relevant improvements of health-related quality of life and exercise capacity.”
Eligibility criteria include a diagnosis of COPD, confirmed by spirometry showing at least mild obstructive pulmonary physiology (defined by FEV1/FVC ratio <70% and FEV1 < 80% of predicted) within 3 months of the start date, as per Medicare requirements. The program is open to all of these patients with COPD. We are particularly targeting and prioritizing COPD patients with recent hospital admissions for COPD exacerbation. Our PR program is led by Lindsay Himes, RRT, Craig Dennison, MS, and the UR pulmonary faculty. Anthony Pietropaoli, MD, is the medical director. The program consists of 12 combined exercise and educations sessions, occurring twice weekly over approximately 6 weeks. A customized exercise prescription is developed and tailored throughout the program. Exercise activities include the treadmill, recumbent bike, NuStep, and upper extremity ergometry. Educational sessions focus on lung function and the pathophysiology of COPD, proper nutrition, breathing techniques, and other important topics for maximizing quality of life when living with COPD. Each session lasts approximately 1.5 hours. To make a referral, please call our office at 341-7100 or electronically in E-Record (search orders with “amb ref to pul rehab”). We look forward to making a difference for your patients with COPD! 1. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FM, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJ, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AM, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Molken MP, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EF. An official american thoracic society/european respiratory society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-64. 2. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. The Cochrane database of systematic reviews 2015;2:CD003793. 3. Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. The Cochrane database of systematic reviews 2011:CD005305.
