Integrated pulmonary rehabilitation: multidisciplinary approaches and clinical outcomes in the management of chronic lung diseases.

Abstract

Integrated pulmonary rehabilitation (PR) is a fundamental pillar in the modern management of chronic lung diseases, aimed at significantly improving the quality of life and overall functionality of patients. According to the latest 2023 American Thoracic Society (ATS) guidelines, PR is defined as a multidimensional set of interventions designed to enhance the physical and psychosocial well-being of patients with chronic respiratory diseases through a personalized approach [1]. This rehabilitative model includes a broad spectrum of measures intended to reduce respiratory symptoms, increase exercise tolerance, and enhance patient autonomy within the context of a multidisciplinary team comprising pulmonologists, physiotherapists, nutritionists, psychologists, and social workers [2].

The origins of PR can be traced back to the 1960s, when physical training was the primary therapeutic strategy for patients with respiratory conditions. Over the decades, as the understanding of chronic lung diseases deepened, this concept evolved substantially, adding essential components such as psychological counseling, nutritional support, education, and social integration, all of which are now standard in treatment protocols [3]. The 2023 ATS guidelines emphasize the necessity of a holistic approach and underscore the central role of personalized rehabilitation programs to meet patients’ individual needs [4].

Physical training, focused on respiratory muscle rehabilitation and general endurance, remains the core of any PR program, with solid evidence supporting improvements in exercise capacity and reduction of dyspnea [5]. Patient education is also central, emphasizing symptom self-management, treatment adherence, and modification of risk behaviors [6]. Psychological support is crucial, given the high prevalence of depression and anxiety among patients with chronic lung diseases, while nutritional counseling contributes to maintaining homeostasis and muscle mass, essential for optimal pulmonary function [7].

Clinical studies highlight the positive outcomes of integrated PR on clinical and functional parameters, including significant reductions in dyspnea, increased exercise capacity, improved quality of life, and decreased hospitalization rates [2]. These benefits are also associated with a reduction in mortality rates, providing conclusive evidence for the importance of a multidisciplinary approach and personalized interventions [3]. In conclusion, integrated PR represents a comprehensive approach essential for optimizing the treatment of patients with chronic lung diseases, with a significant impact on clinical outcomes and quality of life.