La notoriedad de la salud respiratoria y de los profesionales sanitarios que la cuidan / Raising awareness of respiratory health and specialists in respiratory diseases

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[Translated article] Raising awareness of respiratory health and specialists in respiratory diseases / La notoriedad de la salud respiratoria y de los profesionales sanitarios que la cuidan

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Actitudes y percepciones frente a la técnica de punción arterial para gasometría: diferencias entre enfermeras de los servicios de urgencias y de neumología / Attitudes and Perceptions Surrounding Arterial Puncture for Blood Gas Testing: Differences Between Nurses in the Emergency Department and the Pulmonology Department

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American Association for Respiratory Care

Founded in 1947, the AARC is a not-for-profit professional association with more than 52,000 members worldwide. Our primary membership consists of respiratory therapists, allied health practitioners who are trained at the 2- and 4-year college level to assist physicians in the care of patients with lung disorders and other conditions. Respiratory therapists can be found in all areas of health care, including hospitals, home care, nursing homes, and physicians’ offices — in short, anywhere patients are being treated for lung diseases.

Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results.

OBJECTIVE: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. METHODS: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. RESULTS: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). CONCLUSION: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results / Acompanhamento farmacoterapêutico em unidade de terapia intensiva respiratória: descrição e análise de resultados

ABSTRACT Objective: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. Methods: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. Results: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). Conclusion: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

RESUMO Objetivo: Descrever e avaliar o acompanhamento farmacoterapêutico do farmacêutico clínico em uma unidade de terapia intensiva. Métodos: Trata-se de um estudo descritivo, com desenho transversal, realizado no período de agosto a outubro de 2016. Os dados foram coletados por meio de um formulário de registro, com acompanhamento farmacoterapêutico realizado pelo farmacêutico clínico na unidade de terapia intensiva respiratória de um hospital terciário. Os problemas registrados nas prescrições foram quantificados e classificados, sendo avaliados quanto à gravidade; as recomendações realizadas pelo farmacêutico clínico foram analisadas em relação ao impacto na farmacoterapia. Os medicamentos envolvidos nos problemas foram categorizados utilizando o Anatomical Therapeutic Chemical Classification System. Resultados: Foram acompanhados 46 pacientes, tendo sido registrados 192 problemas relacionados à farmacoterapia. Os problemas prevalentes foram informação ausente na prescrição (33,16%) e com gravidade menor (37,5%). Das recomendações realizadas para a otimização da farmacoterapia, 92,7% foram aceitas, sendo prevalentes aquelas referentes a inclusão do tempo de infusão (16,67%) e a adequação da dose (13,02%), com maior impacto na toxicidade (53,6%). Os anti-infecciosos gerais para uso sistêmico constituíram classe de medicamentos mais frequente nos problemas relacionados à farmacoterapia (53%). Conclusão: O acompanhamento farmacoterapêutico realizado pelo farmacêutico em uma unidade de terapia intensiva respiratória mostrou-se capaz de detectar problemas na farmacoterapia dos pacientes e realizar recomendações clinicamente relevantes.

Respiratory Therapist-Managed Arterial Catheter Insertion and Maintenance Program: Experience in a Non-Teaching Community Hospital.

BACKGROUND: Usual practice in community health-care settings indicates that arterial catheters are inserted by physicians. In the context of a respiratory therapist (RT)-managed arterial catheter placement protocol being implemented in our community hospital, the current study describes the implementation and outcomes of this RT-managed arterial catheter insertion and maintenance program. METHODS: Tuality Healthcare is a 215-bed community health-care system (10-bed ICU) in Hillsboro, Oregon. With the goal of enhancing the quality of ICU care, an RT-managed multidisciplinary team was implemented to lead the delivery of protocolized ventilator liberation, arterial catheter insertion, and arterial blood gas utilization. Preparation for the program included didactic teaching, simulation-based training, and precepted procedural experience. A database was created for audit and quality improvement purposes. Outcomes and arterial blood gas utilization data were obtained from the audit database and from the hospital electronic health record. RESULTS: During the 4-y period (March 1, 2012, to April 31, 2016), 256 arterial catheter insertion attempts were made by a team of 12 qualified RTs. The success rate for the initial placement attempt by RT was high (94.5% [242 of 256]). Sixty-three percent of arterial lines were placed in patients to help manage severe sepsis/septic shock. No ischemic or infectious complications were reported during the study period. Nearly 40% (96 of 242) of the successful placements by RTs on initial attempts were performed during the night shift, when intensivists were not physically present in the ICU. CONCLUSIONS: This experience establishes the feasibility of an RT-managed arterial catheter placement program in a community ICU. The RT-managed program was characterized by a high degree of success and safety and allowed arterial catheter placement at times when intensivists were not available in the ICU. This experience extends the sparse reported experience of RT-managed arterial catheter placement programs and underscores the value of RTs as members of the ICU team.

