University of Saskatchewan, Saskatoon, Saskatchewan.
Can Respir J. 2010 Jul-Aug;17(4):159-68. doi: 10.1155/2010/425975.
Pulmonary rehabilitation (PR) participation is the standard of care for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite bronchodilator therapies. However, there are questions about specific aspects of PR programming including optimal site of rehabilitation delivery, components of rehabilitation programming, duration of rehabilitation, target populations and timing of rehabilitation. The present document was compiled to specifically address these important clinical issues, using an evidence-based, systematic review process led by a representative interprofessional panel of experts. The evidence reveals there are no differences in major patient-related outcomes of PR between nonhospital- (community or home sites) or hospital-based sites. There is strong support to recommend that COPD patients initiate PR within one month following an acute exacerbation due to benefits of improved dyspnea, exercise tolerance and health-related quality of life relative to usual care. Moreover, the benefits of PR are evident in both men and women, and in patients with moderate, severe and very severe COPD. The current review also suggests that longer PR programs, beyond six to eight weeks duration, be provided for COPD patients, and that while aerobic training is the foundation of PR, endurance and functional ability may be further improved with both aerobic and resistance training.
肺康复(PR)参与是慢性阻塞性肺疾病(COPD)患者的标准治疗方法,这些患者尽管接受了支气管扩张剂治疗,但仍有症状。然而,关于 PR 编程的具体方面存在一些问题,包括康复治疗的最佳地点、康复编程的组成部分、康复的持续时间、目标人群以及康复的时机。本文件的编制旨在专门解决这些重要的临床问题,使用由具有代表性的跨专业专家小组领导的循证、系统审查过程。证据表明,非医院(社区或家庭场所)或医院场所的 PR 对主要患者相关结局没有差异。强烈建议 COPD 患者在急性加重后一个月内开始 PR,因为与常规护理相比,PR 可改善呼吸困难、运动耐量和健康相关生活质量。此外,PR 的益处在男性和女性以及中、重度和极重度 COPD 患者中均有体现。目前的综述还表明,应向 COPD 患者提供超过六至八周持续时间的更长时间的 PR 方案,并且虽然有氧运动是 PR 的基础,但耐力和功能能力可能通过有氧运动和抗阻训练进一步得到改善。