Page 164 - Hospital Authority Convention 2018

Masterclasses
HOSPITAL AUTHORITY CONVENTION 2018

M10.3 Advances in Chronic Obstructive Pulmonary Disease 09:00 Room 423 & 424
Management

Update on Pulmonary Rehabilitation Programme
Wong WY
Department of Medicine, Haven of Hope Hospital, Hong Kong

Pulmonary rehabilitation (PR) is a comprehensive intervention that includes exercise training, education, and behavioural
change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to
promote long-term adherence of health-enhancing behaviours. There is strong evidence that PR can improve exercise
tolerance, dyspnea and health-related quality of life (HRQoL) of patients with chronic obstructive pulmonary disease (COPD).
There is also evidence that PR can reduce hospital admissions and is cost effective. PR is an essential part of managing
patients with COPD and the benefit of PR is observed in patients with mild to severe COPD. PR is also shown to benefit
patients with other respiratory diseases including bronchiectasis, interstitial lung disease, pulmonary hypertension and
lung transplantation. The international guidelines recommend that PR is delivered within four weeks of hospital discharge
after an acute exacerbation of COPD (AECOPD). Early rehabilitation during AECOPD has been shown to produce short-
term benefits. The low uptake and adherence to PR is a worldwide issue. Lack of public awareness and transportation are
part of the reason. Alternative models of providing PR can be explored in order to increase the accessibility of PR. Studies
on community-based and home-based pulmonary rehabilitation with varying degrees of supervision or support showed
promising results. Tele-rehabilitation is also a promising way to deliver and improve the access to PR programmes. The
benefits of PR often decline over 6 to 12 months, patients are encouraged to continue exercise after completion of PR in
order to maintain the benefit. The efficacy of maintenance exercise training programme remains equivocal. Optimal model of
a maintenance exercise programme is needed.

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