Impact of distance from surgery department on the outcome of patients followed for non-small-cell lung cancer in the respiratory department of nonacademic hospitals: Results of the KBP-2010-study.

OBJECTIVE: Increased postoperative mortality in low volume centers has contributed to merge and space thoracic surgical centers. Some studies have showed that the likelihood of receiving surgery was lower in lung cancer patients living far from a thoracic surgery center. Our objective was thus to determine whether surgery and survival rates in patients with non-small-cell lung cancer (NSCLC) were influenced by the distance between the respiratory and thoracic surgery departments. METHODS: KBP-2010-CPHG is a prospective multicenter epidemiological study including 6083 patients followed in 104 nonacademic hospitals for primary NSCLC diagnosed in 2010. Distance between respiratory and thoracic surgery departments were obtained retrospectively. Predictive factors for surgery and mortality were identified by logistic regression and Cox hazard model. RESULTS: Twenty-three percent of hospitals had a thoracic surgery department; otherwise, mean distance between the hospital and the surgery center was 65km. Nineteen percent of patients underwent surgery. Distance was neither an independent factor for surgery (odds-ratios [95% CI]: 0.971 [0.74-1.274], 0.883 [0.662-1.178], and 1.015 [0.783-1.317] for 1-34, 35-79, and ≥80km vs. 0km) nor for mortality (hazard-ratios [95% CI]: 1.020 [0.935-1.111], 1.003 [0.915-1.099], and 1.006 [0.927-1.091]) (P>0.05). DISCUSSION: This result supports the French national strategy which merges surgery departments and should reassure patients (and physicians) who could be afraid to be lately addressed to surgery or loose chance when being followed far from the thoracic surgical center.

Effect of social deprivation on the admission rate and outcomes of adult respiratory emergency admissions.

BACKGROUND: Patients with respiratory disorders constitute a major source of activity for Acute Medicine. We have examined the impact of Socio-Economic Status (SES) and weather factors on the outcomes (30-day in-hospital mortality) of emergency hospitalisations with a respiratory presentation. METHODS: All emergency respiratory admissions to St. James Hospital, Dublin, from 2002 to 2014 were evaluated. Patients were categorized by quintile of Deprivation Index, and evaluated against hospital admission rate (/1000 population) and 30-day in-hospital mortality. Univariate and multivariable risk estimates (Odds Ratios (OR) or Incidence Rate Ratios (IRR)) were calculated, using logistic or zero truncated Poisson regression as appropriate. RESULTS: There were 32,538 episodes in 14,093 patients, representing 39.5% of medical emergency episodes over the 13-yr period. Deprivation Quintile independently predicted the admission rate, with incidence rate ratios (IRR) of Q3 2.02 (95% CI: 1.27, 3.23), Q4 2.55 (95% CI: 1.35, 4.83) and Q5 5.68 (95% CI: 3.56, 9.06). The 30-day in-hospital mortality for the highest quintile was increased (p < 0.01), Q5 1.31 (95% CI: 1.07, 1.61). Particulate matter (PM10) was predictive for the top two quintiles (>17.2 and 23.8 µg/m3 respectively) with an OR for a worse outcome of Q4 1.22 (95% CI: 1.07, 1.40) and Q5 1.24 (95% CI: 1.08, 1.42). Weather (season) and the daily temperature did not affect the admission rate but were significantly associated with worse outcome. CONCLUSION: Socio-Economic Status influences the admission rate incidence and hospital mortality of respiratory emergency admissions; local environmental conditions (air pollution and temperature) appear only relevant to the mortality outcomes.

Improving Decannulation and Swallowing Function: A Comprehensive, Multidisciplinary Approach to Post-Tracheostomy Care.

