INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation due to exposure to noxious particles or gases (Vogelmeier et al., 2017). COPD is an irreversible disease in which dyspnea worsens with exertion, leading patients to avoid exercise. This avoidance leads to limitations in activities of daily living and subsequent functional decline (Nici and ZuWallack, 2014; Spruit et al., 2013). The primary treatment goals for COPD are to relieve symptoms such as dyspnea, maintain activity levels to optimize physical and social function, and prevent acute exacerbations. To achieve this, COPD management includes both pharmacological and nonpharmacological treatments focused on maintaining function and preventing exacerbations (Nici et al., 2006). Specifically, nonpharmacological treatments have been reported to improve and maintain quality of life by improving respiratory function, exercise capacity, exercise endurance, and overall health. These treatments include health education, medication management, and pulmonary rehabilitation interventions, including breathing exercises.
Pulmonary rehabilitation is a comprehensive, patient-tailored intervention based on a thorough patient assessment. It integrates exercise training, education, and behavioral change to improve the physical and psychological well-being of patients with chronic respiratory diseases and promote long-term adherence to health-promoting behaviors (Spruit et al., 2013). This treatment utilizes education and various techniques to alleviate symptoms, manage disease, and prevent complications. The goal of this rehabilitation is to improve patients’ exercise capacity and psychological well-being, enabling them to achieve optimal functional performance in daily life (Kang, 2006). Pulmonary rehabilitation is cost-effective for patients with COPD. By alleviating symptoms and improving physical, social, and psychological functioning, pulmonary rehabilitation improves activities of daily living and self-regulation. This improved self-management improves quality of life and reduces hospital visits and hospitalizations, thereby reducing healthcare costs (Haggerty et al., 1999).
In Korea, pulmonary rehabilitation intervention studies have primarily been conducted in outpatient or hospital settings. Whether hospital-based or home-based, these studies often incorporate only fragmented components of existing recommendations. Substantial differences in intervention duration, content, and delivery methods across studies hinder the definition of core strategies for effective pulmonary rehabilitation. Therefore, a consensus on the content of pulmonary rehabilitation interventions in Korea is needed. In particular, there is a paucity of studies evaluating the effectiveness of interventions that integrate core elements from the literature, such as exacerbation action plans to address symptom exacerbations (Effing et al., 2012) and cognitive-behavioral strategies to promote patient responsibility and engagement in self-management (Turner et al., 2014).
This study reviewed existing research to identify nursing interventions appropriate for pulmonary rehabilitation in patients with COPD. Currently, research on the application and trends of pulmonary rehabilitation interventions for COPD patients in the field of rehabilitation nursing is lacking. This systematic literature review aims to analyze recent research trends in pulmonary rehabilitation nursing interventions for COPD patients in Korea. The purpose of this systematic literature review is to identify trends in pulmonary rehabilitation nursing intervention research for COPD patients. This analysis will provide valuable information for future restructuring and research directions in pulmonary rehabilitation nursing.
MATERIALS AND METHODS
Study design
This systematic literature review analyzes domestic studies on pulmonary rehabilitation nursing interventions for patients with COPD published in the field of rehabilitation nursing over the past 10 years.
Study selection and literature search
To analyze published studies in the field of rehabilitation nursing in Korea, we searched the databases of the National Assembly Library, the Korean Studies Information Service System, DBpia, and RISS4U. Using the keywords “chronic obstructive pulmonary disease,” “rehabilitation nursing,” and “pulmonary rehabilitation,” we identified studies published in Korea from 2000 to 2024. Unpublished papers, conference proceedings, non-human studies, general reviews, and articles for which full texts were unavailable were excluded. Full texts of 12 studies meeting the selection criteria were obtained and analyzed.
Data analysis
To analyze research trends, this review analyzed the general characteristics (year of publication, number of participants), intervention method, content (outcome measures), and effectiveness of the selected studies based on existing research. For quantitative analysis, descriptive statistics, including frequencies and percentages, were calculated using IBM SPSS Statistics ver. 21.0 (IBM Co., USA).
RESULTS
General characteristics of the studies
Table 1 presents the characteristics of the selected studies. Looking at the publication period, six studies (50.0%) were published between 2000 and 2009, five studies (41.7%) between 2010 and 2019, and one study (8.3%) between 2020 and 2024. In 11 studies (91.7%), the first author was a nurse, while in one study (8.3%), the first author was a nonnurse.
