Pulmonary rehabilitation for COPD: A narrative review and call for further implementation in Saudi Arabia.

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From: Annals of Thoracic Medicine(Vol. 16, Issue 4)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 5,184 words
Lexile Measure: 2120L

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Byline: Abdulelah. Aldhahir, Saeed. Alghamdi, Jaber. Alqahtani, Khaled. Alqahtani, Ahmed. Al Rajah, Bedor. Alkhathlan, Sally. Singh, Swapna. Mandal, John. Hurst

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable condition, in which outcomes can be improved with careful management. Pulmonary rehabilitation (PR) comprises exercise and education, delivered by multidisciplinary teams. PR is a cost-effective management strategy in COPD patients which improves exercise performance, reduces dyspnea, reduces the risk of exacerbation, and improves health-related quality of life. All COPD patients appear to benefit irrespective of their baseline function, and PR has also been shown to be a clinically and cost-effective management approach following an acute exacerbation. COPD patients with greater disability and those recovering postexacerbation should be specifically targeted for PR. Due to limited current capacity, the latter group may not currently be able to benefit from PR. Therefore, there is a need for the wider implementation of PR services in Saudi Arabia, requiring us to address challenges including capacity and workforce competency.

In simple terms, chronic obstructive pulmonary disease (COPD) is a progressive lung condition associated with poorly reversible airflow obstruction. COPD is a common cause of morbidity and mortality worldwide.[1] Individuals with COPD tend to have daily symptoms such as dyspnea, cough with or without sputum production, wheeze, and chest tightness. They also have reduced exercise capacity and increased susceptibility to periodic chest infections or worsening of their symptoms, referred to as 'exacerbations' that might lead to hospital admissions.[2]

The Global Initiative for Obstructive Lung Disease strategy document summarizes current approaches to COPD management.[3] Cost-effective treatment approaches for stable COPD, described in the London respiratory 'Value Pyramid,' include smoking cessation, influenza vaccination, and pulmonary rehabilitation (PR).[4] PR is a multidisciplinary program that offers exercise training and education to improve the quality of life and exercise performance in patients with chronic respiratory disease.[5],[6],[7],[8] Multiple high-quality randomized controlled trials (RCTs) and meta-analysis have demonstrated that PR is a cost-effective management strategy in COPD, and more cost-effective compared to pharmacologic intervention.[5],[6],[7],[8],[9],[10] As PR is recognized as an effective nonpharmacological management approach in COPD, there is the need for greater implementation including in Saudi Arabia. This review summarizes the history of PR, program content and structure, and the effectiveness of PR in COPD as a resource to further support the provision of PR services in Saudi Arabia.


We conducted a narrative review of the history, program content and structure, and the effectiveness of PR with COPD patients. A literature search was performed using PubMed, Medline, EMBASE, and Google Scholar with keywords of PR, PR, rehabilitation, exercise, pulmonary disease, chronic pulmonary disease, chronic obstructive lung disease, lung disease, emphysema, chronic bronchitis, Saudi Arabia, and KSA. Only English language full articles were reviewed to identify the current evidence.

History and Definition

The importance of physical activity and healthy diet in respiratory disease were first introduced in 1895 by Dr. Denison, Professor of Diseases of the Chest and of Climatology at the University of Denver, in his book titled Exercise and Food for...

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Gale Document Number: GALE|A680637879