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To determine the frequency of common symptoms in long COVID and their effect on the quality of life, and to determine the factors contributing to a more severe long COVID.The study enrolled 266 patients who were either referred to long-COVID outpatient clinic or were inpatients undergoing rehabilitation. The data were collected between December 2020 and May 2021. We evaluated the symptoms experienced during acute and long COVID and comorbidities. Functional status was assessed with Post Covid Functional Status (PCFS).The final sample consisted of 261 patients. After acute COVID-19 period (4 weeks), almost 80% of patients had impaired functional status. Only 21.5% reported no functional impairment (0 on PCFS scale). A higher PCFS score was associated with female sex (P0.001) and oxygen therapy requirement during acute disease (P=0.001). However, it was not associated with having a pre-existing lung disease (P=0.749). Disease severity did not pose a risk for developing a more severe long COVID.Women were at greater risk for developing greater functional impairment in long COVID, although we have no explanation why. Malignant disease and hypertension also presented a risk factor for greater functional impairment. More studies are warranted to determine if patients with certain lung disease are more susceptible to long COVID.

Coronavirus-2 pandemic has changed the functioning of health systems worldwide. It is not yet fully known which symptoms of the disease are most commonly presented in patients referred for pulmonary rehabilitation. Our aim was to investigate the profile of patients referred for pulmonary rehabilitation; what symptoms they had during the acute phase of the disease and what symptoms were still present at the start of pulmonary rehabilitation.Study included ongoing symptomatic and post-COVID patients who attended standard, in person pulmonary rehabilitation program. Patients had COVID-19 disease at least four weeks before attending pulmonary rehabilitation. Patients completed questionnaires of self-reported somatic deficits during acute and post-COVID-19 stage as well as questionnaires regarding their psychological symptoms. Pulmonary function test, expiratory and inspiratory muscle strenght, hand grip strenght and six-minute walk test was performed prior and after pulmonary rehabilitation.Study included 63 patients (32 male, 31 female), with mean age of 52.9 years. During acute COVID-19, majority of patients complained of fatigue, cough, dyspnea, myalgia and headache. More than 85% of patients reported pulmonary deficits during ongoing symptomatic and post-COVID-19 stage. Emotional distress and anxiety levels were significantly elevated in acute stage, while depression, anger and the need for help was not significantly elevated. All reported symptoms were significantly reduced in post-COVID-19 stage. There was statistically significant difference in six-minute walk distance, inspiratory and expiratory muscle strenght and hand grip strenght between first and final testing.Results of our study are similar with previous studies, the most common symptoms during acute phase were fatigue, cough and dyspnea and fatigue and respiratory problems during ongoing symptomatic and post-COVID stage. Emotional distress diminishes signifiacantly in post-COVID stage. Further larger studies are needed to clarify which acute disease symptoms are predominant in patients referred to pulmonary rehabilitation and cause prolongued discomfort.

To determine the effect of lockdown measures on lung transplant patients during the COVID-19 pandemic.We collected data from Croatian lung transplant patients before and after the lockdown and analyzed changes in weight, BMI, lung function and blood lipid status.An average increase of 3.74 kg (+4.92%) body weight during the 4 month lockdown period was observed. Lung function values and blood lipid status remained stable.Such weight gain could have detrimental effects on the morbidity and mortality of lung transplant patients. Further follow up is needed to determine the long term impacts of this observation.

Background: Besides the burden of acute covid care, a fraction of patients report symptoms after the period of acute covid illness which affect quality of life and prolong recovery. Aim: To assess the profile of patients reporting to our post-covid clinic, their quality of life and frequency of persisting symptoms. Methods: Covid- 19 survivors, referred (at least a month after the acute illness) from December 2020 to January 2021 to our Centre’s post-covid clinic. Patients entered this study by filling out a questionnaire which also included current symptoms and standardised Post-Covid Functional Scale (PCFS) score. Results: 112 patients were included in the study. Males predominated (62.5% ; mean age 56) over females (37.5% ; mean age 48). In the acute phase, 72.3% were treated as outpatients, 27.6% at the ward and 7.1% in the ICU. Most common comorbidities were hypertension (21.4%), various chronic lung diseases (22.3%) and type 2 diabetes (5.4%). Corticosteroid therapy was given in 45.5% of patients, either in the acute phase, post-covid period, or both. The most frequent post- covid complaints were exhaustion (63.4%), shortness of breath (48.2%), muscle weakness (31.3%), dry cough (34.8%) and chest pain (25.0%). Of 110 patients with known PCFS value, 27 (24.5%) reported 0, while 34 (30.9%), 31 (28.2%), 17 (15.5%), and one (0.9%) patient reported scores of 1, 2, 3, and 4, respectively. Conclusion: Even though the majority of our patients were treated as outpatients in the acute phase and presumably had milder disease forms, three-quarters of them still experience impairment of life quality (PCFS >1) with pronounced respiratory symptoms months after the illness.

