What else can we do? It is very important to consider a form of pulmonary rehabilitation. The following table shows the goals of pulmonary rehabilitation.

If a program isn't available in your patient's community, refer them to a regular rehab program. They need to start exercising again. They need to start walking. Once patients are able to breathe we need to encourage them to exercise and to move. You can see how important this is when you consider patients who have had a lung transplant. You give them a new lung and they can breathe. Their lung function is perfectly normal—but they cannot move. They have developed such severe muscle myopathy that they may have to be retrained to exercise. This is where pulmonary rehab is going to play a role.

Study after study has shown the benefits of pulmonary rehab. It reduces symptoms, decreases disability, improves the overall quality of life. It can have an economic impact for some patients.

I believe the most important part of pulmonary rehabilitation is the support group. Patients who have the same disease, suffer the same limitations in life, can get together and talk about it. They can help each other find ways to cope with the disease.

This is something that we physicians cannot always do. Recently a patient came into my office and asked if I noticed the difference in her. I couldn’t figure it out. I looked at her and she looked the same as she does every time I have seen her. The difference was that through her pulmonary rehab program, somebody found her eyeglasses frames that allow you to connect the oxygen to the glasses. There is a little device on the bottom of the glasses that delivers the oxygen so she doesn’t have to have the cannula in her face anymore. That is a small detail but it has made a significant impact on this patient’s life.

I have not suffered this disease. I don’t know how to tell a patient to return to a fuller life. I prescribe medication that will make them feel better, but I don’t know what it means to have this disease. This is why rehab plays such an important role. Patients are going to get together. They are going to exercise together and going to work together, and at the end of the day, together they are going to improve. Their lung function and exercise capacity is going to get better. Studies have also shown that pulmonary rehab has other benefits, for instance a reduction in exacerbations and hospitalizations.

There are other rescue therapies. As we discussed previously, lung transplant surgery is only for a very small number of patients. It is not realistic to expect that most of your patients are going to be able to have a lung transplant, but we may not even need it in the future. With this new pharmacotherapy that is changing the course of the disease combined with earlier intervention and reduction of risk factors, our patients are going to improve and probably won't need lung transplants and surgical procedures.