The honest answer is: often, both. At Pulmovista Clinics, the initial assessment includes a complete medication review — and if I identify that better medication would meaningfully improve baseline symptoms before rehabilitation begins, I address that first. But in the majority of patients with Stage 3 or Stage 4 COPD or ILD, even optimal medication leaves a significant gap between what the lungs can do and what the patient can do in daily life. That gap — the deconditioning, the muscle wasting, the breathlessness anxiety, the nutritional deficit — is precisely what pulmonary rehabilitation closes. The two are complementary, not alternatives.