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Catching your breath with home or community-based pulmonary rehabilitation

The Bottom Line

  • Chronic obstructive pulmonary disease, or COPD, is a leading cause of death worldwide. 
  • Pulmonary rehabilitation—which combines exercise, education, and behaviour change—can be carried out within hospital, home, or community settings; and is one COPD management strategy. 
  • In people with COPD, home and community-based rehabilitation is more effective for breathing and quality of life than no treatment; and is as effective as hospital-based rehabilitation for these outcomes. 
  • Consult with your health care provider to learn more about your pulmonary rehabilitation options. 

The 90s were home to historic moments in the areas of science and technology, cinema and television, politics, and sports. They also brought with them many projections for what the future could look like. One forecast, in particular, concerned the leading causes of death and disability worldwide (1). And within it, researchers suggested that chronic obstructive pulmonary disease—more commonly known as COPD—might go from being the sixth leading cause of death in 1990 to the third leading cause of death by 2020 (1;2). Fast forward 26 years to 2016, and this prophecy did indeed become a reality (3).


If we zero in on the lungs of someone with COPD, we see damage to or changes in the structure of the primary airways, smaller passageways, and air sacs (2). In turn, these contribute to difficulty breathing, a common symptom of COPD (4). Now, imagine trying to go about your day—be it walking your dog, making dinner, cleaning your house, or taking a shower—when you start experiencing an intense bout of shortness of breath, which causes you to stop what you are doing. This example highlights how routine daily activities can be impacted for people living with COPD.


However, there are strategies that help control symptoms and enhance wellbeing. While medication is one of the most common approaches, pulmonary rehabilitation—which involves a combination of exercise, education, and lifestyle changes—is another (2;4). Pulmonary rehabilitation is often done in clinical settings such as hospitals, but access to these services can be enhanced through home or community-based options. This gives rise to two main questions. First, how do home or community-based rehabilitation impact symptoms and wellbeing in people with COPD? Second, how do home or community-based strategies stack up against hospital-based rehabilitation? One systematic review took on this investigation (2).


What the research tells us

The review found a couple of promising results. For instance, in comparison to people with COPD who do not receive treatment, those who engage in home or community-based rehabilitation can experience improvements in breathing and quality of life. Even more interesting, it appears that home or community-based rehabilitation may be as effective as hospital-based rehabilitation in achieving positive benefits related to ease of breathing, oxygen use during exercise, and quality of life (2).


So, do not waste your breath! If you face barriers to accessing hospital-based services, prefer the comfort of home, or like the convenience that comes along with staying within your community, speak with your health care provider about the home and community-based rehabilitation options available to you.


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References

  1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global burden of disease study. Lancet. 1997; 349(9064):1498-504. doi: 10.1016/S0140-6736(96)07492-2.  
  2. Neves LF, Reis MH, Goncalves TR. Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Cad Saude Publica. 2016; 32(6). doi: 10.1590/0102-311X00085915.  
  3. World Health Organization. Top 10 causes of death: Situation and trends. [internet] 2018. [cited September 2020]. Available from https://www.who.int/gho/mortality_burden_disease/causes_death/top_10/en/
  4. Chong J, Leung B, Poole P. Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017; 9:CD002309. doi: 10.1002/14651858.CD002309.pub5. 
 

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