Here we retrospectively analyzed the post-COVID-19 register of University Hospital Zagreb, Clinic for Pulmonary Diseases Jordanovac in Croatia to compare COVID-19 incidence between smokers and nonsmokers. No significant differences among smokers and non-smokers were found regarding the severity of the disease. COVID-19 should be used as a chance to educate the public about adaptive, healthy stress-release methods and the necessity for smoking cessation, to prevent and preserve overall physical and psychical health.

Background: Smoking is one of the major preventable risk factor for respiratory diseases and a global public health problem. Public awareness and access to smoking cessation schools should be one of the principal goals in disease prevention and public health initiatives. Cognitive-behavioral treatment has proven to be efficient in smoking cessation. Aim: The aim of this paper is to present the results of a two year ongoing smoking cessation school. Methods: Smoking cessation program started in 2017 as a public health interdisciplinary initiative. It consists of 12 visits, organized in a group, over one month, free of charge and accessible to all adult smokers motivated to quit. Education, psychoeducation, cognitive-behavioural techniques (self-monitoring, cognitive restructuring, reframing, breathing and progressive muscle relaxation, relapse prevention, etc.) and group counseling are included. It also includes measurement of exhaled CO at the beggining and end of the programme, and spirometry to screen for early stages of respiratory obstruction. Attendants evaluate the program in a written form on their last visit. Results: In two years, nine cycles of smoking cessation schools were completed. The program completed 91 person and 39 (42,9%) sucsessfuly quit smoking. Follow up at six months after the end of program showed a success rate reduction of 3% in average. Futher follow up is needed. Conclusion: Interdisciplinary, cognitive-behavioraly based, publicly accessible smoking cessation school represent an efficient way of smoking cessation. Due to its remarkable results so far, it is considered to be adopted as a nation–wide prevention program, during national lung cancer screening program.

Background: Dyspnea is traditionally considered as a physically caused phenomenon. Recent research suggests that being breathless has two components (sensoric and affective) and that factors other than biological are contributing to its subjective intensity. Aim: To determine the predictive value of biological, psychological and social factors in dyspnea intensity among patients with chronic obstructive pulmonary disease (COPD). Methods: Study included 74 COPD patients with following variables measured: biological - age, gender, smoking status, body mass index, pulmonary functions tests and blood oxygen saturation; psychological- anxiety sensitivity, positive/negative affect, personality traits, locus of control and coping strategies; social - education, working and socioeconomic status, marital status and percieved social support. Using stepwise linear regression data was analysed, with above mentioned variables included as predictors and dyspnea intensity as a criterion. Results: This combination of biopsychosocial predictors explained 29% of dyspnea intensity in COPD patients. The biggest contribution to dyspnea intensity was shown by psychological factors (14%), followed by biological (10%) and social factors (5%). This combination of psychosocial factors explained more of dyspnea intensity (19%) than did biological (10%). Method: Dyspnea is a complex, multidimensional sensation, affected not only by biological, but psychosocial factors too. By identifying and understanding all factors that play a role in dyspnea, we can better understand a specific patient needs, offer treatments which include psychosocial interventions to better target the psychosocial component of breathlessness.

Objective: Weight loss and an underweight status are serious problems in chronic obstructive pulmonary disease (COPD), independent of the degree of airflow obstruction. Body mass index (BMI), does not reflect changes in body composition that may occur with aging or with the level of disease. BIA is a simple, inexpensive, quick and non-invasive technique for measuring body composition, due to ability to identify malnutrition. Aim: To analyze values of BIA- Phase angle (PA), Fat Free Mass (FFM), Visceral Mass (VM) and obstruction level (FEV1) and their importance in the prediction of exercise capacity measured by six-minute-walking test (6MWT). Method: We analyzed results from 68 stable COPD male (44) and female (24) patients, aged M= 55.9 who attended standard PRP five days weekly, during four weeks. Nutritional status during rehabilitation was evaluated by BIA. Data analysis was performed using linear regression with following predictor variables: patient’s age, BIA values (PA, FFM, VM), FEV1 and 6MWT as a criterion variable. Results: Our results showed that chosen predictors explain a significant 40% (p Conclusion: Age, FEV1 and PA are significant predictors of exercise capacity. Therefore, PA as a measure of body composition status is an important tool in PRP to detect early changes in body composition in COPD patients so they can start immediately with nutrition support and pulmonary rehabilitation which in combination produce the best results regarding patient’s functionality.

