Improving Pulmonary Function and Functional Ability through Pulmonary Rehabilitation in Patients with Pleural Effusion: A Literature Review
Downloads
Introduction: Pleural effusion (PE) is characterized by reduced lung distensibility and expansion, resulting in decreased lung volume. Pleural effusion patients often experience respiratory symptoms that impair quality of life (QoL) and daily activities. Pulmonary rehabilitation (PR) has been developed to enhance functional capacity, alleviate symptoms, improve exercise tolerance, and reduce health service utilization. However, data on the specific implementation and benefits of PR in PE patients are limited.
Methods: This literature review synthesized data from a search using Public Medline (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar databases. The search was based on keywords relevant to study objectives and comprised various article types, ranging from review papers to original research. Articles with titles and abstracts relevant to the study objectives proceeded to a full-text evaluation.
Results: A narrative review discussing PE from pathology to rehabilitation management was formulated from 12 articles that elucidated various aspects of functional impairment in PE patients and 24 sources that discussed rehabilitation management.
Conclusion: Rehabilitation interventions, especially mobilization programs and lung expansion techniques, have shown effectiveness in improving pulmonary function and functional activities. Data regarding the role of inspiratory muscle training and aerobic exercise specific to PE remain limited. Given the functional impairments associated with PE, both before and after the removal of pleural fluid, PR programs are crucial in improving symptoms, pulmonary function, and overall functional ability in these patients.
Santos EDCD, da Silva JDS, Filho MTTDA, et al. Adding Positive Airway Pressure to Mobilisation and Respiratory Techniques Hastens Pleural Drainage: A Randomised Trial. J Physiother 2020; 66: 19–26. [PubMed]
Kookoolis AS, Puchalski JT, Murphy TE, et al. Mortality of Hospitalized Patients with Pleural Effusions. J Pulm Respir Med 2014; 4: 184. [PubMed]
Martinez-Pitre PJ, Sabbula BR, Cascella M. Restrictive Lung Disease. Treasure Island (FL), 2025. [PubMed]
Garske LA, Kunarajah K, Zimmerman PV, et al. In Patients with Unilateral Pleural Effusion, Restricted Lung Inflation is the Principal Predictor of Increased Dyspnoea. PLoS One 2018; 13: e0202621. [PubMed]
Cartaxo AM, Vargas FS, Salge JM, et al. Improvements in the 6-Min Walk Test and Spirometry Following Thoracentesis for Symptomatic Pleural Effusions. Chest 2011; 139: 1424–1429. [PubMed]
Yu H. Management of Pleural Effusion, Empyema, and Lung Abscess. Semin Intervent Radiol 2011; 28: 75–86. [PubMed]
Bintcliffe OJ, Lee GYC, Rahman NM, et al. The Management of Benign Non-Infective Pleural Effusions. Eur Respir Rev 2016; 25: 303–316. [PubMed]
Thomas R, Jenkins S, Eastwood PR, et al. Physiology of Breathlessness Associated with Pleural Effusions. Curr Opin Pulm Med 2015; 21: 338–345. [PubMed]
Hanada M, Kasawara KT, Mathur S, et al. Aerobic and Breathing Exercises Improve Dyspnea, Exercise Capacity and Quality of Life in Idiopathic Pulmonary Fibrosis Patients: Systematic Review and Meta-Analysis. J Thorac Dis 2020; 12: 1041–1055. [PubMed]
Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2021; 18: e12–e29. [PubMed]
Santos EDCD, da Silva JDS, Filho MTTDS, et al. Use of Lung Expansion Techniques on Drained and Non-Drained Pleural Effusion: Survey with 232 Physiotherapists. Fisioterapia em Movimento; 33. [Journal]
Valenza-Demet G, Valenza MC, Cabrera-Martos I, et al. The Effects of a Physiotherapy Programme on Patients with a Pleural Effusion: A Randomized Controlled Trial. Clin Rehabil 2014; 28: 1087–1095. [PubMed]
Oliveira JF, Mello FCQ, Rodrigues RS, et al. Effect of Continuous Positive Airway Pressure on Fluid Absorption among Patients with Pleural Effusion due to Tuberculosis. Rev Bras Fisioter 2010; 14: 127–132. [PubMed]
Tonelli R, Cocconcelli E, Lanini B, et al. Effectiveness of Pulmonary Rehabilitation in Patients with Interstitial Lung Disease of Different Etiology: A Multicenter Prospective Study. BMC Pulm Med 2017; 17: 130. [PubMed]
Porcel JM. PLEASE, Take a Deep Breath. The European Respiratory Journal; 55. Epub ahead of print May 2020. [PubMed]
