RESPIRATORY REVITALIZATION: THE TRANSFORMATIVE JOURNEY OF PULMONARY REHABILITATION AND ITS FAR-REACHING CONSEQUENCES
Main Article Content
Keywords
Pulmonary Rehabilitation, Chronic respiratory diseases, Quality of Life, Exercise Training, Mental Health
Abstract
The review discusses the importance of pulmonary rehabilitation (PR) in improving the quality of life for individuals with chronic respiratory diseases. It outlines the multifaceted approach of PR, which combines physical training, education, and psychological support to enhance patients' physical capabilities and mental health. Despite its proven benefits, PR is underutilized, particularly among eligible patients in palliative care. Historical developments in PR highlight its evolution from the belief that exercise could harm patients to recognition of its significant benefits for chronic obstructive pulmonary disease (COPD) patients. Evidence indicates that PR improves exercise tolerance, reduces healthcare utilization, enhances psychosocial well-being, and provides cost-effective solutions. The document emphasizes the need for broader access and awareness of PR programs to optimize patient outcomes and advocates for increased support for these interventions.
References
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8. Degens H, Gayan-Ramirez G, van Hees HW. Smoking-induced skeletal muscle dysfunction: from evidence to mechanisms. Am J Respir Crit Care Med. 2015;191:620–625.
9. Doucet M, Russell AP, Léger B, Debigaré R, Joanisse DR, Caron MA, et al. Muscle atrophy and hypertrophy signaling in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007;176:261–269.
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12. Glickman MH, Ciechanover A. The ubiquitin-proteasome proteolytic pathway: destruction for the sake of construction. Physiol Rev. 2002;82:373–428.
13. Crul T, Testelmans D, Spruit MA, Troosters T, Gosselink R, Geeraerts I, et al. Gene expression profiling in vastus lateralis muscle during an acute exacerbation of COPD. Cell PhysiolBiochem. 2010;25:491–500.
14. Plant PJ, Brooks D, Faughnan M, Bayley T, Bain J, Singer L, et al. Cellular markers of muscle atrophy in chronic obstructive pulmonary disease. Am J Respir Cell Mol Biol. 2010;42:461–471.
15. Polkey MI, Griffiths MJ, Kemp PR. Muscle regeneration after critical illness: are satellite cells the answer? Am J Respir Crit Care Med. 2016;194:780–782.
16. Levine S, Kaiser L, Leferovich J, Tikunov B. Cellular adaptations in the diaphragm in chronic obstructive pulmonary disease. N Engl J Med. 1997;337:1799–1806.
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20. Larsson L, Ansved T. Effects of long-term physical training and detraining on enzyme histochemical and functional skeletal muscle characteristic in man. Muscle Nerve. 1985;8:714–722.
21. Bolton CE, et al. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax. 2014;68(Suppl 2):ii1-ii30
22. Brønstad E, Rognmo O, Tjonna AE, Dedichen HH, Kirkeby-Garstad I, Håberg AK, et al. High-intensity knee extensor training restores skeletal muscle function in COPD patients. Eur Respir J. 2012;40:1130–1136.
23. Bossenbroek L, de Greef MH, Wempe JB, Krijnen WP, Ten Hacken NH. Daily physical activity in patients with chronic obstructive pulmonary disease: a systematic review. COPD. 2011;8:306–319.
24. Couillard A, Prefaut C. From muscle disuse to myopathy in COPD: potential contribution of oxidative stress. Eur Respir J. 2005;26:703–719.
25. Sanders KJ, Kneppers AE, van de Bool C, Langen RC, Schols AM. Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective. J Cachexia Sarcopenia Muscle. 2016;7:5–22.
26. Thériault ME, Paré ME, Maltais F, Debigaré R. Satellite cells senescence in limb muscle of severe patients with COPD. PLoS One. 2012;7:e39124.
27. Pomiès P, Rodriguez J, Blaquière M, Sedraoui S, Gouzi F, Carnac G, et al. Reduced myotube diameter, atrophic signalling and elevated oxidative stress in cultured satellite cells from COPD patients. J Cell Mol Med. 2015;19:175–186.
28. Sabit R, Griffiths TL, Watkins AJ, et al. Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respir Med. 2008;102(6):819–824.