BACKGROUND: Multidisciplinary tracheostomy teams have been successful in improving operative outcomes; however, limited data exist on their effect on postoperative care. We aimed to determine the effectiveness of a multidisciplinary tracheostomy service alone and following implementation of a post-tracheostomy care bundle on rates of decannulation and tolerance of oral diet before discharge. METHODS: Prospective data on all subjects requiring tracheostomy by any trauma/critical care surgeon were collected from January 2011 to December 2013 following development of a tracheostomy service and continued following implementation of the post-tracheostomy care bundle. Rates of decannulation and tolerance of oral diet were compared between all groups: pre-tracheostomy service (baseline, historical control), tracheostomy service alone, and tracheostomy service with post-tracheostomy care bundle. RESULTS: Three hundred ninety-three subjects met the criteria for analysis with 61 in the baseline group, 124 following initiation of a tracheostomy service, and 208 after the addition of the post-tracheostomy care bundle. There were significant overall differences between all groups in the proportion of subjects decannulated, proportion of subjects tolerating oral diet, and number of subjects receiving speech evaluations. Pairwise comparisons showed no differences in decannulation or tolerance of oral diet following implementation of the tracheostomy service alone but significant improvement with the addition of the post-tracheostomy care bundle compared with baseline. (P = .002 and P = .005, respectively). Likewise, the number of speech language pathologist consults significantly increased compared with baseline only after the post-tracheostomy care bundle (P = .004). Time to speech evaluation significantly decreased with the post-tracheostomy care bundle compared with baseline and tracheostomy service (P < .013). CONCLUSIONS: The addition of a post-tracheostomy care bundle to a multidisciplinary tracheostomy service significantly improved rates of decannulation and tolerance of oral diet.

Delay in the Provision of Medication by a Pharmacy Outside the Respiratory Outpatient Department.

Respiratory medicine physicians prescribe many different kinds of medications depending on patient's condition. To examine an outside pharmacy's ability to meet the demand of our respiratory prescription services, we developed a questionnaire for all the patients who came to our outpatient department from November 1, 2015 to January 31, 2016. A total of 298 of 330 patients answered the questionnaire. Overall, 169 patients mainly went to the pharmacy near our hospital, whereas 64 patients mainly went to another pharmacy. Specifically, 23 of 219 patients who answered the question "When you went to the pharmacy with prescription, have you ever been not immediately given medication?", were not immediately given medication by the pharmacy. The results show that the other pharmacy significantly delayed medication compared with the one near our hospital. Interestingly, there were many types of inhaler cases that were out of stock in both pharmacies. Also, we found that 9 of 11 patients who were not provided medication on the spot acquired the medication within 1 or 2 d. Further, 10 of 20 patients who were not provided medication on the spot were only able to obtain the medication once. We did not observe any changes in patients' physical condition due to the delay in medication.

Nursing and Respiratory Collaboration Prevents BiPAP-Related Pressure Ulcers.

In early 2012, an increase in the incidence of BiPAP-related pressure ulcers was noted in the progressive care unit of a large pediatric facility. An interdisciplinary team of nursing and respiratory staff and leadership formed a collaborative to address the gaps in practice, recommend, and implement evidence-based interventions using a quality improvement model. Interventions included piloting new masks, changing the skin barrier from a hydrocolloid dressing to a foam dressing and using a template for better fit, including skin assessments every 4 hours as part of nursing and respiratory therapists' workflow, and implementing a notification process that included Wound Ostomy Continence Nurses, respiratory, and nursing leadership for any redness of skin noted. Weekly rounding and communication by nursing and respiratory leadership ensured consistency and sustainability of practice. Aside from implementation of interventions, the primary focus was to develop a collaborative relationship between nursing and respiratory teams for shared ownership and accountability of patients on BiPAP support. Three months after the implementation of interventions, the occurrence of BiPAP-related pressure ulcers decreased from eleven in the first three quarters to one occurrence in the fourth quarter of fiscal year (FY) 2012. In 2013, the occurrence decreased to five for the entire fiscal year. Since the end of FY 2013, there has only been one occurrence of a BiPAP-related pressure ulcer in the progressive care unit. Close collaboration between respiratory and nursing has been the primary factor in decreasing BiPAP-related pressure ulcers. An important lesson learned is that interdisciplinary collaboration leads to improved patient outcomes.

Calidad del diagnóstico de neumonía en el servicio de enfermedades respiratorias / Quality of the diagnosis of pneumonia in the service of respiratory diseases

Introducción: las infecciones respiratorias agudas se mantienen como un grupo importante de afecciones con alta morbilidad y mortalidad infantil y dentro de ellas las neumonías, la pandemia olvidada.Objetivo: verificar el diagnóstico de los niños ingresados por neumonías en el servicio de enfermedades respiratorias del Hospital General Docente Aleida Fernández Chardiet, del municipio de Güines.Métodos: se realizó un estudio descriptivo prospectivo de corte transversal de los pacientes ingresados con diagnóstico de neumonías en el servicio de enfermedades respiratorias del Hospital General Docente Aleida Fernández Chardiet, en el primer trimestre del 2013, tomando el universo de los pacientes ingresados con este diagnóstico 256.Resultados: el 72,8 por ceinto de los niños fueron del sexo masculino y el 48,1 por ciento menor de 1 año, el 61,7 por ciento, con radiografía de tórax normal al ingreso, el 45,6 por ciento sin signos clínicos, el 45,6 por ciento tratado con penicilina y en el 60,6 por ciento de los pacientes se retiro antibiótico y el 93,5 por ciento de ellos evolucionaron satisfactoriamente.Conclusiones: la neumonía predominó en el menor de un año, del sexo masculino, más de la mitad con radiografía de tórax Rx T normal al ingreso, el tratamiento de elección fue la penicilina, con evolución satisfactoria (AU)

