Pulmonary Rehabilitation* Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines

Andrew L. Ries, MD, MPH, FCCP (Chair); Gerene S. Bauldoff, RN, PhD, FCCP; Brian W. Carlin, MD, FCCP; Richard Casaburi, PhD, MD, FCCP; Charles F. Emery, PhD; Donald A. Mahler, MD, FCCP; Barry Make, MD, FCCP; Carolyn L. Rochester, MD; Richard ZuWallack, MD, FCCP; Carla Herrerias, MPH

Disclosures

CHEST. 2007;131(5):4S-42S. 

In This Article

Summary of Recommendations

  1. A program of exercise training of the muscles of ambulation is recommended as a mandatory component of pulmonary rehabilitation for patients with COPD.
    Grade of Recommendation: 1A

  2. Pulmonary rehabilitation improves the symptom of dyspnea in patients with COPD.
    Grade of Recommendation: 1A

  3. Pulmonary rehabilitation improves health-related quality of life in patients with COPD.
    Grade of Recommendation: 1A

  4. Pulmonary rehabilitation reduces the number of hospital days and other measures of health-care utilization in patients with COPD.
    Grade of Recommendation: 2B

  5. Pulmonary rehabilitation is cost-effective in patients with COPD.
    Grade of Recommendation: 2C

  6. There is insufficient evidence to determine if pulmonary rehabilitation improves survival in patients with COPD. No recommendation is provided.

  7. There are psychosocial benefits from comprehensive pulmonary rehabilitation programs in patients with COPD.
    Grade of Recommendation: 2B

  8. Six to 12 weeks of pulmonary rehabilitation produces benefits in several outcomes that decline gradually over 12 to 18 months.
    (Grade of Recommendation: 1A)
    Some benefits, such as health-related quality of life, remain above control at 12 to 18 months.
    (Grade of Recommendation: 1C)

  9. Longer pulmonary rehabilitation programs (12 weeks) produce greater sustained benefits than shorter programs.
    Grade of Recommendation: 2C

  10. Maintenance strategies following pulmonary rehabilitation have a modest effect on long-term outcomes.
    Grade of Recommendation: 2C

  11. Lower-extremity exercise training at higher exercise intensity produces greaterphysiologic benefits than lower-intensity training in patients with COPD.
    Grade of Recommendation: 1B

  12. Both low- and high-intensity exercise training produce clinical benefits for patients with COPD.
    Grade of Recommendation: 1A

  13. Addition of a strength training component to a program of pulmonary rehabilitation increases muscle strength and muscle mass.
    Strength of evidence: 1A

  14. Current scientific evidence does not support the routine use of anabolic agents in pulmonary rehabilitation for patients with COPD.
    Grade of Recommendation: 2C

  15. Unsupported endurance training of the upper extremities is beneficial in patients with COPD and should be included in pulmonary rehabilitation programs.
    Grade of Recommendation: 1A

  16. The scientific evidence does not support the routine use of inspiratory muscle training as an essential component of pulmonary rehabilitation.
    Grade of Recommendation: 1B

  17. Education should be an integral component of pulmonary rehabilitation. Education should include information on collaborative self-management and prevention and treatment of exacerbations.
    Grade of Recommendation: 1B

  18. There is minimal evidence to support the benefits of psychosocial interventions as a single therapeutic modality.
    Grade of Recommendation: 2C

  19. Although no recommendation is provided since scientific evidence is lacking, current practice and expert opinion support the inclusion of psychosocial interventions as a component of comprehensive pulmonary rehabilitation programs for patients with COPD.

  20. Supplemental oxygen should be used during rehabilitative exercise training in patients with severe exercise-induced hypoxemia.
    Grade of Recommendation: 1C

  21. Administering supplemental oxygen during high-intensity exercise programs in patients without exercise-induced hypoxemia may improve gains in exercise endurance.
    Grade of Recommendation: 2C

  22. As an adjunct to exercise training in selected patients with severe COPD, noninvasive ventilation produces modest additional improvements in exercise performance.
    Grade of Recommendation: 2B

  23. There is insufficient evidence to support the routine use of nutritional supplementation in pulmonary rehabilitation of patients with COPD. No recommendation is provided.

  24. Pulmonary rehabilitation is beneficial for some patients with chronic respiratory diseases other than COPD.
    Grade of Recommendation: 1B

  25. Although no recommendation is provided since scientific evidence is lacking, current practice and expert opinion suggest that pulmonary rehabilitation for patients with chronic respiratory diseases other than COPD should be modified to include treatment strategies specific to individual diseases and patients in addition to treatment strategies common to both COPD and non-COPD patients.

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