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Pulmonary rehabilitation and airway clearance
Pulmonary rehabilitation improves breathlessness, exercise capacity and quality of life, and cuts readmissions in COPD — without changing FEV1 — because it acts on the muscles, the breathing pattern and behaviour, not on the lung itself.
Why it matters in the exam
Under ATS/ERS 2013 and GOLD, pulmonary rehabilitation suits every patient with chronic lung disease and breathlessness or reduced function despite drug treatment, and especially after a COPD exacerbation — starting within about four weeks of discharge is recommended. The programme usually lasts at least 6–8 weeks, 2–3 sessions a week, and includes endurance training (walking or cycling), limb strength training, education, breathing techniques, nutrition and psychological support. The common outcome measure is the 6-minute walk test.
Breathing techniques: pursed-lip breathing slows the breathing rate, prevents airway collapse and reduces air trapping; breathing control and a forward-leaning posture ease breathlessness. Oxygen during training is given to those who desaturate. In severe COPD with undernutrition adequate nutrition must be ensured. Pulmonary rehabilitation also suits interstitial lung disease, stable pulmonary hypertension, before and after lung surgery and after transplantation.
Airway clearance: active techniques — the active cycle of breathing (ACBT) and the "huff" (forced expiration with an open mouth); positive expiratory pressure (PEP) or oscillating devices; postural drainage and chest percussion; and high-frequency chest wall oscillation — mainly in cystic fibrosis and bronchiectasis. An incentive spirometer is meant mainly to prevent atelectasis after surgery and is not an airway clearance technique. In neuromuscular disease a peak cough flow below about 270 litres per minute indicates a need for assisted cough — manual or a mechanical cough device; nocturnal non-invasive ventilation is offered when there is hypoventilation.
Key points
- Pulmonary rehabilitation improves breathlessness, exercise and quality of life.
- After an exacerbation — within about four weeks.
- At least 6–8 weeks, endurance and strength training.
- Pursed lips reduce air trapping.
- Weak cough in neuromuscular disease — assisted cough.
Summary table
| Component | What is done | Main point |
|---|---|---|
| Endurance training | Walking or cycling | Improves exercise capacity and breathlessness |
| Strength training | Limb weights | Peripheral muscle weakness |
| Breathing techniques | Pursed lips, forward-leaning posture | Less air trapping |
| Airway clearance | ACBT, huff, PEP, postural drainage | Cystic fibrosis and bronchiectasis |
| Assisted cough | Manual or a mechanical cough device | Peak cough flow below about 270 litres per minute |
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Sources
- ATS/ERS Statement: Key concepts and advances in pulmonary rehabilitation, 2013 — Definition, components and outcomes
- GOLD Global Strategy for the Diagnosis, Management and Prevention of COPD, 2025 report — Pulmonary rehabilitation and follow-up after exacerbation
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.