Lung disease patients breathe easier with rehab

Pulmonary rehabilitation produces significant benefits for patients with advanced emphysema and plays an important role in the selection of patients for lung surgery, according to results of the National Emphysema Treatment Trial, or NETT.

“The NETT highlights the important benefits of pulmonary rehabilitation—as practiced in a large number of centers across the country—as a standard of care for patients with advanced chronic lung disease and an important adjunct to lung volume reduction surgery programs,” said Dr. Andrew L. Ries, from the University of California, San Diego.

“We believe that pulmonary rehabilitation plays a key role not only in preparing such patients for surgery and facilitating their recovery after surgery, but also in optimally selecting patients for such high risk procedures,” he added.

In the NETT cohort, a total of 1,218 patients with severe emphysema underwent pulmonary rehabilitation before and after being randomly assigned to so-called lung volume reduction surgery or continued medical management at 17 NETT centers and 539 satellite centers.

The NETT Research Group reports in the medical journal CHEST that pulmonary rehabilitation produced significant improvements in exercise capacity, dyspnea, and health-related quality of life. These improvements were consistent across NETT centers and satellite centers.

Many patients—perhaps 10 percent—who came to the study eager for lung surgery experienced such positive effects from pulmonary rehabilitation that they were subsequently unwilling to have surgery, Ries and colleagues note.

“Other patients, who might have initially seemed appropriate for surgery, were subsequently found during pulmonary rehabilitation to be too ill or fragile for surgery,” they add.

The importance of the NETT, writes Dr. Roger S. Goldstein from the University of Toronto in a related editorial, lies in “the message that rehabilitation practiced over many sites, only some of which are academic, can improve walking and quality of life for many patients.”

SOURCE: CHEST December 2005.

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