60th RESPIRATORY CARE Journal Conference


Pulmonary Rehabilitation: Current Evidence and Future Directions

June 22–23, 2023

Vinoy Renaissance Resort (Plaza C–D Ballroom)
St Petersburg, Florida

Neil R MacIntyre MD FAARC
Surya P Bhatt MD MSPH
Conference Co-chairs

Presented under the auspices of the

Attendance limited to faculty, representatives from supporting organizations, and staff.


Pulmonary rehabilitation (PR) describes processes using exercise, education, and psycho-social support to improve functional status, reduce costs of care and improve quality of life in patients with chronic lung diseases. PR can be provided using a variety of approaches ranging from formal facility based programs to innovative platforms providing services in the home. Positive outcomes from PR have been reported in multiple studies and the evidence base supporting the benefits of PR and the utility of various techniques is growing rapidly. Challenges include establishing the best delivery models, improving access to the many patients who can benefit, and assuring reimbursement is adequate for programs to operate. This conference is designed to bring together 12 PR experts from diverse backgrounds to review the evidence base and to offer insights into how PR can both improve its cost-effectiveness and expand its access.

Presentation Rules

  • Each presenter will have 30 minutes for a concise presentation. No additional time will be allotted. At the conclusion of each presentation, there will be a 15-minute open discussion.
  • Each presentation MUST focus on the key issues and include thoughts for the future with respect to the assigned topic. The goal of each presentation is to review the pertinent available data but, as importantly, to discuss the topic in terms of new and upcoming strategies.
  • Remember that the on-site audience is composed of only the conference faculty, and, thus, there is no need to review basic material. All conference presenters are deemed experts in the field. However, the manuscript should be written for the readers of Respiratory Care.
  • One of the key goals of the presentation is to stimulate discussion. Controversial topics and perspectives are encouraged.
  • Because of the importance of the discussions, it is important that all faculty attend all presentations.

Instructions for Manuscripts

  • Unlike the presentation, the manuscript should be a comprehensive review of the assigned topic. Each manuscript should include a pertinent review of the available literature, the topics presented at the conference, and thoughts for the future care of adult patients with respect to the assigned topic.
  • Manuscripts should include a liberal use of figures and tables to illustrate key points and support the text.
  • It is vital to the success of the conference for the controversial nature of issues to be emphasized for the readers.

The discussion associated with each presentation will be audiotaped, transcribed, and published with their respective manuscripts. You will be able to edit your comments prior to publication.

Publication Timeline

June 22–23, 2023Conference held in St. Petersburg, FL
Aug. 22Discussion transcripts sent to speakers for editing
Aug. 31Edited discussion transcripts returned
Sept. 2Submit manuscript (sooner is desirable)
Nov. 18Peer review complete
Dec. 31Submission of revised manuscript
Feb. 1, 2022All manuscripts accepted
March 1Manuscripts to production
April 15All proof reviewed and revised
June 2024Manuscripts and discussions published in the June 2024 issue of Respiratory Care

Thursday, June 22

8:00 a.m.–8:15 a.m.

Dean Hess

Overview, Introductions, Ground Rules

Neil MacIntyre and Surya Bhatt


8:15 a.m.–8:45 a.m.
Pulmonary Rehabilitation: History and Definitions

Neil MacIntyre

History of pulmonary rehabilitation and evolution of the rehabilitation concept for chronic lung disease over the past 60 years. What is the target population? What are the key components? What are the overarching goals?

8:45 a.m.–9:00 a.m.
Discussion of Dr. MacIntyre’s presentation.

Why Does Pulmonary Rehabilitation Work?

9:00 a.m.–9:30 a.m.
Pulmonary Rehabilitation: Mechanisms of Functional Loss and Benefits of Exercise

Linda Nici

What is the impact of impaired gas exchange on function? What are the effects of systemic inflammation due to chronic lung disease? What are the effects of skeletal muscle abnormalities (sarcomere injury) from systemic inflammation, hypoxemia, malnutrition, lung disease comorbidities (e.g., cardiac, metabolic, OSA)? What is the role of exercise in managing functional loss in CLD? Aerobic training? strength training? respiratory muscle focus? How much is needed?

9:30 a.m.–9:45 a.m.
Discussion of Dr. Nici’s presentation.
9:45 a.m.–10:00 a.m.
10:00 a.m.–10:30 a.m.
Respiratory Assist Devices in Pulmonary Rehabilitation

Gerard Criner

What are the benefits of oxygen supplementation for exercise related hypoxemia (short- and long-term effects)? Is oxygen also helpful in the non-hypoxemic chronic lung disease patient? Are portable positive pressure assist devices (NIV and others) effective during exercise? Do they work? Are they beneficial? Does NIV at night in hypercapneic patients or those with OSA facilitate pulmonary rehabilitation exercise programs? Are inspiratory muscle training and PEP devices useful during pulmonary rehabilitation?

10:30 a.m.–10:45 a.m.
Discussion of Dr. Criner’s presentation.
10:45 a.m.–11:15 a.m.
Psychosocial Support in Pulmonary Rehabilitation

Abebaw Yohannes

How do anxiety and depression, which are common features in patients with chronic lung disease, impact functional status, quality of life, health care costs and outcomes? How best to assess anxiety and depression in patients with chronic lung disease? How aggressive should pharmacotherapy be to facilitate pulmonary rehabilitation? What are features of pulmonary rehabilitation that can mitigate anxiety and depression?

