Respiratory rehabilitation after acute exacerbations of chronic obstructive pulmonary disease

Respiratory rehabilitation has gained a prominent role in the management of stable chronic obstructive pulmonary disease (COPD). Recent data suggest however, that rehabilitation may be particularly effective in improving prognosis when initiated after an exacerbation. Arguments for early rehabilitation include the use of a window of opportunity to refer COPD patients to rehabilitation when they are receptive to changing their health behaviour. But the effects of rehabilitation may not only be dependent upon timing but also on the risk profile of patents. Patients experiencing exacerbations often have a number of modifiable risk factors for further exacerbations and early death that can be addressed effectively by rehabilitation. Potential drawbacks of early rehabilitation include the risk of further exacerbations during the rehabilitation that may interrupt the programme. Also, patients in unstable pulmonary condition require more supervision compared to rehabilitation in stable state. As a consequence, early rehabilitation often takes place in hospitals. The subsequent implementation of exercise and self-management into daily life is challenging. Evidence is not conclusive whether early or late rehabilitation is preferable. Future studies will show whether the timing or the risk of COPD patients is critical when deciding for or against rehabilitation after exacerbations.