SUMMARY Pulmonary hypertension (PH) is a chronic disease which severely impairs quality of life (QoL). The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is the first disease-specific tool to assess patient-reported symptoms, functioning and QoL in PH patients. The aim of this study was to adapt and validate the CAMPHOR for use in Croatia. The adaptation process involved three stages: translation (bilingual and lay panel), cognitive debriefing interviews with patients and psychometric validation. For the latter stage, a postal survey was conducted with 50 patients to examine the reliability and validity of the adapted scale. All three scales of the Croatian CAMPHOR demonstrated excellent internal consistency (Symptoms = 0.93; Activity limitations = 0.94; QoL = 0.92) and test-retest reliability correlations (Symptoms = 0.90; Activity limitations = 0.95; QoL = 0.90). Predicted correlations with the SF-36 scales provided evidence for construct validity of the CAMPHOR scales. Evidence for known group validity was shown by the ability of the scales to distinguish between participants based on patient-perceived general health and disease severity. The Croatian version of the CAMPHOR is a valid and reliable tool for use in clinical routine and clinical research.

Background: Significantly lower quality of life in transplanted patients has been reported in the domains of physical functioning, pain and health. [1] Aims: Are there any statistically significant difference among patients after lung transplantation and the general population in: 1) intensity, nature and quality of the pain 2) degree of the pain which interferes with the performance of various activities. Method: A prospective trial was conducted from Apr to Aug 2017 on a sample of patients after lung transplantation(N=30) and individuals from the general population–control group(N=30), to determine presence of pain in patients after lung transplantation. Criteria for the selection of transplanted patients: monitored by our clinic, 18–65 years of life, criteria for the control group to suit a group of transplanted by: age, sex and education. We used the following measuring instruments: painDETECT, Brief Pain Inventory. Results: 1)There was a statistically significant difference in the nature of the pain between study and control group, but no significant difference in intensity and quality of pain. 2)Brief Pain Inventory equally has been perceived by study and control groups. Conclusion: Transplanted patients had presence of pain that was different in its nature, but degree of the pain which interferes with the performance of various activities does not show statistically significant differences between the study and control group. Perhaps it can be assumed due to the strict rules of the lifestyle after lung transplantation in these patients, but further research are needed.

Background: Asthma patients, due to their symptoms, often experience fear and anxiety when faced with daily activities. Such functional impairment over time causes lowered quality of life (QoL) and additional psychological distress expressed with depression, anxiety and stress symptoms. Objective: To evaluate the role of aerobic treadmill training among asthma patients attending pulmonary rehabilitation (PR) in their walking capacity (6 minute walking test - 6MWT), in improving QoL and reducing psychological distress. Method: We analyzed the results from 77 patients with persistent asthma divided in two groups. Patients in both groups had the same level of obstruction. They attended standard PR program five days weekly, during four weeks. In one group aerobic treadmill exercise training was added three times a week. Intensity was set at 60% of maximal work rate. Baseline and post PR status were evaluated by 6MWT in both groups, QoL, Depression (D), Anxiety (A) and Stress (S) symptoms. Results: All patients had a significant increase in 6MWT after PR (p

Dyspnea or breathlessness is a term primarily used in respiratory medicine. Nevertheless, in the last fifteen years, studies from other fields focus on the affective component of this complex phenomenon due to the frequent observation that psychological states can cause or be caused by dyspnea. Research so far shows that besides the biological component, dyspnea has a strong emotional and psychosocial determinant. This means that apart from its biological factors, dyspnea and its intensity are affected by emotions, personality, anxiety and depression, etc. Individuals with psychiatric disorders, in the same conditions, will evaluate their dyspnea as more intense and disturbing compared to individuals without psychiatric comorbidity. Emotional states in healthy individuals can amplify the sense of dyspnea which is of extreme importance for clinical practice in order to consider the whole person and not just the symptom which is being presented. Also, dyspnea seems to be frequent complaint in some groups of patients with psychiatric disorders (e.g.panic disorder), where the fear of suffocation is presented as clinical symptom. Further research of dyspnea as a complex, multicomponent phenomenon, can contribute to better treatment options and better differential diagnosis concerning possible psychiatric background of physical symptoms.

