Extra-pulmonary manifestations of COPD and the role of pulmonary rehabilitation: a symptom-centered approach

ABSTRACT

Introduction: Chronic obstructive pulmonary disease (COPD) is a complex and heterogenous disease that is associated with a range of respiratory and non-respiratory symptoms, which highly contribute to the daily burden of the disease. Symptoms burden remains high despite optimal bronchodilator therapy, but pulmonary rehabilitation (PR) is an effective intervention to improve patients’ symptoms. A comprehensive interdisciplinary approach within the framework of a PR program is warranted to tackle these complex symptoms and their consequences.

Areas covered: This narrative review describes how symptoms of dyspnea, fatigue, cough, sputum, anxiety, depression, pain, sleep disturbances, and cognitive decline arise in COPD and can contribute to several non-pulmonary manifestations of the disease. It also describes evidence of the effectiveness of interdisciplinary PR programs to counteract these symptoms. A literature search was performed on PubMed and Scopus between June and July 2020.

Expert opinion: Respiratory and non-respiratory symptoms are highly prevalent, often not comprehensively assessed, and result in several extra-pulmonary manifestations of the disease (physical, emotional and social). Interdisciplinary PR programs can improve these negative manifestations through different pathways, contributing for an effective symptoms’ management. A thorough assessment of symptoms (beyond dyspnea) should be routinely performed and may support the identification of treatable traits, allowing the tailoring of PR interventions and assessment of their real-life impact.

KEYWORDS:

• COPD
• dyspnea
• fatigue
• cough
• sputum
• anxiety
• depression
• pain
• sleep disturbances
• cognitive decline

Article Highlights

• More than 80% of patients with COPD suffer from symptoms burden on a daily basis

• Dyspnea, fatigue, cough, sputum, anxiety, depression, pain, sleep disturbances and cognitive decline are highly prevalent symptoms in patients with COPD

• Symptoms result in several non-pulmonary manifestations and play a crucial role on reduced health status and impaired quality of life

• A thorough symptoms assessment (beyond dyspnea) should be routinely performed

• Comprehensive symptoms assessment allows identification of treatable traits, tailoring of interventions, and assessment of their real-life impact

• An effective symptoms’ management demands comprehensive, tailored and interdisciplinary PR programs involving the integration of several therapies (e.g., exercise training, education, self-management, behavior change, respiratory physiotherapy, smoking cessation, relaxation, nutritional support, inspiratory muscle training)

• To deliver an optimal interdisciplinary PR program, an interdisciplinary team must be available

Declaration of interest

The authors declare that this paper was not funded or sponsored by any agency. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was funded by Programa Operacional de Competitividade e Internacionalização – POCI, through Fundo Europeu de Desenvolvimento Regional - FEDER (POCI-01-0145-FEDER-007628), Fundação para a Ciência e Tecnologia (SFRH/BD/147200/2019) and under the project UIDB/04501/2020.