Pneumologische Rehabilitation

Verminderte körperliche Leistungsfähigkeit, Dysfunktion der Skelettmuskulatur und ein inaktiver Lebensstil stehen in direkter Verbindung mit Erschöpfungs- und Dyspnoesymptomen bei Patienten mit chronischer Lungenerkrankung. Viele dieser extrapulmonalen Manifestationen gelten als behandelbare Eigenschaften der pneumologischen Rehabilitation (PR), einer umfassenden, individuellen, nicht-pharmakologischen Intervention.

Reduced exercise capacity, skeletal muscle dysfunction, and a physically inactive lifestyle are linked with symptoms of fatigue and dyspnea in people suffering from chronic lung disease. Numerous such extrapulmonary manifestations have been identified as treatable aspects of pulmonary rehabilitation (PR). PR is an extensive personalized non-pharmaceutical intervention, encompassing, but not limited to, exercise training, respiratory therapy, and education. The content and goals of a PR-program are based on a comprehensive patient assessment at the time of rehabilitation admission, with personalized therapies provided by a multidisciplinary team of healthcare professionals. This article provides an overview of PR including possible indications, therapy contents (e. g. exercise training, respiratory therapy), and evidence (COPD, interstitial lung disease, COVID-19). Finally, options for pulmonary rehabilitation maintenance services in Germany are presented.

Schlüsselwörter

Körperliche Leistungsfähigkeit - Trainingstherapie - Atemphysiotherapie - Schulung - Lebensqualität

Keywords

Exercise performance - exercise training - respiratory physiotherapy - education - quality of life

