Head Physician Enrico Maria Clini,
Specialist in Respiratory Diseases and Pharmacology

Respiratory Rehabilitation is a treatment based on a multidisciplinary approach, consisting of an integrated combination of medical and nursing care, pharmacological therapy, psycho-nutritional support, behavioural intervention and education programmes. It is designed to help patients suffering from chronic respiratory diseases (particularly Chronic Obstructive Pulmonary Disease - COPD) to control symptoms and improve their activities day after day. Patients thus work in close contact not only with physicians but also with physiotherapists, psychologists and dieticians.

Hospital Care
Treatment can be delivered through:
•    Day Hospital care (for patients whose conditions do not require clinical observation and full-time care)
•    Ordinary Hospitalization (for patients suffering from the most severe functional impairments)

Waiting time
For Day Hospital admission    based on bed availability
For Ordinary Hospitalization  based on bed availability, up to a maximum of 15 days

Booking can be made either by phone (0536 42039) or in person at the Hospital Admission office

Diseases and Conditions Treated
Respiratory Rehabilitation is designed for patients who may be suffering from the following diseases and syndromes:
■ Chronic Obstructive Bronchitis COPD                                    ■ Respiratory Failure
■ Bronchiectasis                                                                    ■ Pulmonary Fibrosis
■ Bronchial Asthma                                                               ■ Sleep Apnoea
■ Pulmonary Emphysema                                                      ■ Thoracic cage diseases (kyphoscoliosis, etc.)
■ Neuromuscular Diseases with respiratory

consequences (ALS, muscular dystrophy)                               ■ Workplace diseases (silicosis, asbestosis)
■ After-effects of thoracic-upper abdominal surgery


Main Goals
The main goals of Respiratory Rehabilitation are to help patients improve their quality of life by restoring, even just partially, their functional independence. Respiratory Rehabilitation enhances the patient’s knowledge of the problems associated with the illness itself and of the best methods of treatment; it contributes to controlling its progression with a view to reducing ongoing and costly recourse to healthcare measures (excessive or insufficient medication, hospitalization and so on) and encourages healthy behaviour such as smoking cessation, eating a balanced diet and taking regular exercise (although the disease itself makes this challenging). All this helps to boost the patient’s chances of living longer and enjoying a better quality of life.

Individual Rehabilitation Plan
The Individual Rehabilitation Plan (IRP), developed by the pulmonologist in collaboration with the other professionals in the team (nurse, psychologist, rehabilitation therapist, nutritionist-dietician), combines the various components in a mutually enhancing way. It is patient-centred and, as such, is unique to each patient.

The IRP:

  • provides a comprehensive overview of the patient’s functional status and residual capacities, using, wherever possible, scales validated and/or recognized by scientific communities
  • defines the interventions that can help achieve the set goals, focussing on the various ascertained problems
  • involves regular assessment of the results achieved and verification of expected goals, is shared with the patient and, if possible, with the family

The main areas of IRP intervention are:

  • Comprehensive Diagnostic Evaluation and Interdisciplinary Assessment
  • Nursing Care
  • Chest Physiotherapy (de-obstruction of the airways, breathing exercises)
  • Exercises to train the lower and upper limbs and (in certain cases) the respiratory muscles
  • Psychosocial Support
  • Nutrition Support
  • Education and Behaviour Programmes designed to help patients to control their symptoms, use drug therapies correctly and learn more about their illness
  • Comprehensive Diagnostic Evaluation and Interdisciplinary Assessment

The comprehensive diagnostic evaluation, performed in the first days of hospitalization, analyses not only the clinical variables but also the psychological and social variables that may have influenced the development of the disease or condition. This patient approach is developed by the interdisciplinary team which assesses the patient, following and observing their work and therapeutic outcomes.
The pulmonologist in particular will deal with the patient’s clinical assessment, existing complications, therapies and the recovery of their state of health. Should he deem it necessary, he will prescribe further, non-routine, specialist visits and tests.

Nursing Care

The functions performed by nursing staff and care workers are essential in order to:
• put into effect the intervention plans developed for the patient and related monitoring actions (prevention of surgical infections, treatment/prevention of skin lesions, taking care of primary needs, improvement of breathing pattern, inhaled therapy management education, taking charge of concomitant needs-conditions and so on)
• comfort and support the patient in tackling minor and major everyday challenges

 Rehabilitation Therapy
Chest Physiotherapy:
• includes techniques for draining bronchial secretions, controlled breathing techniques, muscular stretching exercises and mobilization of the shoulder joints.
Training of the lower limbs:
• exercises involving primarily the lower part of the body (such as free walking, pedalling on the stationary bike, going up/down steps) contribute to strengthening the leg muscles in order to boost muscle tone and flexibility. These exercises are crucial in helping the patient to move more easily, more frequently and for longer periods of time.
Training of the upper limbs:
• exercising the upper part of the body boosts the strength and resistance of the arm and shoulder muscles; these provide support to the thoracic cage and can help counteract any breathing difficulties. These exercises can also be helpful in movements requiring use of the arms in everyday life such as carrying things, cooking, doing household chores and in personal hygiene.
 Training of breathing muscles:
• weak breathing muscles can contribute to serious respiratory problems and often make it difficult for patients to carry out the exercise programme; training breathing muscles can improve symptoms and hence the ability to tackle the efforts required in daily life.

Psychosocial Support
In addition to training and exercising, Respiratory Rehabilitation programmes typically include support to the patient in learning how to cope with the most common forms of emotional stress, which are very frequent in COPD. Many of these patients in fact develop depression, anxiety, an increased sense of loneliness, difficult relationships with family and friends and lowered self-esteem. Psychological support can be delivered through stress-management programmes, relaxation techniques, group meetings and one-to-one interviews aimed at formulating and adopting strategies for controlling risk factors, including smoking habits, and bringing about changes in lifestyle.

Nutrition Support
This is an additional action designed to foster the wellbeing of the patient suffering from chronic respiratory conditions. These patients can in fact show both abnormal weight-gain and, as often happens in advanced stages of COPD, signs of hypo-nutrition and protein deficiency. A tailored diet formulated through an interview with the dietician is specifically designed to help with such problems.

Education and Behaviour Programme
The education programme provides information through the distribution of booklets, practical demonstrations and group lessons on: chronic lung disease; use, beneficial effects and side effects of prescribed medication; recognizing problems associated with acute exacerbations; and how travelling and journeys can be tackled even by those with advanced respiratory problems.

Hospital Discharge and Continuum of Therapy and Care
On completion of the rehabilitation plan, the team assesses the effectiveness of the interventions carried out and verifies whether planned goals have been attained, sharing the information with the patient. Together they agree on the patient’s return home or on the need for a hospital discharge under a continuing care scheme. The pulmonologist fills out the hospital discharge letter, setting down the outcomes of the tests and examinations performed, the recommended drug therapy, any examinations to be carried out at home and the indications for an appropriate lifestyle that the patient will be required to follow.