**8.3 Education**

### *8.3.1 Disease education*

To provide a holistic care, every pulmonary rehabilitation program should incorporate patient education. It has been well proven that COPD patients who are well aware about the nature of their disease, its management and long-term implications are able to cope with both the disease and treatment better [101]. Education about the disease empowers the COPD patients to better recognize their symptoms, make lifestyle changes and get involved in the management of the disease. This leads to increased motivation to participate in pulmonary rehabilitation and adhere to the exercise regimen.

At the beginning of the rehabilitation program, individual educational needs of each patient are identified. This is continuously reassessed while the patients are undergoing the rehabilitation program. Instead of a didactic teaching, a patient centered and self-management teaching approach focusing on lifelong behavioral changes are adopted these days [45]. Specifically for COPD patients, a collaborative self-management plan which helps them in an identification of symptoms of onset of an exacerbation, make treatment modification and to communicate early with a healthcare provider, is highly beneficial in the long run [102]. Patient education runs alongside the exercise training. It is meant to supplement the knowledge gaps and instill confidence in the principles of ongoing training. Various topics regarding disease and its management are covered with utilization of the expertise of various specialists.

**11**

*Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease*

Exacerbation of COPD is an additional burden on patient's already weakened functional capacity. It leads to hospitalization, further inactivity, deterioration of lung capacity and mortality. It may also disrupt any advances the patient may have made in improving their exercise capacity and muscle strength [45, 46]. There is an emerging data suggesting that there is benefit in instituting and/or continuing with pulmonary rehabilitation during hospital admission or within a month of hospital discharge. An early initiation of pulmonary rehabilitation reduces risk of re-hospitalization and improves overall symptoms without any adverse effects [103].

A pulmonary rehabilitation program incorporating occupational therapy is important in COPD patients [104, 105]. Occupational therapy assists COPD patients with development of specific strategies to perform ADLs with least expenditure of energy [106]. With conservation of energy expenditure, there is an improvement in subjective perception of breathlessness, increased efficiency in performing daily basic activities, elevated sense of control and better social engagement [104–107]. Occupational therapy skills even though simple in principle, require a learning process, which is achieved through a multidisciplinary rehabilitation program. There is an ever-increasing evidence that improvement in occupation performance of COPD patients lead to a holistic improvement in their health [108]. Occupational therapist can also instruct COPD patient to use wheeled walking aids, which can result in increased functional autonomy, ventilatory capacity and waling efficiency [109–112]. Since this therapy has a major impact on social networking of COPD

Body composition in COPD patients may change as the disease severity progresses. While obesity predominates in the milder stages of the disease, patients with advanced disease and emphysema tend to be underweight and have generalized muscle wasting [114, 115]. Factors other than the lung disease itself, which can lead to this shift, includes inactivity, systemic inflammation, osteoporosis and glucocorticoids use. Studies have shown an increase in mortality in COPD patients who are underweight, independent of their disease severity [116, 117]. These patients with decreased fat free mass have higher limitation to exercise tolerance and thereby reported a decreased HRQoL status in comparison to COPD patients with normal weight [118–121]. Various studies have shown a survival benefit with weight gain as low as 2 kg or by increase in one body mass index unit [116, 117]. This is why nutritional education are particularly essential in rehabilitation of COPD patients.

Every pulmonary rehabilitation program should include nutritional screening with measurement of BMI at the least. A more comprehensive program may also include fat free mass estimate using skinfold anthropometry or bioimpedance analysis. Estimation of osteoporosis can be done using dual energy X-ray absorptiometry (DEXA) scanning. Improvement of nutritional status requires a multi-pronged approach with utilization of both physiologic and pharmacological interventions. Endurance and strength training as described previously in this chapter can improve muscle mass as well as bone strength. Nutritional interventions include adding nutritional supplementation to patient's diet with emphasis on adequate protein intake to maintain or restore lean body mass. Patients who are unable to eat large meals due to dyspnea can switch to frequent small meals. It has been shown that a 6-month intervention involving dietary counseling, nutritional supplementation and positive reinforcement led to a significant weight gain in advanced COPD patients [60].

patients, it serves well to involve patient's family and friends [113].

*DOI: http://dx.doi.org/10.5772/intechopen.81742*

*8.3.2 Occupational therapy*

*8.3.3 Nutritional education*

### *Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease DOI: http://dx.doi.org/10.5772/intechopen.81742*

Exacerbation of COPD is an additional burden on patient's already weakened functional capacity. It leads to hospitalization, further inactivity, deterioration of lung capacity and mortality. It may also disrupt any advances the patient may have made in improving their exercise capacity and muscle strength [45, 46]. There is an emerging data suggesting that there is benefit in instituting and/or continuing with pulmonary rehabilitation during hospital admission or within a month of hospital discharge. An early initiation of pulmonary rehabilitation reduces risk of re-hospitalization and improves overall symptoms without any adverse effects [103].