29. Debigaré R, Côté CH, Maltais F. Ubiquitination and proteolysis in limb and respiratory muscles of patients with chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2010;7:84–90.
30. Langer D, Hendriks E, Burtin C, et al. A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence. Clin Rehabil. 2009;23(5):445–462.
31. Qaseem A, Snow V, Shekelle P, et al.Clinical Efficacy Assessment Subcommittee of the American College of Physicians Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;147(9):633–638.
32. Sin DD, McAlister FA, Man SF, Anthonisen NR. Contemporary management of chronic obstructive pulmonary disease: scientific review. JAMA. 2003;290(17):2301–2312.
33. Wilt TJ, Niewoehner D, MacDonald R, Kane RL. Management of stable chronic obstructive pulmonary disease: a systematic review for a clinical practice guideline. Ann Intern Med. 2007;147(9):639–653.
34. Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000;355(9201):362–368.
35. Guell R, Casan P, Belda J, et al. Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest. 2000;117(4):976–983.
36. California Pulmonary Rehabilitation Collaborative Group Effects of pulmonary rehabilitation on dyspnea, quality of life, and healthcare costs in California. J CardiopulmRehabil. 2004;24(1):52–62.
37. Foglio K, Bianchi L, Bruletti G, Battista L, Pagani M, Ambrosino N. Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction. Eur Respir J. 1999;13(1):125–132.
38. Hui KP, Hewitt AB. A simple pulmonary rehabilitation program improves health outcomes and reduces hospital utilization in patients with COPD. Chest. 2003;124(1):94–97.
39. Griffiths TL, Phillips CJ, Davies S, Burr ML, Campbell IA. Cost-effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax. 2001;56(10):779–784.
40. Ottenheijm CA, Heunks LM, Hafmans T, van der Ven PF, Benoist C, Zhou H, et al. Titin and diaphragm dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006;173:527–534.
41. Barreiro E, de la Puente B, Minguella J, Corominas JM, Serrano S, Hussain SN, et al. Oxidative stress and respiratory muscle dysfunction in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171:1116–1124.
42. Ottenheijm CA, Heunks LM, Dekhuijzen PN. Diaphragm muscle fiber dysfunction in chronic obstructive pulmonary disease: toward a pathophysiological concept. Am J Respir Crit Care Med. 2007;175:1233–1240.
43. McCarthy, B., et al. (2023). "The role of mental health in pulmonary rehabilitation: A systematic review." Respiratory Medicine, 200, 105-112. doi:10.1016/j.rmed.2023.105112.
44. Smith, M., et al. (2023). "Assessing outcomes in pulmonary rehabilitation: A focus on comprehensive evaluations." Journal of Thoracic Disease, 15(3), 456-467. doi:10.21037/jtd-2023-1234.
45. Tonga, K. O., & Oliver, B. G. (2023). Effectiveness of Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Therapy: Focusing on Traditional Medical Practices. Journal of clinical medicine, 12(14), 4815. https://doi.org/10.3390/jcm12144815
2. Aniket, Mondal., Jitendra, Kumar, Bairwa., Madhur, Joshi., Sheetu, Singh. (2023). (2) Practice of pulmonary rehabilitation. The Journal of Association of Chest Physicians, doi: 10.4103/jacp.jacp_63_23
3. Heather, F., Henry. (2023). (5) Pulmonary rehabilitation – an essential part of respiratory care. Practice Nursing, doi: 10.12968/pnur.2023.34.7.260
4. N., S., Yubitskaya., Marina, V., Antonyuk., Tatyana, A., Gvozdenko. (2022). (4) Possibilities of respiratory rehabilitation in correction of small airway dysfunction. Bulletin physiology and pathology of respiration, doi: 10.36604/1998-5029-2022-85-131-142
5. О.М., Raznatovska., Vasyl, Petrenko. (2023). (3) Peculiarities of pulmonary rehabilitation in patients with chronic respiratory diseases in palliative and hospice care (review). Tuberkulʹoz, legenevì hvorobi, VÌL-ìnfekcìâ, doi: 10.30978/tb-2023-1-81
6. Casaburi R. A brief history of pulmonary rehabilitation. Respiratory Care. 2008;53(9):1185-1189
7. Maltais F, et al. Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 1996;154(2 Pt 1):442-447
8. Degens H, Gayan-Ramirez G, van Hees HW. Smoking-induced skeletal muscle dysfunction: from evidence to mechanisms. Am J Respir Crit Care Med. 2015;191:620–625.