Background. Holistic scope in treating persons with chronic respiratory diseases is one of the main features of pulmonary rehabilitation program (PRP) at Zagreb University. Interventions are provided by a team made of physicians and other health care professionals - physiotherapists, respiratory therapists, nurses, psychologists, occupational therapists, social workers, behavioral specialists, among others. The program itself is tailored to attend to each person's specific needs through careful interdisciplinary examination and treatment planning, establishing commom ground to address disease severity, respiratory symptoms, comorbidities, psychological manifestations and specific limitations a person has in everyday activities. The focus of PRP is the whole person rather than just a person's disease.Aim. To show the impact of PRP's person-centered approach on patient's quality of life (QoL), anxiety, depression and stress levels.Method. Questionnaires designed to measure quality of life (single question scale), anxiety, depression and stress (DASS21) were administred to 54 patients at the beginning and at the end of a three-week pulmonary rehabilitation program. Each patient underwent an individualized program of education, respiratory exercises, nutrition consultation, and psychosocial/behavioral support and intervention.Results. Results showed significant improvement in all measured parameters – higher overall QoL (p

Background: Is there a statistically significant difference in quality of life between the patients after lung transplantation and the general population. Aim: To compare quality of life in patients after lung transplantation and individuals of general population. Method: A prospective trial was conducted at the Clinic for lung diseases on a sample of patients after lung transplantation (N=30) and individuals from the general population – control group (N=30), in order to determine quality of life of patients after lung transplantation. These are the results from April to July 2016. Criteria for the selection of transplanted patients: monitored by our clinic and 18 – 65 years of life, while the criteria for the control group to suit a group of transplanted by: age, sex and education. For the study were used the following measuring instruments: SF36 Questionnaire, Personal Wellbeing Index (PWI) and Questionnaire on demographic and socioeconomic characteristics of the respondents. Results: 1) There was no significant difference between the study and control groups. Personal level of wellbeing equally has been perceived by transplanted and control groups. 2) Component Score SF-36: Significantly lower quality of life in transplanted patients has been reported in the domains of physical functioning, pain and health. Conclusion: The quality of life of transplanted patients and subjects from the general population does not show statistically significant differences. Comparing the quality of life of these two groups came to the conclusion that respondents from the general population state better results only in the domain of physical health.

Introduction: Anxiety sensitivity (AS) is a stable personality trait characterized by fear of bodily symptoms that accompany anxiety. It is considered to be important in many chronic illnesses, especially respiratory, since the fear from the symptoms acts as an „symptom amplifier“. As such, it can worsen clinical manifestations of chronic illnesses. Aim: To compare asthma, lung cancer patients and healthy subjects in their sensitivity to anxiety symptoms. Method: Study included 121 subjects (N(A)asthma=52, N (Ca)Cancer=17, N(H)Healthy=52). To measure anxiety sensitivity we used a validated questionnaire Anxiety Sensitivity Index (ASI) consisting of 16 items evaluating fear of bodily and psychological symptoms and social threats. Patients completed ASI during outpatient check-ups. Healthy subjects were recruited through on-line survey. Group differences were analysed using ANOVA. Results: Results show significant difference between groups (F=7.513, p 0.05). Conclusions: Despite much more difficult course of lung cancer illness in comparison to asthma, fear of bodily symptoms and sensations seem to be similar in both illnesses. This finding poses a question of the importance of diseases onset and duration (adjustment period), person9s coping mechanisms and personality traits as manageable contributing factors in respiratory disease management.