11:15 a.m.–11:30 a.m.
Discussion of Dr. Yohannes’ presentation.
11:30 a.m.–2:00 p.m.
Recess (On your own)
2:00 p.m.–2:30 p.m.
Self-management of Chronic Lung Disease

Roberto Benzo

Proper chronic lung disease management is complex — drugs, devices, O2, exercise plans, airway care, etc., can be overwhelming to patients. Are exacerbation action plans effective? Education is key and can be based in PR programs. However, reliable support structures (e.g., home visits, hot lines, ongoing education programs) are also needed. Can PR programs be the infrastructure to support these activities? The technology enabling home monitoring (spirometers, oximeters, respiratory pattern monitors, hemodynamic monitors, activity monitors, etc.) is growing rapidly. Which monitors provide real benefit? How might maintenance and/or telemedicine PR programs interact with these?

2:30 p.m.–2:45 p.m.
Discussion of Dr. Benzo’s presentation.

Patient Focused Clinical Benefits of Pulmonary Rehabilitation

2:45 p.m.–3:15 p.m.
The Evidence for Pulmonary Rehabilitation in COPD

Christopher Mosher

Beyond exercise capacity improvement — PR has effects on quality of life, health care utilization, mortality. What is the evidence for these benefits? What is the cost effectiveness of PR in COPD

3:15 p.m.–3:30 p.m.
Discussion of Dr. Mosher’s presentation.
3:30 p.m.–3:45 p.m.
3:45 p.m.–4:15 p.m.
Pulmonary Rehabilitation in non-COPD Chronic Lung Diseases

Rachael Evans

Chronic lung disease is more than COPD and includes ILD, post COVID, PAH, transplant, and others. Like COPD, these chronic conditions can impact functional status, quality of life, health care utilization, mortality, and costs. Can pulmonary rehabilitation provide benefits like those seen in COPD to those with non-COPD CLD?

4:15 p.m.–4:30 p.m.
Discussion of Dr. Evans’ presentation.

Access and Maintenance

4:30 p.m.–5:00 p.m.
Barriers to Pulmonary Rehabilitation

Carolyn Rochester

How many patients with chronic lung disease utilize PR? What are the medical, societal, and geographic barriers? How does financial/insurance coverage serve as a barrier? What might be the health care costs benefits to increased access?

5:00 p.m.–5:15 p.m.
Discussion of Dr. Rochester’s presentation.
5:15 p.m.
6:00 p.m.–7:00 p.m.

In the Mezzanine. Families and friends are welcome.

Friday, June 23

8:00 a.m.–8:30 a.m.
Maintenance Rehabilitation

Marilyn Moy

PR is more than a specific interventional program—it is a lifetime commitment. What are the challenges of maintaining benefits or either facility or home-based programs? What are the challenges to translating rehabilitation to improvements in physical activity?

8:30 a.m.–8:45 a.m.
Discussion of Dr. Moy’s presentation.

Models of Pulmonary Rehabilitation Delivery — A Pro/Con

8:45 a.m.–9:15 a.m.
Center-based Pulmonary Rehabilitation is the standard: Pro

Richard Casaburi

What is the evidence for center-based pulmonary rehabilitation?

9:15 a.m.–9:45 a.m.
Center-based Pulmonary Rehabilitation is the gold standard: Con

Surya Bhatt

What is the Evidence for home and tele-pulmonary rehabilitation?

9:45 a.m.–10:00 a.m.
10:00 a.m.–10:15 a.m.
Casaburi rebuttal
10:15 a.m.–10:30 a.m.
Bhatt rebuttal
10:30 a.m.–10:45 a.m.
Pro/con discussion
10:45 a.m.–11:15 a.m.
Pulmonary Rehabilitation: Reimbursement Challenges

Chris Garvey

What are the models for reimbursement? What drives payer decisions? Lifetime limits on coverage? Coverage for Non-COPD pulmonary rehabilitation? What about coverage for maintenance rehabilitation?

11:15 a.m.–11:30 a.m.
Discussion of Ms. Garvey’s presentation.
11:30 a.m.


Roberto Benzo MD
Mayo Clinic
Rochester, MN
[email protected]

Surya P Bhatt MD MSPH
University of Alabama at Birmingham
Birmingham, AL
[email protected]

Richard Casaburi PhD MD
Los Angeles, CA
[email protected]

Gerard J Criner MD
Temple University Hospital
Philadelphia PA
[email protected]

Rachael Evans MBChB MRCP(UK) PhD
University of Leicester, UK
[email protected]

San Francisco CA
[email protected]

Neil R MacIntyre MD FAARC
Duke University Medical Center
Durham, NC
[email protected]

Christopher Mosher MD
Duke University Medical Center
Durham, NC
[email protected]

Marilyn Moy, MD, MSc
Medical Director, Pulmonary Rehabilitation Program
VA Boston Healthcare System
Associate Director, VA Boston REPPAIR REAP
Associate Professor of Medicine, Harvard Medical School
[email protected]

Linda Nici MD
Providence Veterans Affairs Medical Center
Providence, RI
[email protected]

Carolyn L. Rochester, MD
Yale School of Medicine
New Haven, CT
[email protected]

Abebaw Yohannes
Azusa Pacific University
Azusa, CA
[email protected]

Journal and AARC Staff

Richard D Branson MSc RRT FAARC
Editor-In-Chief, Respiratory Care
[email protected]

Lynda T. Goodfellow EdD RRT FAARC
Director of Clinical Practice Guideline Development
[email protected]


Managing Editor, Respiratory Care
[email protected]

Daniel D. Garrett
Publisher, Respiratory Care
[email protected]