Why pulmonary rehabilitation is crucial for people suffering from chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) affects more than 250 million people worldwide and takes at least 3.15 million lives each year. With a dramatic increase in air pollution levels in metropolitans, this condition has grown to epidemic proportions in India. About a million lives were lost to this disease in 2017 alone, making COPD the second biggest cause of death in the country after heart disease.  

COPD is incurable and progressively weakens the lungs by inflaming the airways and obstructing the air sacs. This drastically brings down the oxygen uptake in the lungs and lowers their capacity to expel waste. The symptoms include persistent cough, breathlessness, wheezing, tightness or heaviness in the chest and excessive mucus production.  

While COPD cannot be cured or reversed completely, rehabilitation can provide patients with a better quality of life.  

As is the case with most chronic disease rehabilitation programmes, COPD rehabilitation is also a long process requiring a lot of patience, sincere hard work and some serious lifestyle changes. While the diagnosis in many cases is delayed due to asymptomatic early-stage disease or symptoms that are often mistaken to be a normal sign of ageing, it requires a special test called spirometry to examine the lung functions.  

COPD often calls for a pulmonary rehabilitation programme that is symptom-based and requires a multi-pronged approach to deal with the various related complications. A holistic treatment plan for lung disease including dyspnoea, persistent bronchial asthma and interstitial lung disease comprises preliminary patient assessment followed by medicinal treatment, lifestyle modifications, physical exercise, nutritional support, self-awareness and psychological counselling. Some major aspects of the rehabilitation programme are as follows.

Quit smoking 

More than 85% of smokers go on to develop COPD at some point in their life. The first step to pulmonary rehabilitation is to quit smoking. While this cannot reverse the condition, it can certainly prevent further damage to the lungs. And this not only helps in slowing the progress of the disease by alleviating some of the symptoms but also improves the way the body responds to treatment.  

**Exercise ** 

Physical activity is a very important aspect of pulmonary rehab as improving lung capacity is paramount to improving the quality of daily living. While COPD patients will have to begin with low-impact training which targets chest and back muscles, more intense forms of exercises can be added later. From simple physical activities such as walking on a treadmill to more rigorous exercises such as climbing stairs, resistance training can be done depending on individual progress and capacity.  

Breathing techniques 

COPD patients may find it hard to even blow a balloon. Learning breathing techniques that gradually alleviate the pressure on the lungs is important. Yoga with different types of pranayama can be beneficial in improving symptoms of breathlessness.  

**Nutrition ** 

A balanced diet not only helps improve immunity and health in general but also alleviates certain symptoms of COPD. Patients under the pulmonary rehab programme are recommended to eat a diet rich in complex carbs and fibres along with other micronutrients. This can also help in managing weight in patients as obesity can further stress out the lungs.

**Lifestyle modifications ** 

Living with COPD can be quite difficult as patients may find it hard to go about even the simplest of tasks. They may be required to bring in a lot of changes in their daily life including educating oneself about the triggers, common irritants in indoor and outdoor air, using an inhaler correctly and looking out for worsening symptoms that require urgent medical intervention.  

The challenges

While many pulmonary rehabilitation programmes are being implemented in India at a clinical level, most of them are ineffective in addressing all the needs of a COPD patient. This is because these programmes are not customized to individual requirements or based on symptoms and personal capacities.  

The system lacks proper staging and assessment of the disease, mainly because the infrastructure required for proper diagnosis is not in place in most healthcare centres.

Typically, a lot of focus is on setting up primary care clinics, OPDs and emergency rooms and rehabilitation centres are not given due importance. Since these programmes are long term, they require a lot of funds, time, manpower and systematic planning when done at a hospital or clinical level. Therefore, many of these rehab centres lack the necessary infrastructure and equipment to continually monitor and assess the progress of patients.  

Another challenge is that most clinicians lack proficiency in dealing with COPD and do not have the required expertise and infrastructure for an accurate diagnosis. The lack of awareness about COPD among the general public further exacerbates this problem, leading to dismal reporting and data. While many patients do not know that they are suffering from COPD, some others go undiagnosed due to lack of proper testing. This lack of knowledge among patients and the inability of medical practitioners in counselling them results in many checking out of these programmes after attending a few sessions.  

The way forward

It is time that the nation strongly addresses this growing prevalence of COPD. Treatment of COPD requires holistic planning and support at each level. As shown in this study, we need to recognize that high-intensity pulmonary rehabilitation can bring about high degrees of improvement in severe COPD patients. A six-week programme is quite effective in improving the quality of life in many cases.  Considering the lack of proper rehabilitation facility at hospitals, pulmonary rehab can be done at home by trained professionals.

This article has been authored by Dr Vishal Sehgal, Medical Director, Portea Medical.