Effective home-based pulmonary rehabilitation in patients with restrictive lung diseases

Patients with chronic obstructive pulmonary disease (COPD) are commonly referred for pulmonary rehabilitation (PR), but the use of PR is not common for patients with restrictive lung disease, neuromuscular diseases, and those who have sustained a severe respiratory illness or undergone thoracic surgery. We investigated the effects of PR in patients with restrictive lung diseases in comparison with COPD patients using a home-based setting. Twenty-six restrictive lung diseases patients and 40 COPD patients who had a Medical Research Council (MRC) dyspnea score ≥ 2, a clinically stable condition, and who had completed a 6-month PR program, were enrolled in the present study. The definition of restrictive lung disease was a forced vital capacity (FVC) of ≤ 80% of the predicted value with a forced effort volume in one second/FVC of > 70%. Our PR consisted of breathing retraining, exercise training, respiratory muscle stretching calisthenics, level walking, inspiratory and expiratory muscle exercises, and a monthly education program. Patients were strongly instructed to practice this program daily at home, and were supervised by a respiratory therapist every 2 weeks in our hospital. Patients with restrictive lung diseases showed the significant increases in inspiratory and expiratory muscle forces, the 6-minute walking distance, the Chronic Respiratory Disease Questionnaire and the Short-Form 36, and decreased MRC scores after 6 months. In conclusion, our home-based PR improves respiratory muscle forces, exercise tolerance, health-related quality of life, and the perception of dyspnea in patients with restrictive lung disease to the same extent as in COPD patients.