December 29, 2005

Lung disease patients breathe easier with rehab

By Megan Rauscher

NEW YORK (Reuters Health) - Pulmonary rehabilitation
produces significant benefits for patients with advanced
emphysema and plays an important role in the selection of
patients for lung surgery, according to results of the National
Emphysema Treatment Trial, or NETT.

"The NETT highlights the important benefits of pulmonary
rehabilitation -- as practiced in a large number of centers
across the country -- as a standard of care for patients with
advanced chronic lung disease and an important adjunct to lung
volume reduction surgery programs," Dr. Andrew L. Ries, from
the University of California, San Diego told Reuters Health.

"We believe that pulmonary rehabilitation plays a key role
not only in preparing such patients for surgery and
facilitating their recovery after surgery, but also in
optimally selecting patients for such high risk procedures," he

In the NETT cohort, a total of 1,218 patients with severe
emphysema underwent pulmonary rehabilitation before and after
being randomly assigned to so-called lung volume reduction
surgery or continued medical management at 17 NETT centers and
539 satellite centers.

The NETT Research Group reports in the medical journal
CHEST that pulmonary rehabilitation produced significant
improvements in exercise capacity, dyspnea, and health-related
quality of life. These improvements were consistent across NETT
centers and satellite centers.

Many patients -- perhaps 10 percent -- who came to the
study eager for lung surgery experienced such positive effects
from pulmonary rehabilitation that they were subsequently
unwilling to have surgery, Ries and colleagues note.

"Other patients, who might have initially seemed
appropriate for surgery, were subsequently found during
pulmonary rehabilitation to be too ill or fragile for surgery,"
they add.

The importance of the NETT, writes Dr. Roger S. Goldstein
from the University of Toronto in a related editorial, lies in
"the message that rehabilitation practiced over many sites,
only some of which are academic, can improve walking and
quality of life for many patients."

SOURCE: CHEST December 2005.