Pulmonary rehabilitation and telemedicine

Chronic patients require the services of a network of actors who cooperate in coordinating the wide spectrum of health care activities that come under the umbrella of "continuing care" which are delivered throughout the long course of disease management. The increasing health care costs due to the growth of chronic disabling illnesses, the new normative and organizational care contexts and the need for health cost rationatization have recently prompted interest in applying technological benefits to the home environment, in particular the model of telemedicine. Studies utilizing this new clinical approach have been carried out in asthmatic, chronic obstructive pulmonary disease and obstructive steep apnoea syndrome patients on long term oxygen therapy or home mechanical ventilation with the major end points being to test program feasibility, reduce relapses and subsequent hospitalizations and reduce care costs. Studies have specifically tested feasibility and outcomes (effort tolerance, dyspnea) of well structured home physiotherapy programs aiming to cut the dangerous vicious cycle between dyspnea and daily life activity limitation. In conclusion telemedicine seems the ideal. instrument to obtain an integrated mode of continuing care with the educational reinforcement typically necessary in a rehabilitative program. Physiotherapy and training programs can find a valid support from telemedicine. Future studies will be able to demonstrate if this modality may represent a cost effective approach compared to the usual mode of rehabilitation.