LAUSR

We accept with enthusiasm the call by Jacome et al. published in this issue of Pulmonology. Pulmonary rehabilitation may be used for a wide range of purposes and may include decreasing hospital care services, reducing the cost of care, improving adherence to physical activities, training and correcting life styles, improving accessibility, extending services to remote locations, improving selfmonitoring, better understanding of prescribed treatments, improving adherence and better communication with health professionals. Tele-health has been defined as the use of information and communication technologies to deliver health care services and transmit medical data over long and short distances. It encompasses a wide variety of technologies such as videoconferencing, internet platforms, store-and-forward devices, streaming media, and ground and wireless communication. Tele-rehabilitation works to address a basic question: how to improve access to rehabilitation services for patients, in an efficacious, cost-effective, and safe manner? It may provide an ideal opportunity to either improve access to pulmonary rehabilitation (PR) and/or help maintain positive results following a traditional program. Tele-rehabilitation reduces barriers such as insufficient programs and inadequate numbers of qualified health professionals, particularly in rural and regional areas, reduces problems of transportation, accessible parking, as well as walking distance from parking to the hospital. An emerging area of application of technology refers to the use of wearable sensors to facilitate the implementation of home-based rehabilitation interventions. Systems that aim to facilitate the implementation of rehabilitation exercise programs often leverage the combination of sensing technology and interactive gaming or virtual reality (VR) environments. Previous studies illustrated the potential of tele-health to facilitate the delivery of PR to patients with chronic obstructive pulmonary disease in their home, as well as to remote settings without the benefits of an established program. The Coronavirus (COVID-19) pandemic ‘‘day after’’ is coming and people, who suffered from mild to severe pneumonia up to hypoxemic respiratory failure, might be at risk of longterm impairment and disability. Like all patients who have undergone critical illnesses, COVID-19 patients can present dyspnoea and fatigue at rest and during activities of daily living, disability, exercise intolerance, reduction in peripheral muscle function and in nutritional status with significant weight loss. In particular, they may be at risk of residual or worsening parenchymal damage with respiratory muscle function impairment. Furthermore, the infection can negatively affect also other organs like heart, kidneys, muscles and brain, with significant health impacts that may persist. Additionally, people requiring intensive care are at increased risk of posttraumatic stress disorder, anxiety, and depression. The newly discovered Coronavirus (COVID-19) and the rigorous request for social distancing has put tele-health (tele-coaching/tele-monitoring/telerehabilitation) in the front line. Tele-rehabilitation may represent the most appropriate response in the post-acute COVID phase by combining need for rehabilitation with need for social distancing. It should be adopted in post COVID patients with mild to moderate disabilities, who need frequent monitoring, reside in isolated areas or are not available to participate in standard programs. Our recent experience in this field in a subgroup of post COVID patients (unpublished data) with reduced exercise tolerance, exercise induced desaturation, mild restrictive ventilatory pattern and persistent pathological lung imaging, has given promising results: average adherence to a 30-day program was 88% with improvement in exercise tolerance, dyspnoea and muscle fatigue. Strong monitoring should be maintained through wireless devices and when available wearable technology. Contacts by video-call or phone in order to verify patient adherence to rehabilitation sessions and quality of signals are needed. Despite this preliminary observation, the ideal post COVID candidate, duration of intervention, demonstration of efficacy equivalent to a traditional rehabilitation program to be applied and cost effectiveness are still unknown. Many patients who attend rehabilitation programs are older and may not be using, or have