Promoting Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease, Strategies of Top-performing Systems: A Qualitative Study.

Pulmonary rehabilitation (PR) after hospitalization for chronic obstructive pulmonary disease (COPD) is recommended by guidelines; however, few patients participate, and rates vary between hospitals. To identify contextual factors and strategies that may promote participation in PR after hospitalization for COPD. Using a positive-deviance approach, we calculated hospital-specific rates of PR after hospitalization for COPD among a cohort of Medicare beneficiaries.

A Geographic Analysis of Racial Disparities in Use of Pulmonary Rehabilitation After Hospitalization for COPD Exacerbation.

Background: Guidelines recommend pulmonary rehabilitation (PR) after hospitalization for an exacerbation of COPD, but few patients enroll in PR. We explored whether density of PR programs explained regional variation and racial disparities in receipt of PR.

Methods: We used Centers for Medicare & Medicaid Services data from 223,832 Medicare beneficiaries hospitalized for COPD during 2012 who were eligible for PR postdischarge.

Participation in Pulmonary Rehabilitation after Hospitalization for Chronic Obstructive Pulmonary Disease among Medicare Beneficiaries.

Rationale: Current guidelines recommend pulmonary rehabilitation (PR) after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, but little is known about its adoption or factors associated with participation.

Objectives: To evaluate receipt of PR after a hospitalization for COPD exacerbation among Medicare beneficiaries and identify individual- and hospital-level predictors of PR receipt and adherence.

Methods: We identified individuals hospitalized for COPD during 2012 and recorded receipt, timing, and number of PR visits.

Physical activity patterns and clusters in 1001 patients with COPD.

We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expiratory volume in the first second [FEV], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed.

Integrating the care of the complex COPD patient.

Proceedings of the European Seminars in Respiratory Medicine course, Long-Term Integrated Care of COPD Patients held in Stresa, Italy, on 16-17 June, 2016.

An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation.

Rationale: Pulmonary rehabilitation (PR) has demonstrated physiological, symptom-reducing, psychosocial, and health economic benefits for patients with chronic respiratory diseases, yet it is underutilized worldwide. Insufficient funding, resources, and reimbursement; lack of healthcare professional, payer, and patient awareness and knowledge; and additional patient-related barriers all contribute to the gap between the knowledge of the science and benefits of PR and the actual delivery of PR services to suitable patients.

Objectives: The objectives of this document are to enhance implementation, use, and delivery of pulmonary rehabilitation to suitable individuals worldwide.

Pulmonary Rehabilitation and Physical Activity in Patients with Chronic Obstructive Pulmonary Disease.

Physical inactivity is common in patients with chronic obstructive pulmonary disease (COPD) compared with age-matched healthy individuals or patients with other chronic diseases. Physical inactivity independently predicts poor outcomes across several aspects of this disease, but it is (at least in principle) treatable in patients with COPD. Pulmonary rehabilitation has arguably the greatest positive effect of any current therapy on exercise capacity in COPD; as such, gains in this area should facilitate increases in physical activity.

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.

An Official American Thoracic Society/European Respiratory Society Statement: Research questions in chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this Official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.

An official American Thoracic Society/European Respiratory Society statement: research questions in COPD.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.

Pulmonary rehabilitation: future directions.

Pulmonary rehabilitation is now an established standard of care for patients with chronic obstructive pulmonary disease (COPD). Although pulmonary rehabilitation has no appreciable direct effect on static measurements of lung function, it arguably provides the greatest benefit of any available therapy across multiple outcome areas important to the patient with respiratory disease, including dyspnea, exercise performance, and health-related quality of life. It also appears to be a potent intervention that reduces COPD hospitalizations, especially when given in the periexacerbation period.

Pulmonary rehabilitation: definition, concept, and history.

Pulmonary rehabilitation is a complex intervention for which it is difficult to craft a succinct yet inclusive definition. Pulmonary rehabilitation should be considered for all patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic or have decreased functional status despite otherwise optimal medical management. The essential components of pulmonary rehabilitation are exercise training and self-management education, tailored to the needs of the individual patient and integrated into the course of the disease trajectory.

Differences in content and organisational aspects of pulmonary rehabilitation programmes.

The aim was to study the overall content and organisational aspects of pulmonary rehabilitation programmes from a global perspective in order to get an initial appraisal on the degree of heterogeneity worldwide. A 12-question survey on content and organisational aspects was completed by representatives of pulmonary rehabilitation programmes that had previously participated in the European Respiratory Society (ERS) COPD Audit. Moreover, all ERS members affiliated with the ERS Rehabilitation and Chronic Care and/or Physiotherapists Scientific Groups, all members of the American Association of Cardiovascular and Pulmonary Rehabilitation, and all American Thoracic Society Pulmonary Rehabilitation Assembly members were asked to complete the survey via multiple e-mailings.

Measuring unsupported arm lifts as an outcome in pulmonary rehabilitation of chronic obstructive pulmonary disease patients.

Pulmonary rehabilitation includes upper and lower extremity exercise training. While validated tests such as the six-minute walk distance (6MWD) and shuttle walk tests are available to evaluate the effectiveness of lower extremity training, the optimal method of evaluating the effectiveness of upper extremity training has not been determined. This study evaluates the potential utility of unsupported arm lifts (UALs) testing as an outcome measurement for pulmonary rehabilitation.

Comprehensive pulmonary rehabilitation results in clinically meaningful improvements in anxiety and depression in patients with chronic obstructive pulmonary disease.

Purpose: Pulmonary rehabilitation (PR) improves anxiety and depression in patients with chronic obstructive pulmonary disease. However, little is known regarding its ability to produce clinically meaningful improvements in these outcomes.

Methods: We retrospectively analyzed 366 patients who participated in our 8-week outpatient PR program.

Modifying the course of chronic obstructive pulmonary disease: looking beyond the FEV1.

COPD is defined by airflow limitation that is not fully reversible and is usually progressive. Thus, airflow obstruction (measured as FEV(1)) has traditionally been used as the benchmark defining disease modification with therapy. However, COPD exacerbations and extrapulmonary effects are common and burdensome and generally become more prominent as the disease progresses.

How do we increase activity and participation in our patients?

Patients with chronic respiratory disease such as chronic obstructive pulmonary disease (COPD) are generally very inactive physically, and this physical inactivity is detrimental to their health. Physical inactivity not only impairs quality of life, it probably shortens life expectancy. Therefore, increasing physical activity should be a prominent goal in pulmonary rehabilitation.

The roles of bronchodilators, supplemental oxygen, and ventilatory assistance in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease.

In patients with chronic obstructive pulmonary disease, pulmonary rehabilitation significantly improves dyspnea, exercise capacity, quality of life, and health-resource utilization. These benefits result from a combination of education (especially in the promotion of collaborative self-management strategies and physical activity), exercise training, and psychosocial support. Exercise training increases exercise capacity and reduces dyspnea.

Clinically meaningful outcomes in patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation, gas exchange abnormalities, hyperinflation, and other pathophysiologic events. However, patients are usually unaware of these physical changes and only seek medical attention when distressing symptoms, such as dyspnea and exercise limitation, begin to appear. Therefore, it is reasonable to directly assess these clinical areas of importance to the patient, both as determinants of the impact of the disease process and as outcomes following intervention.