Care-Related intervention in Rehabilitative Pneumology: Pulmonary Rehabilitation in Chronic Obstructive Broncopneumopathies (COPD) can benefit from a multidisciplinary approach? [Cure correlate in Pneumologia Riabilitativa: La Riabilitazione Polmonare nelle Broncopneumopatie Croniche Ostruttive (BPCO) può trarre beneficio da un approccio multidisciplinare?]

Cardiovascular diseases, osteoporosis, depression/anxiety, musculoskeletal impairment and obstructive sleep apnea are frequent and important comorbidities in COPD, often under-diagnosed, and associated with poor health status and prognosis. Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health care in patients with chronic respiratory disease. By definition it is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behavior change and 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. Exercise limitation in patients with COPD is multifactorial and includes ventilatory limitation, gas transfer abnormalities, pulmonary vascular and cardiac dysfunction, limb muscle dysfunction, and comorbid impairments. Overall, pulmonary rehabilitation aims to improve cardiorespiratory and skeletal muscle function improving respiratory symptoms and quality of life in daily life activities adding a synergic support to the pharmacologic inhaled therapy. COPD has a variable natural history, but most of the time chronic respiratoryfailure complicates disease progression. Supplemental oxygen and noninvasive mechanical ventilation have been proven to improve survival and reduce hospital admissions in COPD patients. Furthermore additional studies have shown that exercise performance benefit from supplemental oxygen and NIV used both during rehabilitation exercise programs and over the night. In conclusion, an overarching approach to diagnosis, assessment of severity of COPD and its frequent comorbidities should guide to a multidisciplinary and synergic approach in terms of pharmacological and nonpharmacological management of a systemic inflammatory syndrome.