Pulmonary Diseases, Providence VA Hospital, Providence, RI, USA.
Eur J Phys Rehabil Med. 2011 Sep;47(3):465-74.
The optimal therapy of an individual with chronic respiratory disease usually requires a combination of pharmacologic and non-pharmacologic therapies. A case of a 68-year-old man with advanced chronic obstructive pulmonary disease is given to illustrate this point. He is a recent ex-smoker with severe chronic obstructive pulmonary disease by spirometric criteria, frequent exacerbations of this disease, considerable recent health care utilization, dyspnea with minimal activities, severe functional status limitation, prominent systemic effects of the disease (e.g., weight loss) and substantial comorbidities. The primary respiratory disease cannot be isolated from and treated independently of these important factors. Pulmonary rehabilitation is an important therapeutic option in situations like this, providing a mode of integrating care, complementing otherwise standard medical therapy, and producing significant gains across multiple outcome areas of importance to the patient. Pulmonary rehabilitation has been defined by the American Thoracic Society and European Respiratory Society as: "an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease". Its components include comprehensive assessment, education, exercise training, and psychosocial intervention. Outcomes assessment is usually performed for quality assessment. Pulmonary rehabilitation produces the greatest improvements of any available therapy in dyspnea, exercise capacity, and health-related quality of life. These gains are realized despite the fact that pulmonary rehabilitation has no direct effect on lung function. It works primarily through reducing the impact of the systemic manifestations of the disease and frequent comorbidity. Pulmonary rehabilitation also leads to substantial reductions in subsequent health care utilization, possibly through collaborative self-management strategies emphasized in the program. Although pulmonary rehabilitation has been utilized by astute clinicians for many years, its science has been developed over the past two decades.
慢性呼吸系统疾病患者的最佳治疗方法通常需要药物和非药物治疗相结合。通过一个 68 岁患有晚期慢性阻塞性肺疾病（COPD）的男性病例来说明这一点。他是一位最近戒烟的患者，根据肺量计标准患有严重的 COPD，疾病频繁恶化，最近大量使用医疗保健，轻微活动时呼吸困难，严重的功能状态受限，疾病的全身性影响明显（例如，体重减轻）和大量合并症。主要的呼吸系统疾病不能孤立于这些重要因素之外进行治疗。在这种情况下，肺康复是一种重要的治疗选择，提供了一种整合护理的模式，补充了其他标准的医疗治疗，并在对患者重要的多个结果领域产生显著收益。美国胸科学会和欧洲呼吸学会将肺康复定义为：“一种基于证据的、多学科的、综合性的干预措施，适用于有症状且经常日常活动减少的慢性呼吸系统疾病患者。它被整合到患者的个体化治疗中，旨在通过稳定或逆转疾病的全身表现来减轻症状、优化功能状态、增加参与度并降低医疗保健成本。”其组成部分包括全面评估、教育、运动训练和心理社会干预。结果评估通常用于质量评估。肺康复在呼吸困难、运动能力和健康相关生活质量方面产生了任何可用治疗中最大的改善。尽管肺康复对肺功能没有直接影响，但这些改善还是实现了。它主要通过减轻疾病的全身性表现和频繁合并症的影响来实现。肺康复还导致随后的医疗保健利用率大幅降低，这可能是通过方案中强调的协作自我管理策略实现的。尽管肺康复已经被敏锐的临床医生使用多年，但它的科学在过去二十年中得到了发展。
