EC Pulmonology and Respiratory Medicine

Pulmonary rehabilitation (PR) has emerged as a valuable nonpharmacological intervention that encompasses exercise training, education, nutritional counseling, and psychosocial support for chronic respiratory diseases (CRDs). Implementing a nationwide accessible PR program is vital for improving health outcomes and promoting healthier lifestyles through preventive measures and comprehensive management strategies for individuals with respiratory conditions. The first structured nationwide PR program in India was initiated in 2022. Details of its evolution and outcomes are presented here. The program involves a team of 113 PR therapists across 84 cities in India. The PR program components include patient assessment, exercise training, education, and psychosocial rehabilitation. Since its inception from April 2022 to July 2024, 27,402 patients have been enrolled. The most common diagnoses were chronic obstructive pulmonary disease (COPD) and asthma (32% each), followed by interstitial lung disease (8%), and others (28%). Learnings from this first nationwide structured PR program will lay the foundation for future initiatives in this realm.

 Keywords: Asthma; Chronic Obstructive Pulmonary Disease; Health Care; India; Pulmonary Rehabilitation

1. Chen X., et al. “Global, regional, and national burden of chronic respiratory diseases and associated risk factors, 1990-2019: Results from the Global Burden of Disease Study 2019”. Frontiers in Medicine 10 (2023): 1066804.
2. GBD 2019 Chronic Respiratory Diseases Collaborators. “Global burden of chronic respiratory diseases and risk factors, 1990-2019: An update from the Global Burden of Disease Study 2019”. EClinicalMedicine 59 (2023): 101936.
3. Priya N., et al. “Effect of home‑based pulmonary rehabilitation on health‑related quality of life, lung function, exercise tolerance, and dyspnea in chronic obstructive pulmonary disorder patients in a tertiary care center in South India”. Lung India 3 (2021): 211-215.
4. Sharma BB and Singh V. “Pulmonary rehabilitation: An overview”. Lung India4 (2011): 276-284.
5. Sebio Sebio-García R. “Pulmonary rehabilitation: time for an upgrade”. Journal of Clinical Medicine 9 (2020): 2742.
6. Borbeau J and Bhatt SP. American Journal of Respiratory and Critical Care Medicine 207 (2023): 7.
7. McCarthy B., et al. “Pulmonary rehabilitation for chronic obstructive pulmonary disease”. Cochrane Database of Systematic Reviews 2 (2015): CD003793.
8. Vivek K., et al. “Pulmonary rehabilitation in patients with interstitial lung diseases in an outpatient setting: A randomised controlled trial”. The Indian Journal of Chest Diseases and Allied Sciences 59 (2017): 75-80.
9. Bairapareddy KC., et al. “Telerehabilitation for chronic obstructive pulmonary disease Patients: An underrecognized management in tertiary care”. Indian Journal of Palliative Care 4 (2018): 529-533.
10. Dong J., et al. “Efficacy of pulmonary rehabilitation in improving the quality of life for patients with chronic obstructive pulmonary disease: evidence based on nineteen randomized controlled trials”. International Journal of Surgery 73 (2020): 78-86.
11. Ryrsø CK., et al. “Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis”. BMC Pulmonary Medicine 1 (2018): 154.
12. Aboumatar H., et al. “Effect of a program combining transitional care and long-term self-management support on outcomes of hospitalized patients with chronic obstructive pulmonary disease: a randomized clinical trial”. Journal of the American Medical Association 22 (2018): 2335-2343.
13. Ryrsø CK., et al. “Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis”. BMC Pulmonary Medicine 1 (2018): 154.
14. , et al. “Pulmonary rehabilitation for interstitial lung disease”. Cochrane Database of Systematic Reviews 2 (2021): CD006322.
15. Osadnik Gleeson C., et al. “Pulmonary rehabilitation versus usual care for adults with asthma”. Cochrane Database of Systematic Reviews8 (2022): CD013485.
16. Shenoy MA and Paul V. “Pulmonary Rehabilitation”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing (2023).
17. Raghu G., et al. “Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline”. American Journal of Respiratory and Critical Care Medicine9 (2022): e18-e47.
18. Global initiative for Asthma management, 2024.
19. Holland AE., et al. “Defining modern pulmonary rehabilitation. An official American Thoracic Society workshop report”. Annals of the American Thoracic Society 5 (2021): e12-e29.
20. Rochester CL., et al. “Pulmonary rehabilitation for adults with chronic respiratory disease: An Official American Thoracic Society Clinical Practice Guideline”. American Journal of Respiratory and Critical Care Medicine 4 (2023): e7-e26.
21. Newman ANL., et al. “The effects of pulmonary rehabilitation on inflammatory biomarkers in patients with chronic obstructive pulmonary disease: Protocol for a systematic review and meta-analysis”. PLoS One 6 (2023): e0287549.
22. Bourbeau J and Bhatt SP. “Constructing modern pulmonary rehabilitation: another brick from the wall”. American Journal of Respiratory and Critical Care Medicine7 (2023): 804-805.
23. Bhadra R., et al. “Pulmonary rehabilitation in the management of chronic obstructive pulmonary disease among Asian Indians-current status and moving forward, COPD”. Journal of Chronic Obstructive Pulmonary Disease 4 (2021): 476-481.
24. Augustine A., et al. “Barriers to pulmonary rehabilitation - A narrative review and perspectives from a few stakeholders”. Lung India 1 (2021): 59-63.