Response to pulmonary rehabilitation: toward personalised programmes?

Clinical practice should be based on the best scientific evidence, which does not always correspond to evidence-based medicine, involving guidelines, meta-analyses and protocols as a basis for clinical approach [1, 2]. There is no need of further randomised controlled trials (RCTs) for evidence that pulmonary rehabilitation (PR) improves daily symptoms, exercise performance and health status in patients with chronic obstructive pulmonary disease (COPD), independently of disease stage and complexity [3]. Although the direct demonstration of a clear benefit in survival is lacking (as is also true for most therapies used in COPD), PR is well recognised as a fundamental part of the integrated care of these patients and it has been incorporated in most guidelines for their management [4].