Jacobs B, Sheikh G, Youness HA, et al. Diagnosis and Management of Malignant Pleural Effusion: A Decade in Review. Diagnostics (Basel, Switzerland); 12. Epub ahead of print April 2022. [PubMed]
Umbrello M, Mistraletti G, Galimberti A, et al. Drainage of Pleural Effusion Improves Diaphragmatic Function in Mechanically Ventilated Patients. Crit Care Resusc 2017; 19: 64–70. [PubMed]
Mitrouska I, Klimathianaki M, Siafakas NM. Effects of Pleural Effusion on Respiratory Function. Can Respir J 2004; 11: 499–503. [PubMed]
Gilmartin JJ, Wright AJ, Gibson GJ. Effects of Pneumothorax or Pleural Effusion on Pulmonary Function. Thorax 1985; 40: 60–65. [PubMed]
Estenne M, Yernault JC, De Troyer A. Mechanism of Relief of Dyspnea after Thoracocentesis in Patients with Large Pleural Effusions. Am J Med 1983; 74: 813–819. [PubMed]
Muruganandan S, Azzopardi M, Thomas R, et al. The Pleural Effusion and Symptom Evaluation (PLEASE) Study of Breathlessness in Patients with a Symptomatic Pleural Effusion. Eur Respir J; 55. Epub ahead of print May 2020. [PubMed]
Torres JR, Martos IC, López LL, et al. Psychological Distress at Hospital Admission is Related to Symptoms Severity and Health Status in Malignant Pleural Effusion Patients. Eur J Cancer Care (Engl) 2020; 29: e13212. [PubMed]
Marcondes BF, Vargas F, Paschoal FH, et al. Sleep in Patients with Large Pleural Effusion: Impact of Thoracentesis. Sleep Breath 2012; 16: 483–489. [PubMed]
Boshuizen RC, Vincent AD, van den Heuvel MM. Comparison of Modified Borg Scale and Visual Analog Scale Dyspnea Scores in Predicting Re-Intervention after Drainage of Malignant Pleural Effusion. Support Care Cancer 2013; 21: 3109–3116. [PubMed]
Yorke J, Swigris J, Russell AM, et al. Dyspnea-12 is a Valid and Reliable Measure of Breathlessness in Patients with Interstitial Lung Disease. Chest 2011; 139: 159–164. [PubMed]
Jany B, Welte T. Pleural Effusion in Adults-Etiology, Diagnosis, and Treatment. Dtsch Arztebl Int 2019; 116: 377–386. [PubMed]
Beaudoin S, Gonzalez AV. Evaluation of the Patient with Pleural Effusion. CMAJ 2018; 190: E291–E295. [PubMed]
Wong CL, Holroyd-Leduc J, Straus SE. Does this Patient Have a Pleural Effusion? JAMA 2009; 301: 309–317. [PubMed]
Martinez J, Rodrigues H, Portelinha A. A Novel Position for Postural Relief of Dyspnea. J Bras Pneumol 2011; 37: 829–830. [Journal]
Campbell IA, Bah-Sow O. Pulmonary Tuberculosis: Diagnosis and Treatment. BMJ 2006; 332: 1194–1197. [PubMed]
Liu W, Mu X, Wang X, et al. Effects of Comprehensive Pulmonary Rehabilitation Therapy on Pulmonary Functions and Blood Gas Indexes of Patients with Severe Pneumonia. Exp Ther Med 2018; 16: 1953–1957. [PubMed]
Light RW, Lee YCG. Textbook of Pleural Diseases. CRC Press, https://books.google.co.id/books?id=gm2mCwAAQBAJ (2016).
Ruppel GL. What is the Clinical Value of Lung Volumes? Respir Care 2012; 57: 26–28. [PubMed]
Vijayasekaran D, Subramanyam L, Balachandran A, et al. Spirometry in Clinical Practice. Indian Pediatr 2003; 40: 626–632. [PubMed]
Flesch JD, Dine CJ. Lung Volumes: Measurement, Clinical Use, and Coding. Chest 2012; 142: 506–510. [PubMed]
Budweiser S, Moertl M, Jörres RA, et al. Respiratory Muscle Training in Restrictive Thoracic Disease: A Randomized Controlled Trial. Arch Phys Med Rehabil 2006; 87: 1559–1565. [PubMed]
Tran D. Cardiopulmonary Exercise Testing. Methods Mol Biol 2018; 1735: 285–295. [PubMed]
Adachi H. Cardiopulmonary Exercise Test. Int Heart J 2017; 58: 654–665. [PubMed]
Ersöz H, Dayılar Candan H. Evaluation of Quality of Life in Patients With Pleurodesis. South Clin Istanbul Eurasia; 30. Epub ahead of print 1 July 2019. [ResearchGate]
Sivakumar P, Saigal A, Ahmed L. Quality ofLife after Interventions for Malignant Pleural Effusions: A Systematic Review. BMJ Support Palliat Care 2020; 10: 45–54. [PubMed]
Copyright (c) 2025 Arnengsih Nazir, Gabriella Anggraini, Brandon Clementius, Hana Athaya Nurhalizah, Agung Budi Sutiono

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
1. The journal allows the author to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions.
3. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution Share-Alike (CC BY-SA).
4. The Creative Commons Attribution Share-Alike (CC BY-SA) license allows re-distribution and re-use of a licensed work on the conditions that the creator is appropriately credited and that any derivative work is made available under "the same, similar or a compatible license”. Other than the conditions mentioned above, the editorial board is not responsible for copyright violation.