Introduction: Difficulties resulting from chronic pulmonary diseases carry a great psychological burden that is expected to be greater with greater difficulties. Pulmonary rehabilitation (PR) has proven its positive effects in this field. Aim: To show if higher levels of physiological difficulties in asthma and chronic obstructive pulmonary disease (COPD), mean a bigger psychological burden. To compare asthma and COPD patients in the size of that burden pre and post PR. Methods: Study included 102 asthma and COPD patients who completed PR in 20 visits. Physiological difficulties were measured with spirometry (FVC, FEV1, FEV1/FVC) and 6-minute walking distance (6MWD). Depression(D), anxiety(A) and stress(S) were measured with DASS21. Quality of life (QoL) was obtained by single item estimation. We compared pre- and post PR data for all patients and in regards to physiological and psychological variables. Results: All patients, regardless of disease and physiological/psychological difficulties had improved after PR in all outcomes (p(FVC, FEV1, FEV1/FVC, 6MWD, QoL, D, A, S)< .01). As expected, COPD patients had significantly larger physiological difficulties pre PR (p

Introduction: An increasing number of patients with asthma and chronic obstructive pulmonary disease (COPD) and coexisting obesity are being referred to pulmonary rehabilitation (PR). Aim: To compare one of PR's outcomes – exercise capacity measured by 6-minute walking distance (6MWD) among asthma and COPD patients in regards to body mass index (BMI). Methods: Study included 107 COPD and 80 asthma patients divided to: “non-obese” (normal and overweight, BMI

Introduction: Capnogram is the curve obtained by continuous recording of the carbon dioxide mass mol in a sample of expiratory air(PECO2). Several studies have demonstrated significant correlation between indices describing the shape of the capnogram and the usual spirometric parameters. Aim: Aim of the study was to investigate whether capnogram can differentiate between patients with and without airway obstruction. Method: In 50 subjects spirometry was measured and according to FEV1/FVC ratio they got assigned either to the group with (FEV1/FVC 70%). Capnographic measurements were made in both groups using ultrasonic measurement principle (Ganshorn Spiro Scout spirometer)that simultaneously measures airflow, temperature and gas density,providing data on volume and gas exchange from a single measurement using only quiet tidal breathing. Data on exhaled CO2 slope characteristics were expressed as α angle (°). Results: Results show significant negative correlations between α angle and FEV1 (r= -0.760;p

Introduction: Efficacy of pulmonary rehabilitation program (PRP) in reducing psychological distress has been previously demonstrated. Nevertheless, possible separate and different impact of anxiety and depression on pulmonary rehabilitation outcomes remains unclear. Aim: The aim was to investigate whether anxiety (ANX) and depression (DEP) have different affects on PRP outcomes - six-minute walking test (6MWT), fatigue (F) and dyspnea (DYS). Method: Study included 50 subjects with chronic obstructive respiratory disease. Before PRP they were divided to 4 groups according to DASS21 questionnaire score: normal anxiety level, normal depression level, moderate /severe anxiety level, moderate/severe depression level. All subjects were measured in 6-minute walking test, dyspnea and fatigue (Borg scale) prior to and after three week standard PRP. We observed the difference in measured variables (6MWT,DYS, F) at baseline and after PRP for all subjects and in regards to group division. Results: All measured outcomes have significantly improved after PRP. Elevated ANX at baseline was significantly related to higher dyspnea (p

Astma i kronična opstruktivna plućna bolest (KOPB) predstavljaju bolesti s učestalim psihološkim komorbiditetima. Visoka prevalencija anksioznosti i depresije u bolesnika je poznata, a također i pozitivan utjecaj koji program plućne rehabilitacije ima na psihičku dobrobit ovih bolesnika. Cilj: Ispitati utjecaj programa plućne rehabilitacije na psihološke varijable – anksioznost, depresivnost i kvalitetu života u grupi bolesnika s astmom i KOPB uzevši u obzir stupanj težine njihove bolesti. Metoda: Kod 44 bolesnika (22 s astmom i 22 s KOPB) izmjerena je razina anksioznosti, depresivnosti i kvalitete života na početku i na kraju trotjednog programa plućne rehabilitacije. Stupanj težine bolesti izražen je kroz vrijednost FEV1 – forsirani ekspiratorni volumen u prvoj sekundi. U grupi s normalnom FEV1 vrijednošću bilo je 19 bolesnika, 10 u grupi s blagom opstrukcijom, 6 u grupi s umjerenom i 9 u grupi s teškom opstrukcijom. Svi bolesnici sudjelovali su u aktivnostima programa plućne rehabilitacije sukladno propisanim smjernicama. Rezultati: Rezultati su pokazali značajno smanjenje simptoma depresivnosti i anksioznosti (p

