Advancing sustainable pulmonary rehabilitation in Latin America

Abstract

Demographic changes, combined with exposure to environmental factors, have led to a global increase in the prevalence, morbidity, and mortality of chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, and lung cancer. In COPD, reports indicate that the prevalence in the general population over 35 years of age is 8.9%, with higher rates among male smokers. Regarding asthma, more than half of the countries report a prevalence of 15% or higher, highlighting social inequality as a highly relevant factor. For interstitial lung diseases, 320,014 deaths were recorded between 1990 and 2019, with higher mortality observed among older adults and in the Andean region. This progressive increase in the prevalence of chronic diseases has created the need for a new paradigm of care for these patients, along with profound changes in healthcare systems. In 2002, the World Health Organization (WHO) developed the document Innovative Care for Chronic Conditions: Building Blocks for Action, aimed at providing guidelines for the adoption of policies to mitigate the threat that chronic diseases pose to the general population, healthcare systems, and economies. This document was based on the concept of integrated care, defined as “the coordinated action of health systems to provide, deliver, manage, and organize services related to diagnosis, treatment, care, rehabilitation, and health promotion.” The systemic and emotional effects of chronic respiratory diseases lead to progressive inactivity, exacerbating exercise intolerance and limitations in daily activities. This creates a vicious cycle of physical restriction, feelings of disability, and social disadvantage. Pulmonary rehabilitation-through exercise, education, and behavior change-interrupts this cycle by improving symptoms, functional capacity, and quality of life, with strong evidence of effectiveness in the most prevalent respiratory conditions. However, in resource-limited regions, access to pulmonary rehabilitation as recommended in clinical guidelines is often unattainable. This editorial explores how sustainable pulmonary rehabilitation can serve as a viable alternative in these contexts.