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COVID-19 has proven a difficult illness to characterize. The vast majority of people who get it experience a mild or moderate version of the disease, with symptoms ranging from the more common to clinical signs of pneumonia. But 15% of people develop a grave form of COVID-19 with severe pneumonia requiring oxygen therapy, and the remaining 5% experience complications including respiratory failure, acute respiratory distress syndrome, and even organ failure, according to studies compiled and reviewed over the past two years. 

For the 20% of infected individuals for whom COVID causes a wide and complex range of chronic respiratory issues, pulmonary rehabilitation is an important therapeutic strategy. It involves exercises, training, education, and empowerment that help improve and control what is perhaps the most basic act of human life: breathing. 

A recurring image from the worst days of the pandemic showed patients hospitalized with COVID-19, hooked up to respirators to preserve their pulmonary function and help them stay alive as their bodies fought the virus. 

As the novel coronavirus spread around the world, doctors quickly observed that the respiratory component was central to the illness, both in the evolution of COVID-19 when a person first contracted the virus and in the months after for some individuals who suffered from long-term effects — among them several respiratory conditions. 

For this reason, the use of pulmonary rehabilitation (PR) therapy as an intervention for severe or complex cases of COVID-19 has been studied practically since the beginning of the pandemic. In fact, studies recommend incorporating PR as part of treatment for COVID-19 patients as soon as they are admitted into intensive care, in order to reduce lung-related complications and improve outcomes. 

Studies done in China,  echo these recommendations. These studies compiled lessons learned from the clinical and rehabilitation strategies used on the very first COVID-19 patients in Wuhan. 

What Is Pulmonary Rehabilitation?

Pulmonary rehabilitation is a program designed to help people who suffer from chronic respiratory problems so that breathing difficulties do not prevent them from completing daily tasks or enjoying a good quality of life. 

Pulmonary rehabilitation programs do not replace medical or pharmacological treatment; instead, they are meant to be used together. They are typically recommended for people who live with chronic obstructive pulmonary disease (COPD), especially emphysema or chronic bronchitis; pulmonary fibrosis; cystic fibrosis; asthma; and in cases of lung cancer or lung transplant. Going into the third year of the pandemic, millions of people have joined the list of patients who can benefit from this therapy. 

Essentially, pulmonary rehabilitation involves educating or training the lungs. This also requires teaching the entire body — including the mind — new ways of doing things. These include improving muscular resistance and strength so that breathing doesn’t tire you out; learning about the condition, in order to manage situations and environments that trigger flare-ups; and practicing breathing exercises and techniques to avoid fatigue. 

Prior to starting a pulmonary rehabilitation program, patients are usually asked to complete a stress test to measure oxygen levels, blood pressure, and heart rate while exercising; a pulmonary function test to show how well the lungs are working; and a “6-minute walk test” to measure a person’s aerobic capacity in that time period.  

Pulmonary rehabilitation programs can last weeks or months. After the program is completed, a medical provider will perform new tests to determine whether lung function has improved. Some patients may need long-term PR programs or they may have to incorporate these strategies as part of their larger lifelong health plan, particularly those who live with chronic respiratory conditions.  

Lung Health and Overall Health

Pulmonary rehabilitation can also include psychological support and nutritional counseling. Now more than ever, successful rehabilitation programs must adopt a holistic approach and respect an age-old mantra: mens sana in corpore sano (“a healthy mind in a healthy body.”) 

People who suffer from lung and breathing conditions can experience a vast range of emotions that affect their daily lives, from anxiety to depression. Medical studies have shown depression to be relatively common among these patients, given the limitations caused by respiratory conditions.  

Therapy can help patients and their families navigate the difficulties brought on by chronic illness, as well as improve stress levels through strategies like relaxation exercises and meditation. There are even some applications designed to help individuals complete pulmonary rehabilitation activities. (But their use must always be supervised by a specialist, such as a doctor, nurse, or therapist, to ensure that they are carried out correctly.) 

While the digestive and respiratory systems may appear totally separate in their functions, they work together in various ways. Respiratory activity ensures the functioning of the digestive tract, and vice versa. Additionally, these systems work jointly to furnish the body’s cells with energy.  

Poor nutrition is common among individuals living with chronic pulmonary illnesses. Shortness of breath and fatigue can make it difficult to eat a balanced diet. The amount and type of foods consumed as well as the frequency of meals can also have an impact on breathing. A dietitian or nutritional counselor can offer advice on how to select and prepare adequate meals.  

A holistic or integrative health strategy for pulmonary rehabilitation involves different medical specialists, visits to the hospital or a clinic, and a series of exercises that can be performed at home. 

Among public health professionals, the impact of COVID-19 on the respiratory and lung health of millions of people has rekindled a concept that is far from new: Pulmonary rehabilitation and the health centers where it is performed must adopt an interdisciplinary approach. In most PR programs, doctors, nurses, physical therapists, and nutritionists must work together to design and oversee strategies that work for each individual patient.  

Remember, always consult with your physician to determine the best options for your body and health and to answer any questions you may have regarding any medical matter.