According to the American Thoracic Society (ATS) and the European Respiratory Society (ERS), pulmonary rehabilitation can be defined as follows:
An evidence-based, multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities.
Integrated into the individualized treatment of each patient, pulmonary rehabilitation is designed to:
Over the past 50 years, pulmonary rehabilitation has evolved significantly in response to the growing number of people who suffer from chronic respiratory diseases. Already, in 1935, the benefits of breathing exercises in dealing with asthma were identified and published by Livingston. 20 years later, Miller published his findings on the physiological effects of diaphragmatic breathing for people with COPD. But the most significant advances, particularly those that involve physical exercise, would come much later.
In 1969, an initial study of pulmonary rehabilitation, which incorporated a structured physical exercise program, was conducted over a five-year period, and followed 252 patients with COPD. Subsequently, numerous other studies were done. As a result, they too substantiated the benefits of physical exercise and the other components of pulmonary rehabilitation for people with chronic pulmonary diseases. However, all this would not suffice to convince the medical community that this treatment is truly effective and that it should be a part of the management of chronic respiratory diseases.
Today, pulmonary rehabilitation has been extensively documented. In 1996, a meta-analysis undertaken by Dr. Y. Lacasse (Université Laval, Québec) was published in the Lancet medical journal. The effectiveness of pulmonary rehabilitation could henceforth no longer be called into question. Over the past few decades, significant advances have demonstrated the physiological foundations, which enable us to understand the benefits, including improvements to patients' shortness of breath and fatigue. These advances were made thanks to the research work done by several Canadians, particularly that of Dr. F. Maltais (Université Laval, Quebec City) and Dr. D. O'Donnell (Queens University, Kingston). Over the past 10 years, research has focused upon self-management programs for chronic respiratory diseases and the necessity that they be part and parcel of pulmonary rehabilitation programs. The Quebec-based work of Dr. J. Bourbeau (McGill University, Montreal) was the first to demonstrate the effectiveness of such programs, in other words, the improvements made to the patient's well being and the decrease in the number of visits to the emergency room and the number of hospitalizations.
Several guidelines based upon well-substantiated evidence have been published, which help guide physicians and other health care professionals in the development of pulmonary rehabilitation programs.
In Canada, notwithstanding the well-proven benefits of pulmonary rehabilitation, access to such programs for people with chronic pulmonary disease remains limited. A recent national survey revealed that only 98 pulmonary rehabilitation programs exist in Canada (CTS-2007). This essentially means that fewer than 10,000 patients are able to reap the benefits of such programs in any given year. The prevalence of COPD in Canada, with close to 1 million patients, translates into less than 1% of them having access to this treatment, recognized as being one of the most effective at improving a person's capacity to function and at increasing their autonomy. In some provinces, such as Newfoundland-and-Labrador, these programs are quite simply inexistent.
The situation in the Province of Quebec is similar to that in the rest of Canada. About 40 institutions offer pulmonary rehabilitation services in the Province of Quebec, according to a study conducted in 2007 by the RQAM. About half of them are offered on an outpatient basis. Six regions have no program at all. The study also revealed that only 1% of patients with COPD have access to pulmonary rehabilitation. In some regions, the percentage is higher, but never exceeds 3%. In addition, very few institutions have a budget that is strictly reserved for pulmonary rehabilitation programs.