Chronic respiratory diseases (CRD) pose a significant burden to patients and healthcare system globally. Optimal treatment requires provision of both pharmacological and non-pharmacological therapies. While pharmacological treatments undoubtedly receive significant attention, non-pharmacological therapies are often being neglected. In fact, pulmonary rehabilitation (PR) is a crucial non-pharmacological intervention for not only chronic obstructive pulmonary disease (COPD), but also various CRD including asthma, bronchiectasis, interstitial lung diseases (ILD), and even pulmonary hypertension. To maximize its benefits, it should be "a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors" – the definition of PR provided by the American Thoracic Society/European Respiratory Society statement in 2013 that remains in use today.
The benefits of PR are well established. It improves patients' symptom, restore their functional capacities, and enhance their overall quality of life, thereby reducing morbidity, mortality, and healthcare utilization. Despite all the proven benefits, globally its utilization remains suboptimal due to low uptake and poor completion rates, which adversely affected PR outcomes. Common barriers include transportation issues, frequent hospital visits for PR, and high travel costs. With advancement in medical technology, incorporating telemedicine into conventional PR could be a potential solution as it enhances PR accessibility through overcoming these geographical barriers. This lecture would compare various tele-PR models and their clinical outcomes, emphasizing that supervised home-based tele-PR programs are preferable to unsupervised web-based approaches. The multi-disciplinary supervised home-based tele-PR program implemented at my center would be used as an example to illustrate how tele-PR could broaden the scope of conventional PR, making it more accessible and beneficial for a wider range of CRD patients.
