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Pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) with recommendations for its use. Report of the European Respiratory Society Rehabilitation and Chronic Care Scientific Group (S.E.P.C.R. Rehabilitation Working Group)

Although smoking, the major risk factor for COPD, seems to be declining in the Western World, its consequences will last for decades. The last 30 years have seen widespread efforts to define the components and role of pulmonary rehabilitation in COPD patients; the task for the 1990's will be an extensive multidisciplinary application of scientific principles to pulmonary rehabilitation. In this perspective the empiric approach will be replaced by therapeutic principles aimed to achieve specific benefits for the individual patient, and to define the role of potential outcomes of pulmonary rehabilitation. Decreased mortality and morbidity may seem to be the most important outcome of a rehabilitation programme, but other issues such as physical and mental health, social and role functioning and perception of wellbeing can play a pivotal role to the individual response of a patient enrolled in a long-term rehabilitative programme. The effects of pulmonary rehabili tation on mortality will probably never be elucidated conclusively because the answer would require studies on large populations for many years in comparison to a control group. Pulmonary rehabilitation aims to restore patients to an independent, productive and satisfying life and prevent further clinical deterioration to the maximum extent compatible with the stage of the disease. This goal may be accomplished, without materiaiJy improving lung function, by helping the patients to become more aware of their disease, more actively involved in their own health care and more independent in performing daily care activities, attempting to reverse the disability from disease. Optimum drug therapy and smoking cessation are essential pre-requisites. An understanding of the