The role of pulmonary rehabilitation for patients undergoing lung volume reduction surgery

Lung volume reduction surgery (LVRS) has been shown to be one of the only beneficial treatments for advanced emphysema. It is unfortunately only appropriate for a selected group of patients. The criteria for appropriate candidates were determined after completion of the National Emphysema Treatment Trial (NETT) in 2003. The cooperation of a comprehensive team of professionals is required to assure success with the surgery in this complex group of patients. With the full cooperation of all the team members, careful selection and preparation of patients can be achieved. An essential part of the selection and preparation of patients for LVRS is a complete program of pulmonary rehabilitation. Pulmonary rehabilitation prior to lung reduction surgery includes educational and psychosocial elements in addition to strengthening and conditioning exercises. Additionally, conditioning exercise is essential to prepare the patient physically for surgery as it allows for the appropriate assessment of exercise capacity prior to selection for surgery. An aggressive perioperative and postoperative exercise program is required to allow for successful mobilization after surgery and better recuperation. This is a comprehensive review which presents all the essential elements of an effective preoperative, perioperative, and postoperative pulmonary rehabilitation program for patients with severe emphysema who are being evaluated for and receive LVRS.