PULMONARY REHABILITATION

By: Nermine MounirAssistant prof. chest Department, Ain

Shams University

Definition

It is a multidisciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance.

Patient Selection Criteria for Pulmonary Rehabilitation

Symptomatic chronic lung disease. Stable on standard therapy. Functional limitation from disease. Relationship with primary care provider. Motivated to be actively involved in and

take responsibility for own health care. No other interfering or unstable medical

conditions. No arbitrary lung function or age criteria.

Patient Evaluation

Screening interview. Medical evaluation. Diagnostic testing→ PFTs, Exercise,

ABGs/oximetry. Psychosocial assessment.

Pulmonary Rehabilitation

It is broad program that helps improve the well-being of people who have chronic breathing problems or who need lung surgery , both before and after the surgery.

Include: Exercise training Nutritional counseling Education about the disease and how to manage Energy – conserving techniques Breathing strategies Psychological counseling

It’s a long term commitment. It s a team work Its often an outpatient program It can improve the function and quality of

life even in advanced lung diseases.

Benefits and Risks

Benefits: Improve quality of life Function better in daily life Increase ability to exercise Decrease symptoms Help to manage anxiety and depression

Risks:Usually safe, the risks related to the exercise part of

the program as injuries to muscles or bones.If there is another disorder such as heart disease

may increase heart attack or arrhythmia.

Exercise Training

To improve the endurance and muscle strength.

The plan must include exercises for both arms and legs.

The plan may involve several short sessions with rest breaks in between .

Blood oxygenation should be checked. At least 3 times/ week for the most

benefits.

Exercise programs for pulmonary patients typically emphasize lower extremity training (walking or cycling).

Other types of exercise→ upper extremity training and ventilatory muscle training.

Nutrition

Detection if the patient is overweight or underweight.

Accordingly a healthy eating plan is suggested.

Sufficient caloric intake and protein supplements.

Education

The patient should learn about his disease and its possible management.

Learn to avoid situations that worsen the symptoms e.g. resp. infection, lung irritants such as smoking or air pollution.

Learn about the importance of vaccination and how to prevent infection.

Learn how to take medicines and how to use oxygen therapy, nebulizers and MDI.

Learn Self- management plan to relieve symptoms. Learn how to use exercises, breathing strategies,

and other lifestyle changes.

Respiratory and Chest Physiotherapy Techniques→ chest physiotherapy to control secretions, breathing retraining techniques (diaphragmatic and pursed lips breathing techniques).

Energy Conserving Techniques

To prevent symptoms like dyspnea and to find easier ways to do daily tasks.

Tips include ways to avoid reaching, lifting, and bending.

Stress can use up energy and cause dyspnea.

Breathing Strategies

To improve breathing as take longer, deeper, and less frequent breaths e.g. pursed-lip breathing.

Pursed-lip breathing decreases how often the patient take breaths and keeps the small airways open longer.

Psychological counseling and support

People who have chronic lung diseases are more prone to depression, anxiety, and other emotional problems(denial, anger and isolation).

Cognitive and neuropsycholgical dysfunction, possibly related to or exacerbated by the effects of hypoxemia on the brain.

Results of Pulmonary Rehabilitation

Decrease in →

Medical resource utilizationRespiratory symptomsPsychological symptoms.

Increase in→

Quality of lifePhysical activityExercise tolerance (endurance or maximal level of activities of daily living)

Knowledge independence

Return to work possible.

No change in lung function.

Possible prolonged survival.

Thank you