Abstract
Abstract Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. Methods: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, “Rehabilitation and Chronic Care,” determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. Results: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. Conclusions: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease. KEYWORDS: COPD, pulmonary rehabilitation, exacerbation, behavior, outcomes Copyright © 2013 by the American Thoracic Society This official statement of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) was approved by the ATS Board of Directors, June 2013, and by the ERS Scientific and Executive Committees in January 2013 and February 2013, respectively Author Disclosures: C.G. reported consulting for Boehringer Ingelheim ($1–4,999). R.Z. reported serving as a speaker and on advisory committees of Boehringer Ingelheim, GlaxoSmithKline, and Pfizer ($5,000–24,999), and received research support from Boehringer Ingelheim, GlaxoSmithKline, and Pfizer ($25,000–49,999). C.R. reported serving on advisory committees of GlaxoSmithKline ($1–9,999). F.M. reported serving as a speaker and on advisory committees of AstraZeneca ($1–4,999), Boehringer Ingelheim ($1–4,999), and GlaxoSmithKline ($1–4,999); he received research support from AstraZeneca ($50,000–99,999), Boehringer Ingelheim ($100,000–249,999), GlaxoSmithKline ($100,000–249,999), Novartis ($100,000–249,999), and Nycomed ($100,000–249,999). D.B. received research support from Pfizer (amount unspecified). M.H. received research support from Boehringer Ingelheim (amount unspecified). M.M. reported that he hoped to receive an unconditional travel grant from Boehringer Ingelheim (amount unspecified). M.P.M.H.R.-v.M. reported consulting for Boehringer Ingelheim and receiving research support from Boehringer Ingelheim (amount unspecified). B.M. reported serving as a speaker and on advisory committees of AstraZeneca-Medimmune ($5,000–24,999), Boehringer Ingelheim ($5,000–24,999), Forest (50,000–99,999), and GlaxoSmithKline ($50,000–99,999); he served on advisory committees of Astellas ($1–4,999), Breathe ($1–4,999), Ikaria ($1–4,999), Merck ($1–4,999), and Sunovian ($1–4,999), and as a speaker for Abbott ($1–4,999) and Pfizer ($1–4,999); he received research support from AstraZeneca-Medimmune ($250,000+), Boehringer Ingelheim ($100,000–249,999), Forest ($50,000–99,999), GlaxoSmithKline ($100,000–249,999), and Sunovian ($1–4,999). R.S.G. received research support from AstraZeneca ($5,001–10,000) and Pfizer (amount unspecified). E.F.M.W. reported serving on advisory committees of Nycomed ($1,001–5,000) and as a speaker for AstraZeneca (up to $1,000), GlaxoSmithKline (up to $1,000), and Novartis (up to $1,000); he received research support from AstraZeneca ($1,000–4,999) and GlaxoSmithKline ($1,000–4,999). M.A.S., S.J.S., L.N., K.H., A.E.H., S.C.L., W.D.-C.M., F.P., L.S., J.R., J.B., R. Crouch, F.M.E.F., R. Casaburi, J.H.V., I.V., R. Gosselink, E.M.C., T.W.E., J.v.d.P., T.T., D.J.A.J., E.C., J.G.-A., B.F.F., M.A.P., R. Garrod, A.M.W.J.S., B.C., R.B., P.M., A.L.R., C.A.D., J.L.B., and C.F.D. reported that they had no relevant commercial interests.