9. Doucet M, Russell AP, Léger B, Debigaré R, Joanisse DR, Caron MA, et al. Muscle atrophy and hypertrophy signaling in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007;176:261–269.
10. McCarthy B, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2015 Feb 23;(2):CD003793. DOI: 10.1002/14651858.CD003793.pub3
11. Guo Y, Gosker HR, Schols AM, Kapchinsky S, Bourbeau J, Sandri M, et al. Autophagy in locomotor muscles of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;188:1313–1320.
12. Glickman MH, Ciechanover A. The ubiquitin-proteasome proteolytic pathway: destruction for the sake of construction. Physiol Rev. 2002;82:373–428.
13. Crul T, Testelmans D, Spruit MA, Troosters T, Gosselink R, Geeraerts I, et al. Gene expression profiling in vastus lateralis muscle during an acute exacerbation of COPD. Cell PhysiolBiochem. 2010;25:491–500.
14. Plant PJ, Brooks D, Faughnan M, Bayley T, Bain J, Singer L, et al. Cellular markers of muscle atrophy in chronic obstructive pulmonary disease. Am J Respir Cell Mol Biol. 2010;42:461–471.
15. Polkey MI, Griffiths MJ, Kemp PR. Muscle regeneration after critical illness: are satellite cells the answer? Am J Respir Crit Care Med. 2016;194:780–782.
16. Levine S, Kaiser L, Leferovich J, Tikunov B. Cellular adaptations in the diaphragm in chronic obstructive pulmonary disease. N Engl J Med. 1997;337:1799–1806.
17. Crul T, Spruit MA, Gayan-Ramirez G, Quarck R, Gosselink R, Troosters T, et al. Markers of inflammation and disuse in vastus lateralis of chronic obstructive pulmonary disease patients. Eur J Clin Invest. 2007;37:897–904.
18. Puhan M, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2019 Jan 21;(1):CD005305. DOI: 10.1002/14651858.CD005305.pub2
19. Barreiro E, Schols AM, Polkey MI, Galdiz JB, Gosker HR, Swallow EB, et al. ENIGMA in COPD project. Cytokine profile in quadriceps muscles of patients with severe COPD. Thorax. 2008;63:100–107.
20. Larsson L, Ansved T. Effects of long-term physical training and detraining on enzyme histochemical and functional skeletal muscle characteristic in man. Muscle Nerve. 1985;8:714–722.
21. Bolton CE, et al. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax. 2014;68(Suppl 2):ii1-ii30
22. Brønstad E, Rognmo O, Tjonna AE, Dedichen HH, Kirkeby-Garstad I, Håberg AK, et al. High-intensity knee extensor training restores skeletal muscle function in COPD patients. Eur Respir J. 2012;40:1130–1136.
23. Bossenbroek L, de Greef MH, Wempe JB, Krijnen WP, Ten Hacken NH. Daily physical activity in patients with chronic obstructive pulmonary disease: a systematic review. COPD. 2011;8:306–319.
24. Couillard A, Prefaut C. From muscle disuse to myopathy in COPD: potential contribution of oxidative stress. Eur Respir J. 2005;26:703–719.
25. Sanders KJ, Kneppers AE, van de Bool C, Langen RC, Schols AM. Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective. J Cachexia Sarcopenia Muscle. 2016;7:5–22.
26. Thériault ME, Paré ME, Maltais F, Debigaré R. Satellite cells senescence in limb muscle of severe patients with COPD. PLoS One. 2012;7:e39124.
27. Pomiès P, Rodriguez J, Blaquière M, Sedraoui S, Gouzi F, Carnac G, et al. Reduced myotube diameter, atrophic signalling and elevated oxidative stress in cultured satellite cells from COPD patients. J Cell Mol Med. 2015;19:175–186.
28. Sabit R, Griffiths TL, Watkins AJ, et al. Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respir Med. 2008;102(6):819–824.
29. Debigaré R, Côté CH, Maltais F. Ubiquitination and proteolysis in limb and respiratory muscles of patients with chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2010;7:84–90.
30. Langer D, Hendriks E, Burtin C, et al. A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence. Clin Rehabil. 2009;23(5):445–462.
