# Effects of a pulmonary rehabilitation program in a patient with very severe chronic obstructive pulmonary disease at a primary care center: A case report

## TL;DR

A 12-week pulmonary rehabilitation program significantly improved physical and psychological health in a man with very severe COPD who refused a lung transplant.

## Contribution

Demonstrates the effectiveness of a structured pulmonary rehabilitation program including CBT for very severe COPD patients.

## Key findings

- The patient's dyspnea and health status impact scores improved significantly after 12 weeks of pulmonary rehabilitation.
- Exercise capacity increased by 150 meters in the 6-minute walk test, and muscle strength normalized.
- Psychological well-being improved, with a reduction in anxiety and depression scores.

## Abstract

Severe chronic obstructive pulmonary disease (COPD) is characterized by dyspnea, frequent exacerbations, and diminished quality of life. For patients awaiting lung transplantation, managing symptoms and optimizing physical and psychological health are critical. Pulmonary rehabilitation (PR) is a comprehensive, evidence-based intervention designed to improve these outcomes through exercise training, education, and psychological support.

This case report describes a 53-year-old man with very severe COPD (GOLD group E) who was referred to PR after he refused to undergo a lung transplant operation. At baseline, he presented with functional limitation (mMRC = 4, CAT = 35, 6MWD = 200 m), severe muscle weakness (3/5), and a high hospital anxiety and depression score (HADS = 20). A 12-week individualized PR program was implemented, consisting of weekly supervised high-intensity interval endurance and resistance training, inspiratory muscle training, and educational sessions including cognitive behavioral therapy (CBT), alongside a prescribed home exercise program.

After completion of the 12-week program, the patient showed substantial improvements across all measured parameters. His dyspnea significantly decreased (mMRC = 2), and his health status impact score markedly decreased (CAT = 8). His exercise capacity significantly improved, with a 6-min walk distance increase of 150 m (to 350 m) without supplemental oxygen. His muscle strength normalized to 5/5 in all limbs, and his psychological well-being showed remarkable recovery, with a HADS score improvments to 10, thus indicating amelioration of severe symptoms.

This case illustrates that a structured PR program including CBT can provide physical and psychological benefits for patients with very severe COPD before lung transplantation. PR is an essential intervention to optimize patient status, improve quality of life, and potentially prepare individuals for future surgical interventions.