Pulmonary rehabilitation nursing interventions
Of the 12 studies, 2 (16.7%) used exercise alone, 3 (25.0%) used education alone, and 7 (58.3%) used a combination of exercise and education.
Study content analysis (interventions, methods, tools, and effects)
Table 2 summarizes the interventions, methods, tools, and effects of the reviewed studies. Interventions in the analyzed studies were generally described as “pulmonary rehabilitation nursing interventions” or “pulmonary rehabilitation programs.” They were also categorized by intervention timing (“admission” vs. “discharge”) and delivery method (“group” vs. “one-on-one”). Common delivery methods included educational sessions for knowledge transfer and demonstrations of exercise interventions. Some studies also used telephone calls and text messages to deliver interventions. Most studies measured respiratory function using objective tools such as forced expiratory volume in one second, oxygen saturation, and pulmonary function tests. Other outcome measures included anxiety, fatigue, self-training, self-care behaviors, and knowledge.
Regarding intervention effects, studies that combined exercise and education observed the most significant effects on self-care behaviors, respiratory function, and anxiety, in that order. For exercise-only interventions, the most significant effects were observed on respiratory function, fatigue, and anxiety, in that order. Additionally, in the case of the education-only intervention, the greatest improvement was seen in self-management behaviors, knowledge, and respiratory function, in that order.
DISCUSSION
This systematic literature review analyzed 12 studies on pulmonary rehabilitation nursing interventions for patients with COPD in Korea. Based on the analysis of the general characteristics, intervention methods, content (including outcome measures), and effectiveness of the studies, we discuss research trends and offer recommendations for pulmonary rehabilitation nursing interventions.
First, only one study of the 12 (8.3%) was published between 2020 and 2024. This period coincided with the coronavirus disease 2019 pandemic, limiting patient access and making it difficult to conduct intervention studies (Byun and Yun, 2024). The small number of studies is believed to be due to the limitations of patient-centered research due to the risk of infection. Furthermore, conducting research on hospitalized patients presents numerous ethical and human rights challenges (Lim et al., 2024). To address these challenges, researchers must obtain approval from the Institutional Review Board. Patients should be able to freely decide whether or not to participate, and researchers have a duty to fully explain the purpose, methods, risks, potential benefits, and data privacy protections of the study. Furthermore, researchers must ensure that participating patients receive tangible benefits, not just experimental subjects.
Second, regarding the intervention method, seven studies (58.3%) used a combined exercise and education approach, three studies (25.0%) used education alone, and two studies (16.7%) used exercise alone. These results are consistent with previous research showing that combined interventions are more effective than single- method interventions, although the target populations were different (Jeong and Jung, 2024; Park et al., 2022). Therefore, intervention studies should be designed not simply by combining interventions, but rather by ensuring that each component complements the other to maximize synergistic effects. Furthermore, utilizing various educational media, such as mobile apps, videos, and posters, and incorporating hands-on practice are considered effective approaches to delivering interventions.
Third, in terms of intervention effectiveness, the combined exercise and education intervention showed the most significant improvements in self-care behaviors, respiratory function, and anxiety. Self-care is the process of maintaining health through health promotion and disease management, both in stable and exacerbated states (Riegel et al., 2012). Studies have shown that COPD self-care programs can reduce respiratory-related hospitalizations, improve quality of life, and contribute to reduced mortality (Kessler et al., 2018; Lenferink et al., 2017). Therefore, establishing effective self-care in pulmonary rehabilitation requires evidence-based education, individualized interventions, multidisciplinary collaboration, and continuous monitoring with feedback. Effective disease management in COPD patients requires a deep understanding of their condition and practical behavioral strategies. The greatest improvements in the exercise-only intervention were in respiratory function, fatigue, and anxiety. This suggests that exercise programs should include systematic education to help patients understand their respiratory health and practice effective management skills.
Moreover, professionals need training that combines academic knowledge and clinical skills to manage fatigue and anxiety in patients with COPD. Consistent with previous research, educational interventions have been shown to improve patient knowledge (Choi et al., 2021). This suggests the need for a structured educational program tailored to the knowledge level and specific needs of patients with COPD.
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