Pulmonary rehabilitation is the key component in treating patients with chronic respiratory diseases. In lung transplantation program it plays an important role as an individualized program for every patient before and after surgery. In these patients reduced ability to exercise is an important predictor of outcome and survival after surgery so feature of pulmonary rehabilitation is immenesely important. The intensity of exercise and training regimen depend on the underlying disease. Pretransplant rehabilitation helps optimize and maintain patient’s functional status and supplies important interdisciplinary information about the following surgery. It also includes psychosocial support to patients and their caregivers with the goal to reduce stress and improve adjustment while waiting for operation. Posttransplantation rehabilitation starts in the first 24-48 hours after surgery and it is oriented to optimal lung expansion, airway hygene, efficient breathing, extremity activation and walking. Educational component of the posttransplantation rehabilitation includes teaching recipients about desired health behaviors, risks, adequate medical regimen and healthy diet. Psychosocial support after transplantation involves: helping recipients to recover lost social and family roles, counseling, adapting to new organ and ongoing medical necessities, long-term moderation of their expectations and careing about their psychological wellbeing., Plućna rehabilitacija ključna je komponenta u liječenju osoba s kroničnim bolestima dišnog sustava, a u programu transplantacije pluća igra važnu ulogu u smislu individulanog programa za svakog bolesnika prije i nakon transplantacije. Kod ovih je pacijenata nemogućnost vježbanja snažan predskazatelj ishoda operacije i preživljenja, stoga je baš ovo obilježje plućne rehabilitacije od iznimne važnosti. Intenzitet i režim vježbanja određen je karakteristikama bolesti od koje je pacijent bolovao prije transplantacije. Pretransplantacijska plućna rehabilitacija bolesnicima pomaže u optimiziranju i održavanju funkcionalnog statusa prije operacije uz pružanje interdisciplinarnih informacija važnih za predstojeću operaciju i oporavak. Također uključuje psihosocijalnu potporu za pacijenta i članove obitelji radi umanjivanja stresa i povećanja prilagodbe u periodu čekanja transplantacije. Posttransplantacijska rehabilitacija započinje u prvih 24-48 sati nakon operacije i usmjerena je na optimalno širenje pluća i toaletu dišnih putova, učinkovito disanje, aktivaciju ekstremiteta i hod. Edukacijska komponenta posttransplantacijske rehabilitacije uključuje poučavanje o željenom zdravstvenom ponašanju, rizicima, adekvatnom režimu uzimanja lijekova i zdravoj prehrani. Psihosocijalna potpora odnosi se na pomoć u ponovnom preuzimanju izgubljenih socijalnih i obiteljskih životnih uloga, savjetovanje, prilagodbu na novi organ i daljnje medicinske potrebe, dugoročno moderiranje očekivanja te brigu o psihičkoj dobrobiti pacijenta.

CILJ: Pokazati kako je interdisciplinarni program plućne rehabilitacije provođen u našoj ustanovi utjecao na stupanj izraženosti simptoma, parametre plućne funkcije, toleranciju napora, dužinu hodne pruge i kvalitetu života smanjenjem varijabla psihološkog distresa. ISPITANICI I METODE: U istraživanje je bilo uključeno 122-je bolesnika s kroničnom opstruktivnom plućnom bolesti (astmom i KOPB-om), koji su unatoč redovitu uzimanju preporučene terapije imali slabu toleranciju napora i brzo zamaranje. Svi su provodili isti program četiri tjedna, uz nastavak uzimanja svoje medikamentne terapije. REZULTATI: Pokazano je statistički značajno poboljšanje (p, AIM: To show how the interdisciplinary programme of pulmonary rehabilitation implemented in our institution aff ected the severity of disease symptoms, lung function, exercise capacity, walking distance length and quality of life by decreasing psychological distress variables. PATIENTS AND METHODS: The study included 122 patients with chronic obstructive lung disease (asthma, COPD), who despite regular use of the recommended therapy experienced reduced tolerance to exertion and rapid fatigue. All patients went through the same four-week programme. RESULTS: There was a statistically significant improvement in the following values: Forced Expiratory Volume in the fi rst second (FEV1), Inspiratory Capacity (IC), Six Minute Walk Test (6MWT), Asthma Control Test (ACT), COPD Assessment Test (CAT) and Quality of Life (QOL)with the reduction of depression, anxiety and stress symptoms. CONCLUSION: Pulmonary rehabilitation obviously contributes to improvement in the quality of life by increasing subjective control of the disease and by alleviating depression, anxiety and stress symptoms. Patients achieved better exercise capacity and longer walking distance. Among the parameters of lung function, FEV1 and IC improved signifi cantly while forced vital capacity (FVC) and peak expiratory fl ow (PEF) showed no significant changes.