Introduction: acute respiratory infections remain as an important group of diseases with high morbidity and child mortality and pneumonias are among them, the forgotten pandemic.Objective: to verify the diagnosis of children with pneumonias admitted to the service of respiratory diseases of Aleida Fernández Chardiet General Teaching Hospital of Güines municipality.Methods: a prospective, cross-sectional, descriptive study of patients admitted with a diagnosis of pneumonia in the service of respiratory diseases of Aleida Fernández Chardiet General Teaching Hospital was conducted in the first quarter of 2013 by taking the universe of patients admitted with this diagnosis 256.Results: 72,8 por ciento of children were male and 48,1 por ciento younger than 1 year, 61,7 por ciento with normal thorax radiography on admission, 45,6 por ciento without clinical signs, 45,6 por ciento penicillin treated and 60,6 por ciento of patients were withdrawn antibiotic and 93,5 por ciento of them had successful outcomes.Conclusions: pneumonia predominated in children younger than one year, male, over half with normal thorax radiography Rx T on admission, the chosen treatment was penicillin, with satisfactory outcome (AU)

Mortality and readmissions in patients with acute exacerbation of chronic obstructive pulmonary disease treated at a specialised pulmonary ward and general wards.

INTRODUCTION: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the most common cause of admission to medical wards. In Denmark, patients are often referred to general medical wards, e.g. departments of internal medicine (IM), and only a minority are admitted to highly specialised units such as departments of pulmonary diseases (DPD). MATERIAL AND METHODS: This retrospective study investigated the risk of readmission 12 months after primary admission in 136 patients admitted to either IM or DPD due to AECOPD. Furthermore, mortality 18 months after primary admission was investigated. A subanalysis was made for patients receiving non-invasive ventilation and for patients with telehealthcare. Data were obtained from patients' case records. RESULTS: There was no difference in readmission in patients' primary admission at DPD versus IM. The median number of readmissions for patients participating in telehealthcare was four compared with two in patients who did not (p = 0.026). In-hospital mortality during primary admission was significantly higher at DPD than at IM (relative risk (RR) = 3.54; p = 0.047). Telehealthcare participation was associated with a trend towards a lower mortality. Mortality was significantly higher in patients receiving non-invasive ventilation than in patients at DPD who did not receive non-invasive ventilation at their primary admission (RR = 5.02; p = 0.011). CONCLUSION: There was no difference in the risk of readmission in patients admitted to DPD and IM, respectively. Patients assigned to telehealthcare did not have a higher readmission rate, but those who were readmitted were readmitted more times (p = 0.026). FUNDING: not relevant. TRIAL REGISTRATION: This trial was registered with the Danish Data Protection Agency (J. no. 2008-58-0028).

Nuevos modos de ventilación asistida / New modes of assisted mechanical ventilation

Los mayores avances en ventilación mecánica de los últimos años se han producido en el desarrollo de nuevos modos de ventilación asistida. En comparación con los modos tradicionales como la ventilación controlada-asistida o la presión de soporte, ofrecen una serie de ventajas fisiológicas así como un mayor control sobre el ventilador por parte del paciente. Basados en la utilización de algoritmos de control de asa cerrada que incorporan información de la mecánica, la actividad de la musculatura respiratoria y del estímulo respiratorio, estos modos están diseñados específicamente para mejorar la sincronía paciente-ventilador y reducir el trabajo respiratorio. Dependiendo de las características de funcionamiento específicas de cada modo, estos pueden ayudar en los esfuerzos respiratorios espontáneos del paciente de forma sincronizada en tiempo y magnitud, adaptarse a sus demandas, realizar protocolos automatizados de reducción del soporte y devolver al patrón respiratorio una variabilidad más fisiológica. El clínico tiene ahora a su disposición modos que permiten individualizar y optimizar la asistencia ventilatoria mecánica en la compleja transición de la ventilación controlada a la ventilación espontánea-asistida. La creciente evidencia de las ventajas fisiológicas y clínicas de estos nuevos modos así como las nuevas posibilidades de monitorización que ofrecen, están llevando a su paulatina introducción en la práctica diaria. Futuros estudios permitirán aumentar nuestro conocimiento acerca de estos modos y deberán determinar si sus beneficios se traducen en mejores resultados clínicos

