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Guidelines and statements from ERS, ATS, BTS and SPLF are now available for adequate treatment of COPD. The recommendations are summarised but the author emphasizes what has changed, what remains unchanged or was adapted and what is new and promising. The therapeutic approach tends also to improve symptoms, especially dyspnea, and quality of life. This is mainly obtained with a multidisciplinary team offering the patient a program of rehabilitation.

Purpose: To study a comparison of problems arising in pulmonary rehabilitation programs in North America, Europe, and Tokyo., Methods: The survey instrument was a 13-item questionnaire sent in December 1994 to institutions in North America (n = 178), Europe (n = 179), and Tokyo (n = 399)., Results: Response rates were 51%, 40%, and 51% for North America, Europe, and Tokyo, respectively. Pulmonary rehabilitation programs were available at 56% of hospitals in North America and 74% in Europe, but at only 20% of hospitals in Tokyo. Most PRPs were conducted in an outpatient setting in North American (98%), whereas both outpatient (55%) and inpatient programs (65%) were adopted in Europe. Although the type of lung disease for which patients in both North America and Europe were referred to PRPs was mainly chronic obstructive pulmonary disease, this accounted for only 34% of referrals in Tokyo. However, referrals for primary tuberculosis sequelae (P = 0.028) and bronchiectasis (P = 0.021) were more common in Europe, similar to the situation in Tokyo. The following PRP items were available at significantly higher rates in North America than in Europe, and most were unavailable in Tokyo: family education, psychological support, nutritional instruction, treadmill, bicycle ergometer, walking training, and increasing the activity of daily living., Conclusion: Pulmonary rehabilitation programs in North America are more multidimensional. However, target diseases differ among North America, Europe, and Tokyo. Pulmonary rehabilitation programs in Tokyo differed from those in North America and Europe and were poorly programmed. Problems arising in PRPs in the three regions include lack of staff and insufficient reimbursement.

Over the past few years, pulmonary rehabilitation programs have become more usual in Europe. Even COPD patients on LTOT no longer feel home-bound or grounded. Nevertheless, they experience anxiety when leaving their usual medical environment. The SEP would like to encourage COPD patients to travel by creating a European COPD network. The objectives of this network would be (1) to record all the pulmonary centers in Europe that are involved in pulmonary rehabilitation; (2) to know the availability of oxygen in the different European countries and pulmonary centers; (3) to record those of these centers that would agree to take under supervision COPD patients traveling in their respective area and to provide all technical and medical assistance; (4) to select the most suitable holiday resorts for COPD patients according to ambient temperature, altitude, hotel accommodation, pollution, and possibility for COPD patients to walk around and take excursions; (5) to include oxygen suppliers and medical equipment companies involved in the technical assistance of these COPD patients traveling with all their paraphernalia. Such a European network would enable COPD patients to travel securely, being sure to find medical and technical assistance in all of these "SEP-recommended" places (SEP Guide).