What are the common types of pulmonary diseases in an adult patient, particularly those who may be candidates for pulmonary rehabilitation?

Types of Pulmonary Diseases

The most common pulmonary diseases in adults who are candidates for pulmonary rehabilitation include chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), pulmonary hypertension (PH), asthma, and bronchiectasis (both cystic fibrosis and non-cystic fibrosis related). 1

Primary Obstructive Lung Diseases

Chronic Obstructive Pulmonary Disease (COPD)

• COPD affects approximately 11.7% of people worldwide and represents the most extensively studied condition for pulmonary rehabilitation. 1
• Cardinal features include dyspnea and reduced exercise capacity resulting from structural respiratory changes, skeletal muscle dysfunction, deconditioning, and cardiocirculatory limitations. 1
• Comorbid conditions frequently accompany COPD including anxiety, fear, depression, osteoporosis, metabolic disorders, anemia, and fatigue. 1
• Acute exacerbations further worsen lung function, symptoms, disability, and increase mortality risk. 1

Asthma

• Persistent asthma represents another obstructive disease appropriate for pulmonary rehabilitation referral. 1
• Patients with asthma benefit from rehabilitation programs despite having different pathophysiology than COPD. 1

Bronchiectasis

• Both cystic fibrosis and non-cystic fibrosis bronchiectasis are recognized as conditions benefiting from pulmonary rehabilitation. 1
• Diffuse bronchiectasis and bronchiolitis obliterans are included in obstructive disease categories. 1

Restrictive Lung Diseases

Interstitial Lung Disease (ILD)

• ILD encompasses multiple conditions including interstitial fibrosis, occupational or environmental lung disease, sarcoidosis, connective tissue disease-related ILD, hypersensitivity pneumonitis, and lymphangioleiomyomatosis. 1, 2
• The American Thoracic Society provides a strong recommendation for pulmonary rehabilitation in adults with ILD based on moderate-quality evidence. 1

Chest Wall and Neuromuscular Disorders

• Kyphoscoliosis, ankylosing spondylitis, and post-tuberculosis syndrome represent extrinsic restrictive diseases affecting the chest wall. 1, 2
• These conditions cause restrictive patterns through mechanical limitation rather than parenchymal disease. 2

Pleural Diseases

• Pleural effusion and pleural thickening are types of extrinsic restrictive lung diseases. 2

Pulmonary Vascular Disease

Pulmonary Hypertension

• PH is classified as a distinct category with a conditional recommendation for pulmonary rehabilitation based on low-quality evidence. 1
• Pulmonary vascular abnormalities frequently accompany respiratory disorders and may result in cor pulmonale with right ventricular dysfunction. 3

Other Conditions Appropriate for Pulmonary Rehabilitation

Lung Cancer

• Lung cancer patients benefit from pulmonary rehabilitation both before and after thoracic surgery. 1

Surgical Candidates

• Patients preparing for or recovering from lung transplantation, lung volume reduction surgery, and thoracic/abdominal surgery are appropriate candidates. 1

Post-Acute Conditions

• ARDS survivors and those recovering from SARS-CoV-2 infection (COVID-19) represent emerging populations benefiting from rehabilitation. 1
• Ventilator-dependent patients may also benefit from structured rehabilitation programs. 1

Obesity-Related Respiratory Disease

• Obesity hypoventilation syndrome and obesity-related respiratory compromise are recognized conditions for rehabilitation referral. 1, 3

Key Clinical Indicators for Referral

Regardless of specific diagnosis, the following clinical features warrant pulmonary rehabilitation consideration:

• Dyspnea, fatigue, and chronic respiratory symptoms. 1
• Impaired health-related quality of life and decreased functional status. 1
• Decreased occupational performance and difficulty performing activities of daily living. 1
• Psychosocial problems related to the underlying respiratory illness. 1

Important Caveats

• The 2023 American Thoracic Society guidelines expanded beyond the traditional COPD-only focus to include multiple chronic respiratory diseases, reflecting the evolving evidence base. 1
• Pulmonary rehabilitation benefits patients irrespective of baseline age and disease severity, though many are not referred until advanced disease stages. 1
• Response to pulmonary rehabilitation cannot be predicted by the degree of airflow limitation alone. 1
• In 2023, chronic respiratory diseases accounted for 569.2 million cases and 4.2 million deaths globally, emphasizing the substantial burden these conditions impose. 4