Pulmonary rehabilitation programme in India: Need of the hour

Statistics show that India accounted for about 32 per cent of the total global deaths and disability adjusted years (DALYs) of respiratory diseases in 2016. Air pollution, smoking, climate change, and age-related issues are all factors that are major contributors to chronic lung diseases issues, dyspnoea and other respiratory problems. Alongside the standard treatment procedures for respiratory diseases, there is another trend gaining prominence with time. Known as the pulmonary rehabilitation programme, it is an evidence-based, multi-pronged treatment process for various respiratory complications. Divided into two types — in-hospital and at home — it has proved effective in improving dyspnoea, quality of life and improved activity of daily living (ADLs) in patients suffering from chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), persistent bronchial asthma and other lung manifestations.

An all-encompassing pulmonary rehabilitation programme comprises elements like patient evaluation, maximising benefits of medicinal treatment, physical exercise, self-management awareness, nutritional support and psychological as well as social support to the patient. Exercise training is the most crucial part of an effective pulmonary rehabilitation strategy. Studies have revealed that there is usually an improvement in the physical endurance of a patient, even after a single pulmonary rehabilitation programme. Therefore, it is highly recommended that all efforts are made to provide a monitored exercise training programme, irrespective of the resources available.

Challenges

There are several challenges to pulmonary rehabilitation in India, which stem from patients, society, and hospitals alike. The present treatment processes are not highly satisfactory and are ineffective in stemming the disease or the associated disability. They also do not provide adequate relief from the symptoms. Development of stage-wise effects of the disease may worsen these and lead to weight loss, weakened or dysfunctional respiratory muscles, in turn increasing disability and repeated acute exacerbations.

Typically, priority is given to setting up regular outpatient clinics, emergency and intensive care units instead of a rehabilitation centre. Among the reasons for this is the labour intensive, time consuming and long-term nature of rehabilitation programmes. On the contrary, in the critical scenario of a patient being in the ICU, the results are almost instantaneous and financially rewarding. However, it is important to note that despite being longer in duration, rehabilitation is more cost-effective than the standard treatment.

Generally, medical professionals lack awareness about the positive impacts of pulmonary rehabilitation given the fact that they do not have enough exposure to related concepts and benefits in their undergraduate and post-graduate years – or later, during clinical practice. Another challenge stems from diagnostic labs which are so overloaded with routine tasks that they don’t appoint staff well-trained for pulmonary rehabilitation specific assessment.

All this further leads to a lack of awareness among patients and the general population. The drop-out rate from pulmonary rehabilitation programmes is also quite high. At times, patients may attend the sessions with intent, but when they notice no visible improvement in their condition, they lose interest. Another fact is that in India, patients are often unwilling or incapable of spending extra money on domiciliary oxygen, equipment or on attending the sessions. Another factor that undermines rehabilitation is malnutrition. COPD and various other respiratory as well as lung-ailments are either ignored or inadequately treated with medicinal intervention. This leads to a number of fatalities, which could have been prevented with timely and effective pulmonary rehabilitation programmes.

Opportunities

At the base level, it is imperative to integrate pulmonary rehabilitation concepts and their benefits into the undergraduate and post-graduate curriculum of trainee doctors. Equipped with relevant information and exposure to the concepts, medical professionals will make more accurate and timely recommendations to patients suffering from respiratory disorders like COPD, ILD, etc.

Given that pulmonary rehabilitation programme is a non-medicinal and exercise training-oriented procedure, it holds immense potential for related home-based initiatives. A recent study found that a six weeks home-based pulmonary rehabilitation programme proved effective in enhancing a patient’s exercise endurance, sensation of dyspnoea and overall quality of life among the patients of COPD. There are some homecare start-ups and private as well as government hospitals that now recommend or provide these home-based solutions.

The way ahead

The need of the hour is the establishment of more pulmonary rehabilitation specific centres all over the country. In this digital age, it is easier to spread awareness about the benefits of these programmes in India. While there is already a certain degree of attention on it in the larger cities and speciality hospitals, smaller towns and medical facilities in the government and unorganised sectors must begin promoting these concepts. Healthcare start-ups and ‘at-home’ healthcare providers can make way for the change by spreading awareness about pulmonary rehabilitation programmes, their benefits and offer the same to patients.