Pulmonary rehabilitation: a learning health care model?

COPD is a chronic respiratory disease with a high personal, economic and social impact. A small proportion of patients with COPD experience multiple problems and are eligible for pulmonary rehabilitation. Although simple exercise programs are also considered pulmonary rehabilitation, this dissertation described pulmonary rehabilitation as a comprehensive and integrated intervention that starts with a thorough assessment of pulmonary, extra-pulmonary problems and disease burden. The emphasis was on identifying clusters based on collected data to guide tailored treatment and predict outcomes. Neither clustering based on lung function measurements nor clustering based on lung function measurements expanded with physical, social and emotional functioning led to identifiable clinical pathways. The conclusion is that for this patient group, the right treatment starts with a thorough assessment. A new taxonomy is needed that meets the heterogeneity of this patient group with a chronic condition and multiple problems.