Pulmonary rehab is the best kept secret of pulmonary medicine. Or at least that is what Connie Paladenech, the Manager at Atrium Health Wake Forest Baptist Cardiac and Pulmonary Rehabilitation Center and a member of the Board of Directors at the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) believes. That is because, though it is known to improve the lives of people living with a chronic lung disease like chronic obstructive pulmonary disease (COPD), only about 3% of eligible patients are using this great program. Connie answered some of our questions about pulmonary rehab and shared her insight into why you or your loved one may want to consider a pulmonary rehabilitation program.

Q: What exactly is pulmonary rehab?

A: Pulmonary rehab is a proven component of medical care for people with long-term lung diseases, such as COPD or pulmonary fibrosis. We know that pulmonary rehab provides improvement in breathing-related symptoms, increases your ability to exercise and improves your overall quality of life. It achieves these goals without medications or requiring the patient to undergo surgeries.

We can’t regrow lung tissue without a lung transplant, so some of the breathing tests may not show large measurable changes, but anyone who has worked in the field as long as I have knows the tremendous improvements our patients experience. This is because pulmonary rehab is a comprehensive program that involves many different experts like respiratory therapists, physical therapists, and doctors working together to help you manage a lifelong lung disease. Meaning it also treats the many comorbidities like anxiety or depression that patients experience when they have a chronic lung disease.

Q: How does someone get started with pulmonary rehab? 

A: The first step is for a patient to talk to their healthcare provider to see if pulmonary rehab is a right fit for their treatment plan. Pulmonary rehab is a medically supervised program, so for patient safety and insurance purposes, a physician’s prescription is needed. Once physician approval is received, the journey begins with a thorough assessment either one-on-one or in a group setting. Then the staff and the patient will work together to develop an individually structured plan, which is designed to improve both patients' physical and psychological condition.

There are several therapies that might be included such as exercise training, education to help with more successful self-management and behavior changes. This may include education on medication, breathing and inhaler techniques, energy conservation techniques, self-management skills and even dealing with stress. Another important part of a pulmonary rehab program is socialization and being around other people living with a lung disease.

Besides exercise training, pulmonary rehab also focuses on improving emotional health. In fact, stress is a big problem, so we spend a lot of time helping patients recognize triggers and learn relaxation and coping techniques. Nutrition is another important aspect as many patients are either under or overweight, so we need to help give them the tools necessary to get the adequate nutrition they need to enable them to have the energy to do their daily activities.  

In the over 50 years I have been involved with pulmonary rehab, there have been incredible changes. Treatments are now really tailored to the individual. So, patients will want to determine what specific improvements could make their day-to-day lives easier. For instance, maybe they want to be less short of breath while performing a specific activity like climbing the stairs. Or maybe they just want to have more energy throughout the day. By monitoring oxygen levels during rehab, we are able to make sure they are getting the right amount of oxygen, and if they require supplemental oxygen, we assess whether or not they have the right device or dosage and help correct any discrepancies.

And though the programs have a specific length, we focus on creating lifelong management plans that can help patients continue to live their best lives well after graduating from their program.

“I remember one woman who had a very serious diagnosis. She wasn’t compliant with her meds, was very depressed and she wasn’t communicating with her healthcare providers. She had basically given up. But she reluctantly tried pulmonary rehab and, after initially being withdrawn, she really took to it. When she graduated, she told me she went from planning her funeral to planning her wedding.” - Connie

Q: Why do you think only 3% of patients use this program?

A: Chronic lung disease has a very strong impact on a person’s daily life. People may get short of breath when trying to complete daily activities like bathing or cleaning or even getting dressed. Sometimes they just don’t have the energy to get the information they need or to attend a face-to-face program.

Additionally, we know that many programs are located in areas with larger populations, like cities, but many patients live in more rural areas. So, transportation and availability of pulmonary rehab programs in more rural areas are a huge issue. This is why the use of virtual programs may be a good option for some patients to get a feel for what is offered and why it is worth their time and energy.

Q: Can you really do pulmonary rehab virtually?

A: Since the COVID-19 pandemic, virtual programs have gotten a lot more attention, and so it is an emerging area for pulmonary rehab. However, not all the programs that are available on the internet include all the essential components needed like socialization. The AACVPR and our partners are still working on requirement guidelines for virtual pulmonary rehab, so patients really need to consult their healthcare provider to ensure they are enrolling in a program that will provide the support they need.

Additionally, the AACVPR has a directory of about 1,300 pulmonary rehab programs if you are looking for a good place to start. If a patient wants to explore things further, I suggest contacting an in-person or hospital-based program and asking them for recommendations about a virtual program.

Freedom From Smoking Clinic
Detroit, MI | May 29, 2024
Asthma Basics Workshop - National
, | Jun 18, 2024