From the Guidelines
Pulmonary rehabilitation is a crucial component of the clinical management of patients with chronic respiratory diseases, aiming to reduce symptoms, optimize functional status, and improve quality of life. The lungs are vital respiratory organs in humans and other vertebrates that facilitate gas exchange between the atmosphere and bloodstream. Located in the chest cavity on either side of the heart, lungs are spongy, air-filled organs that expand and contract during breathing. The right lung has three lobes while the left lung has two lobes, making room for the heart. When we breathe in, air travels through the trachea, which branches into bronchi, then smaller bronchioles, and finally into tiny air sacs called alveoli. These alveoli are surrounded by capillaries where oxygen from inhaled air passes into the bloodstream while carbon dioxide moves from the blood into the lungs to be exhaled.
Key Components of Pulmonary Rehabilitation
- Patient assessment
- Exercise training
- Education
- Nutritional intervention
- Psychosocial support As stated in the American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation 1, pulmonary rehabilitation programs involve a comprehensive and multidisciplinary approach to address the functional and psychologic deficits of patients with chronic respiratory diseases.
Benefits of Pulmonary Rehabilitation
- Reduces symptoms
- Optimizes functional status
- Increases participation
- Reduces health care costs The joint ACCP/AACVPR evidence-based clinical practice guidelines on pulmonary rehabilitation 1 emphasize the importance of rehabilitation programs in enhancing standard therapy and optimizing functional capacity for patients with chronic lung diseases.
Implementation of Pulmonary Rehabilitation
Pulmonary rehabilitation should be integrated into the individualized treatment of patients with chronic respiratory diseases, addressing their unique needs and promoting self-management skills and self-efficacy. The interdisciplinary team of health-care professionals involved in pulmonary rehabilitation may include physicians, nurses, respiratory therapists, and other experts, as highlighted in the guidelines 1.
From the FDA Drug Label
The prime action of beta-adrenergic drugs is to stimulate adenyl cyclase, the enzyme which catalyzes the formation of cyclic-3',5'-adenosine monophosphate (cyclic AMP) from adenosine triphosphate (ATP). In vitro studies and in vivo pharmacologic studies have demonstrated that albuterol has a preferential effect on beta2-adrenergic receptors compared with isoproterenol. While it is recognized that beta2-adrenergic receptors are the predominant receptors in bronchial smooth muscle, data indicate that 10% to 50% of the beta-receptors in the human heart may be beta2-receptors Albuterol has been shown in most controlled clinical trials to have more effect on the respiratory tract in the form of bronchial smooth muscle relaxation than isoproterenol at comparable doses while producing fewer cardiovascular effects Controlled clinical studies and other clinical experience have shown that inhaled albuterol, like other beta-adrenergic agonist drugs, can produce a significant cardiovascular effect in some patients, as measured by pulse rate, blood pressure, symptoms, and/or electrocardiographic changes It has been demonstrated that following oral administration of 4 mg of albuterol, the elimination half-life was five to six hours. In controlled clinical trials, most patients exhibited an onset of improvement in pulmonary function within 5 minutes as determined by FEV1. FEV1 measurements also showed that the maximum average improvement in pulmonary function usually occurred at approximately 1 hour following inhalation of 2. 5 mg of albuterol by compressor-nebulizer and remained close to peak for 2 hours.
The lungs are affected by albuterol, as it has a preferential effect on beta2-adrenergic receptors in bronchial smooth muscle, causing relaxation and resulting in improved pulmonary function as measured by FEV1.
- Onset of improvement in pulmonary function occurs within 5 minutes.
- Maximum average improvement in pulmonary function usually occurs at approximately 1 hour following inhalation of albuterol.
- Clinically significant improvement in pulmonary function continues for 3 to 4 hours in most patients and in some patients continues up to 6 hours 2.
From the Research
Lungs and Respiratory Diseases
- Chronic respiratory diseases (CRDs) are a major threat to human health, with smoking being the leading risk factor for death from CRDs worldwide 3
- The incidence of CRDs and deaths have increased over the last 30 years, while the age-standardized incidence rate and death rate have declined 3
- In patients with asthma-COPD overlap, long-acting beta2-agonist (LABA) is associated with decreased risk of myocardial infarction, and the combination therapy of inhaled corticosteroids (ICS) and LABA appears to reduce the risk of death or hospitalization 4
Smoking and Lung Cancer
- Smoking is a major risk factor for lung cancer and chronic respiratory diseases, and quitting smoking is essential for reducing the risk of treatment toxicity, residual/recurrent disease, and all-cause mortality in lung cancer patients 5
- Guidelines recommend screening, counseling, and access to smoking cessation services for all cancer patients, but barriers from both patient and healthcare professional perspectives contribute to lack of implementation 5
- Outreach contacts and shared decision making can increase lung cancer screening rates among primary care patients, particularly those at high risk for lung cancer 6
Lung Cancer Screening
- Annual lung cancer screening is recommended for high-risk patients, but rates are currently low 6
- Strategies such as outreach contacts and shared decision making can increase lung cancer screening rates and referral/scheduling among primary care patients 6
- Further research is needed to assess the additional value of shared decision making on screening uptake and to identify effective strategies for increasing lung cancer screening rates 6