Respiratory Medicine (1996) 90, 39.5400 Topical Review Evaluation in pulmonary rehabilitation N. AMBROSINO* AND E. CLINI Salvatore Maugeri Foundation IRCCS, Pulmonary Division, Medical Center of Gussago, Italy Until fairly recently, rehabilitation programmes could be considered a component of pneumology, possibly even of a secondary importance. Now, with the development of specific evaluation techniques and long-term care programmes, pulmonary rehabili- tation can be applied to patients throughout the course of the disease; from the earliest symptoms to the management of impairment secondary to end- stage respiratory insufficiency. Although comprehen- sive programmes of treatment include pulmonary rehabilitation, reports of the benefits are mostly from uncontrolled and unsupervised studies (1). Proper evaluation of candidates to these programmes is essential to success. In order to optimize the pro- gramme, the pulmonary rehabilitation team needs not only an evaluation of somatic and physiological issues, but also needs to account for, quantify and monitor variables that are important determinants of a patient’s quality of life (QOL). One approach to full account is the so-called functional approach which relates to impairment (the physiological deficit), dis- ability (total effect of impairment on the patient’s life) and handicap (the social disadvantages) as part of the comprehensive programme of care. The functional approach is not only useful for monitoring the patient’s functional status, but it enables the rehabili- tation team to set and achieve goals to improve the health-related quality of the patient’s life (2). Medical and Physiological Evaluation Objectives of the medical evaluation for respira- tory rehabilitation include confirming the diagnosis, characterizing the severity of main symptoms, and identifying the impact of the diseases on the patient’s life-style (3). The first step is an interview on the patient’s medical history and psychosocial problems *Author to whom correspondence should be addressed at: Fondazi- one Salvatore Maugeri, Centro Medico di Riabilitazione, Via Pinidolo 23, 25064 Gussago, (BS), Italy. 0954-611 l/96/070395+06 $12.0010 and needs (4). The patient’s medical history should underline the severity of the patient’s lung disease and identify other problems that might preclude participation in the programme, such as neurological deficits and lack of compliance to a proposed pro- gramme. Tests of rehabilitation effects must recog- nize the nature of affective factors and must be adjusted to suit individual patient capabilities (5). Laboratory data should include pulmonary func- tion, exercise tests, arterial blood gases, chest radio- graph, electrocardiogram and chemistries. Additional diagnostic testing can be planned as needed. Respiratory function tests help to characterize and quantify impairment resulting from the patient’s lung disease. Dynamic and static lung volume measure- ments are the most useful and can be supplemented with other tests such as diffusing capacity, airway resistance, respiratory muscle (RM) strength and endurance. Pulmonary function tests have some limitations. The degree of airflow obstruction as estimated by FEV, and exercise capacity do not correlate well in chronic obstructive pulmonary dis- ease (COPD) patients (6,7). Several factors such as pulmonary vascular disease, diffusion disorder and degeneralized muscle weakness may interfere, adding complexity to this relationship. Malnutrition, de- training and treatment with corticosteroids may contribute to muscle weakness (8-10). Furthermore, it has been reported that baseline lung function cannot predict benefit of pulmonary rehabilitation programmes (11). Assessment of RMfunction is mandatory in pre- scribing and evaluating the results of a pulmonary rehabilitation programme in conditions such as COPD, interstitial lung disease and neuromuscular disease. The simplest approach is to measure inspira- tory and expiratory pressure at the mouth when the subject performs maximal efforts against a closed airway (MIP and MEP, respectively), according to the technique described by Black and Hyatt (12). To obtain reproducible values, the subject needs to 0 1996 W. B. Saunders Company Ltd