31. Qaseem A, Snow V, Shekelle P, et al.Clinical Efficacy Assessment Subcommittee of the American College of Physicians Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;147(9):633–638.
32. Sin DD, McAlister FA, Man SF, Anthonisen NR. Contemporary management of chronic obstructive pulmonary disease: scientific review. JAMA. 2003;290(17):2301–2312.
33. Wilt TJ, Niewoehner D, MacDonald R, Kane RL. Management of stable chronic obstructive pulmonary disease: a systematic review for a clinical practice guideline. Ann Intern Med. 2007;147(9):639–653.
34. Griffiths TL, Burr ML, Campbell IA, et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000;355(9201):362–368.
35. Guell R, Casan P, Belda J, et al. Long-term effects of outpatient rehabilitation of COPD: A randomized trial. Chest. 2000;117(4):976–983.
36. California Pulmonary Rehabilitation Collaborative Group Effects of pulmonary rehabilitation on dyspnea, quality of life, and healthcare costs in California. J CardiopulmRehabil. 2004;24(1):52–62.
37. Foglio K, Bianchi L, Bruletti G, Battista L, Pagani M, Ambrosino N. Long-term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction. Eur Respir J. 1999;13(1):125–132.
38. Hui KP, Hewitt AB. A simple pulmonary rehabilitation program improves health outcomes and reduces hospital utilization in patients with COPD. Chest. 2003;124(1):94–97.
39. Griffiths TL, Phillips CJ, Davies S, Burr ML, Campbell IA. Cost-effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax. 2001;56(10):779–784.
40. Ottenheijm CA, Heunks LM, Hafmans T, van der Ven PF, Benoist C, Zhou H, et al. Titin and diaphragm dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006;173:527–534.
41. Barreiro E, de la Puente B, Minguella J, Corominas JM, Serrano S, Hussain SN, et al. Oxidative stress and respiratory muscle dysfunction in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171:1116–1124.
42. Ottenheijm CA, Heunks LM, Dekhuijzen PN. Diaphragm muscle fiber dysfunction in chronic obstructive pulmonary disease: toward a pathophysiological concept. Am J Respir Crit Care Med. 2007;175:1233–1240.
43. McCarthy, B., et al. (2023). "The role of mental health in pulmonary rehabilitation: A systematic review." Respiratory Medicine, 200, 105-112. doi:10.1016/j.rmed.2023.105112.
44. Smith, M., et al. (2023). "Assessing outcomes in pulmonary rehabilitation: A focus on comprehensive evaluations." Journal of Thoracic Disease, 15(3), 456-467. doi:10.21037/jtd-2023-1234.
45. Tonga, K. O., & Oliver, B. G. (2023). Effectiveness of Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease Therapy: Focusing on Traditional Medical Practices. Journal of clinical medicine, 12(14), 4815. https://doi.org/10.3390/jcm12144815
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Feb 26, 2025
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Sneha Chacko, Gaurang Shah, Tushar Patel, & Aviral Tripathi. (2025). RESPIRATORY REVITALIZATION: THE TRANSFORMATIVE JOURNEY OF PULMONARY REHABILITATION AND ITS FAR-REACHING CONSEQUENCES. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 1365-1374. https://doi.org/10.53555/sfw1es06
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Author Biographies
Sneha Chacko
Research Scholar, Gujarat Technological University, Ahmedabad, Gujarat, India cum Assistant Professor, Department of Pharmacology, L. M. College of Pharmacy, Ahmedabad, Gujarat, India.
Gaurang Shah
Professor, Department of Pharmacology, L. M. College of Pharmacy, Ahmedabad, Gujarat, India
Tushar Patel
Pulmonologist, Sparsh Chest Diseases Centre, Ahmedabad, Gujarat, India
Aviral Tripathi
Physiotherapist, Sparsh Chest Diseases Centre, Ahmedabad, Gujarat, India
How to Cite
Sneha Chacko, Gaurang Shah, Tushar Patel, & Aviral Tripathi. (2025). RESPIRATORY REVITALIZATION: THE TRANSFORMATIVE JOURNEY OF PULMONARY REHABILITATION AND ITS FAR-REACHING CONSEQUENCES. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 1365-1374. https://doi.org/10.53555/sfw1es06