Recent major advances in mechanical ventilation have resulted in new exciting modes of assisted ventilation. Compared to traditional ventilation modes such as assisted-controlled ventilation or pressure support ventilation, these new modes offer a number of physiological advantages derived from the improved patient control over the ventilator. By implementing advanced closed-loop control systems and using information on lung mechanics, respiratory muscle function and respiratory drive, these modes are specifically designed to improve patient-ventilator synchrony and reduce the work of breathing. Depending on their specific operational characteristics, these modes can assist spontaneous breathing efforts synchronically in time and magnitude, adapt to changing patient demands, implement automated weaning protocols, and introduce a more physiological variability in the breathing pattern. Clinicians have now the possibility to individualize and optimize ventilatory assistance during the complex transition from fully controlled to spontaneous assisted ventilation. The growing evidence of the physiological and clinical benefits of these new modes is favoring their progressive introduction into clinical practice. Future clinical trials should improve our understanding of these modes and help determine whether the claimed benefits result in better outcomes

Ventilación mecánica no invasiva en pacientes de edad avanzada: ¿hacia una nueva estrategia de organización hospitalaria? / Non-Invasive Mechanical Ventilation in Elderly Patients: Moving Towards a New Strategy for Hospital Organization?

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Percepção dos familiares de pacientes internados em Unidade de Terapia Intensiva em relação à atuação da Fisioterapia e à identificação de suas necessidades / Perception of relatives of patients admitted in Intensive Care Units with regard to the practice of Physical Therapy and identification of their needs

Trata-se de um estudo descritivo e de abordagem qualitativa, que teve como objetivo verificar o conhecimento dos familiares de pacientes internados na Unidade de Terapia Intensiva do Hospital de Clínicas da Universidade Estadual de Campinas com relação à atuação da Fisioterapia intensiva neste serviço, bem como identificar suas necessidades. Foram entrevistados 60 familiares, sendo estes questionados a respeito do serviço de Fisioterapia e submetidos ao Inventário de Necessidades e Estressores de Familiares em Terapia Intensiva. Foi observado que a maioria deles desconhecia a atuação da Fisioterapia em tal Unidade, porém os que conheciam atribuíram nota máxima ao serviço. Em relação às necessidades dos familiares, notou-se que 56,7% julgaram necessário saber fatos concretos a respeito do progresso de seu familiar; 60% gostariam de ter a certeza que seu familiar está recebendo o melhor tratamento e 71,7% gostariam de ter dias e horários de visitas mais flexíveis. Constatou-se a falta de informações dos entrevistados em relação à atuação da Fisioterapia na Unidade de Terapia Intensiva. Foram identificadas as necessidades dos familiares, sendo possível, com isto, executar ações de melhoria. Por meio do presente estudo, a Unidade de Terapia Intensiva do Hospital de Clínicas da Universidade Estadual de Campinas identificou as principais necessidades dos familiares, adequou o espaço físico, implementou salas de acolhimento familiar e o curso de especialização em Fisioterapia Respiratória em Unidade de Terapia Intensiva Adulto, e criou informativos visuais quanto à sua atuação para melhores acolhimento e compreensão dos familiares.

This is a descriptive study, with a qualitative approach, that aimed at verifying the knowledge of relatives of patients hospitalized at the Intensive Care Unit of Hospital de Clínicas at Campinas State University about the performance of the intensive physical therapy, as well as at identifying their needs. We interviewed 60 relatives, questioning them about the Physical Therapy service. The Critical Family Need Inventory was also applied. We observed that most relatives were unaware of the physical therapy team performance at the Intensive Care Unit; however, those who knew about it attributed the highest score to the service. Regarding the relatives' needs, we observed that 56.7% judged necessary to know the facts about the patients' progress; 60% would like to be sure that the patient is receiving the best treatment, and 71.7% would like more flexibility in days and time of visits. It was possible to observe lack of information regarding the action of physical therapy at the Intensive Care Unit and to identify the relatives' needs, allowing improvement actions. The Intensive Care Unit of Hospital de Clínicas at Campinas State University has adapted the physical space and implemented rooms for family reception, with the help of family support and humanization groups. Along with these actions, it was implemented a specialization course in Respiratory Physical Therapy at the Adults Intensive Care Unit and visual aids regarding its importance and actions to a better reception and understanding of the family were distributed.

Standards for quality care in respiratory rehabilitation in patients with chronic pulmonary disease. Quality Healthcare Committee. Spanish Society of Pneumology and Thoracic Surgery (SEPAR).

Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection.