Scope, introduction and background

The aim of pulmonary rehabilitation is to reduce disability and handicap in people with lung disease and to improve their quality of life while diminishing the health care burden. The fundamental principles of rehabilitation (box 1) are widely accepted and practised unquestioningly in other medical disciplines, yet a recent survey has shown that provision of pulmonary rehabilitation services in the UK for one of the most common causes of disability is very poor.1In other countries, particularly North America, pulmonary rehabilitation has always had a more prominent role in the care of patients with chronic lung disease.2 ,3 The historical reasons for the poor showing in the UK are complex, but may include medical indifference to non-pharmacological management, lack of scientific evidence, poor funding, and ineffective consumer demand. Clinical guidelines also appear to be lagging behind the strength of evidence in respect of rehabilitation.4

Opinions, however, are now beginning to change as the benefits are becoming clear to both clinicians and their patients. The scientific evidence is also beginning to grow as investigative tools appropriate to respiratory medicine and compatible with the original World Health Organisation outcomes of impairment, disability, and handicap have been developed.5 There …