Publication History

Article published online:
05 December 2024

• Literatur

• 1 Burtin C, Wadell K. The rationale for pulmonary rehabilitation. In: Holland AE, Dal Corso S, Spruit MA, eds. ERS monograph – Pulmonary Rehabilitation. Lausanne (CH), Sheffield (UK): European Respiratory Society; 2021: 1-10
• 2 Seymour JM, Spruit MA, Hopkinson NS. et al. The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur Respir J 2010; 36: 81-88
• 3 Spruit MA, Gosselink R, Troosters T. et al. Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax 2003; 58: 752-756
• 4 Pitta F, Troosters T, Probst VS. et al. Physical activity and hospitalization for exacerbation of COPD. Chest 2006; 129: 536-544
• 5 Bui KL, Nyberg A, Rabinovich R. et al. The relevance of limb muscle dysfunction in chronic obstructive pulmonary disease: A review for clinicians. Clin Chest Med 2019; 40: 367-383
• 6 Cordova-Rivera L, Gardiner PA, Gibson PG. et al. Sedentary time in people with obstructive airway diseases. Respir Med 2021; 181: 106367
• 7 Watz H, Waschki B, Meyer T. et al. Physical activity in patients with COPD. Eur Respir J 2009; 33: 262-272
• 8 Spruit MA, Singh SJ, Garvey C. et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188: e13-e64
• 9 McCarthy B, Casey D, Devane D. et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015; 2: CD003793
• 10 Ries AL, Bauldoff GS, Carlin BW. et al. Pulmonary rehabilitation: Joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest 2007; 131: 4S-42S
• 11 Jarosch I, Hitzl W, Koczulla AR. et al. Comparison of exercise training responses in COPD patients with and without Alpha-1 antitrypsin deficiency. Respir Med 2017; 130: 98-101
• 12 Puhan MA, Gimeno-Santos E, Scharplatz M. et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011; 10: CD005305
• 13 Wedzicha JAEC-C, Miravitlles M, Hurst JR. et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J 2017; 50: 1602265
• 14 Lindenauer PK, Stefan MS, Pekow PS. et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among Medicare beneficiaries. JAMA 2020; 323: 1813-1823
• 15 Jones SE, Green SA, Clark AL. et al. Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence. Thorax 2014; 69: 181-182
• 16 Dowman L, Hill CJ, May A. et al. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev 2021; 2: CD006322
• 17 Osadnik CR, Gleeson C, McDonald VM. et al. Pulmonary rehabilitation versus usual care for adults with asthma. Cochrane Database Syst Rev 2022; 8: CD013485
• 18 Schultz K, Wittmann M, Wagner R. et al. In-patient pulmonary rehabilitation to improve asthma control – a randomized controlled study (EPRA, Effectiveness of Pulmonary Rehabilitation for Patients with Asthma). Dtsch Arztebl Int 2021; 118: 23-30
• 19 Koczulla AR, Ankermann T, Behrends U et al. AWMF S1-Leitlinie Long/Post-COVID 2022. Im Internet: https://www.awmf.org/uploads/tx_szleitlinien/020-027l_S1_Post_COVID_Long_COVID_2022-08.pdf ; Stand: 01.07.2023
• 20 Gloeckl R, Leitl D, Jarosch I. et al. Pulmonary rehabilitation in long COVID: more than just natural recovery!?. ERJ Open Res 2021; 7: 00454-02021
• 21 Schultz K, Buhr-Schinner H, Vonbank K. et al. Pneumologische Rehabilitation. München-Deisenhofen: Dustri Verlag Dr. Karl Feistle. 2019
• 22 Jarosch I, Schneeberger T, Stegemann A. et al. Schlafcharakteristik bei post-COVID-19 Patienten im Vergleich zu Gesunden. 2023 Im Internet: https://www.thieme-connect.de/products/ejournals/conferencepdf/094337/10.1055/s-00000059.pdf
• 23 Gloeckl R, Marinov B, Pitta F. Practical recommendations for exercise training in patients with COPD. Eur Respir Rev 2013; 22: 178-186
• 24 Gloeckl R, Zwick RH, Furlinger U et al. Prescribing and adjusting exercise training in chronic respiratory diseases – Expert-based practical recommendations. Pulmonology 2022; S2531–0437(22)00215-X. doi: 10.1016/j.pulmoe.2022.09.004
• 25 Prieur G, Combret Y, Medrinal C. et al. Energy conservation technique improves dyspnoea when patients with severe COPD climb stairs: a randomised crossover study. Thorax 2020; 75: 510-512
• 26 Bruton A, Lee A, Yardley L. et al. Physiotherapy breathing retraining for asthma: a randomised controlled trial. Lancet Respir Med 2018; 6: 19-28
• 27 Breathing Freely – Your guide to breathing retraining for asthma [cited 19.06.2023]. Im Internet: https://lifeguidehealth.org/interventions/b3d7be9b-f284-4645-a3ca-d3453744ee57/pdf_asthma_booklet.pdf
• 28 Charususin N, Gosselink R, Decramer M. et al. Randomised controlled trial of adjunctive inspiratory muscle training for patients with COPD. Thorax 2018; 73: 942-950
• 29 Singh SJ, Puhan MA, Andrianopoulos V. et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J 2014; 44: 1447-1478
• 30 Ammous O, Feki W, Lotfi T. et al. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2023; 1: CD013778
• 31 Regmi B, Friedrich J, Jorn B. et al. Diaphragm muscle Weakness might explain exertional dyspnea fifteen months after hospitalization for COVID-19. Am J Respir Crit Care Med 2023; 207: 1012-1021
• 32 Miravitlles M, Worth H, Soler Cataluna JJ. et al. Observational study to characterise 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS study. Respir Res 2014; 15: 122
• 33 Miravitlles M, Ribera A. Understanding the impact of symptoms on the burden of COPD. Respir Res 2017; 18: 67
• 34 Spielmanns M, Gloeckl R, Jarosch I. et al. Using a smartphone application maintains physical acitivity following pulmonary rehabilitation in COPD patients: a randomised controlled trial. Thorax 2023; 78: 442-450 [e-pub ahead of print]