India has one of the highest burdens of chronic respiratory diseases (CRDs) in the world contributed by chronic obstructive pulmonary disease, asthma, interstitial lung disease, bronchiectasis, postpulmonary tuberculosis lung disease, cystic fibrosis and lung cancers. The COVID pandemic has now added a potential new set of patients with chronic respiratory morbidity. In contrast to the limited role that pharmacotherapy has to offer in the management of CRDs, pulmonary rehabilitation (PR) has a lot to offer. It offers immense benefits, such as improving quality of life, enhancing functional exercise capacity, reducing symptoms of anxiety and depression and preventing hospital admission. The WHO Rehabilitation 2030: a Call for Action has more recently emphasized the need for making PR acceptable and accessible. India is edging toward this positive paradigm shift. Innovative methods like incorporation of traditional practices like yoga and pranayama are being explored to improve acceptability. Accessibility is being further widened by harnessing technology like telerehabilitation and online videoconferencing platforms.
Yet, PR uptake remains very poor, not only in India but across the world. While issues with access, suitability, referral, uptake and attrition are well documented and are attributed to cost of travel, inadequate knowledge of PR, lack of perceived benefit and influence of referrer, psychological variables are indeed important issues that have not received much attention. Misconceptions, misrepresentations or negative connotations surrounding PR have been reported by people with CRDs. The word pulmonary is defined as relating to the lungs, which implies that PR would centre on this organ, when in fact the program promotes whole body aerobic fitness and aims to provide the means for effective self-management. Moreover, patients with CRDs most often have other system involvements, which are either directly or indirectly related to their respiratory disease. Furthermore, there is lack of clarity as to what the program involves and what this means for individuals. The term ‘rehabilitation’ translated in our national language means ‘punarvaas’, or ‘punargathan’, which largely relates to rehabilitation of people who have lost their homes or livelihood. It does not generally refer to health. The term ‘rehabilitation’ can also carry the unfortunate and unwarranted stigma held by drug or alcohol rehabilitative services. This can influence experiences of shame, particularly where smoking has been a contributory factor to the disease. The Life of Breath Study has recently reported several psychological issues related to the term PR and have recommended medical humanities approach to solve this issue.
It is now an opportune time to contemplate what should be the right communication for the word PR in India. We suggest the use of the acronym ‘PRABAL’ for ‘Pulmonary Rehabilitation for better Health Outcomes’ to bring out a more optimistic and motivational connotation to the word PR. PRABAL has its origins in Sanskrit, and it means ‘strong’. If a patient is referred for the PRABAL program, the perception would be of ‘strengthening’. Such a positive branding for PR would play a very important role for accepting PR in our country. We as healthcare providers rarely think about branding, let alone for health interventions. However, Shakespeare’s ‘What is in a name?’ is now obsolete. Today even the government emphasizes on branding, be it the ‘Make in India’ or the ‘Ujjwala Yojana’. It is time we make the Pulmonary Rehabilitation Program PRABAL in India.
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1. 2022 GOLD Reports:Global Strategy for Prevention, Diagnosis and Management of COPD:2022 Report Available from:https://goldcopd.org/2022-gold-reports-2/
Last accessed on 2022 Feb 24
2. Sanchez-Ramirez DC Impact of pulmonary rehabilitation services in patients with different lung diseases J Clin Med 2022 11 407 doi:10.3390/jcm11020407
3. Singh SJ, Halpin DMG, Salvi S, Kirenga BJ, Mortimer K Exercise, and pulmonary rehabilitation for people with chronic lung disease in LMICs:Challenges and opportunities Lancet Respir Med 2019 7 1002–4
4. Sahasrabudhe SD, Orme MW, Jones AV, Tillu G, Salvi SS, Singh SJ Potential for integrating yoga within pulmonary rehabilitation and recommendations of reporting framework BMJ Open Respir Res 2021 8 e000966
5. Bairapareddy KC, Chandrasekaran B, Agarwal U Telerehabilitation for chronic obstructive pulmonary disease patients:An underrecognized management in tertiary Care Indian J Palliat Care 2018 24 529–33
6. Oxley R, Harrison SL, Rose A, Macnaughton J The meaning of the name of 'pulmonary rehabilitation'and its influence on engagement with individuals with chronic lung disease Chron Respir Dis 2019 16 1479973119847659 doi:10.1177/1479973119847659