Maddocks Matthew, Kon Samantha S C, Singh Sally J, Man William D-C
King's College London, Cicely Saunders Institute, London, UK; Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Respirology. 2015 Apr;20(3):395-404. doi: 10.1111/resp.12454. Epub 2014 Dec 22.
Exacerbations of chronic obstructive pulmonary disease (COPD) are one of the commonest causes of emergency hospital admission and are associated with high rates of readmission. Rehabilitation in the peri- and early post-hospitalization setting may counteract the deleterious consequences of an acute hospital admission and target modifiable risk factors for readmission such as physical inactivity, reduced exercise capacity and impaired physical function. Pulmonary rehabilitation in the peri-hospitalization period can improve exercise capacity and health-related quality of life and can also reduce rates of readmission. Consequently, guidelines have recommended the provision of pulmonary rehabilitation in the acute setting. However, recent trials showing less positive results and observational data questioning acceptability may challenge prevailing enthusiasm. This review examines the role of pulmonary rehabilitation in the peri- and early post-hospitalization setting, considering the modifiable risk factors for readmission, the latest evidence regarding rehabilitation in the acute setting, issues around acceptability and uptake, and alternative strategies to help deliver rehabilitation to more patients. The acceptability and effectiveness of pulmonary rehabilitation offered that post-exacerbation could be improved by overcoming issues around the setting, timing and format of rehabilitation approaches, including their integration with self-management interventions.
慢性阻塞性肺疾病（COPD）急性加重是急诊住院最常见的原因之一，且再入院率很高。在住院期间及出院早期进行康复治疗，可能会抵消急性住院带来的有害后果，并针对再入院的可改变风险因素，如身体活动不足、运动能力下降和身体功能受损。住院期间的肺康复可以提高运动能力和与健康相关的生活质量，还可以降低再入院率。因此，指南建议在急性期提供肺康复治疗。然而，最近的试验显示效果不太理想，观察数据也对其可接受性提出质疑，这可能会挑战当前的热情。本综述探讨了肺康复在住院期间及出院早期的作用，考虑了再入院的可改变风险因素、急性康复的最新证据、可接受性和接受度问题，以及帮助更多患者接受康复治疗的替代策略。通过克服康复方法在环境、时间和形式方面的问题，包括将其与自我管理干预相结合，可以提高急性加重后提供的肺康复的可接受性和有效性。
