Exercise and Pulmonary Rehabilitation in

Children with Chronic Lung Diseases Suchada Sritippayawan, MD.

Somjitr Tongkam, BScChanthana Harnruthakorn, BSc.

What is Chronic lung disease?

• CLD of prematurity

• Prolonged MV use

• Chronic aspiration

• Chronic infection

• Bronchiectasis

• Chronic ILD

• Asthma

• etc.

CLD: Burden of the disease

Jan – Dec 2006Out-patient service

- 464/1,095 visits (42%)

- 116 cases

- Chronic aspiration 42 cases

- BPD 39 cases

- Others 35 cases

- 20% on home oxygen therapy

- 2% on home ventilator

70%

CLD: Burden of the disease

Jan – Dec 2006In-patient service

- 246/3,800 admissions (6.5%)

- 246 cases

- Chronic aspiration 91 cases

- BPD 34 cases

- Others 121 cases

- Median age 1.3 yrs

- Admission rate 2.5/case/yr

- Duration of admission 70 days/case/yr

50%

CLD: Pulmonary function

• Depend on underlying disease

• BPD – obstructive, air trapping, BHR

• Bronchiectasis - Mixed obstructive/restrictive, BHR- Not related to CT findings

• ILD- Restrictive- Diffusion defect

Exercise limitation in CLD

CLD

Ventilatory impairmen

t

Circulatory impairmen

t

Malnutrition

Oxidative capacity of

muscles O2 delivery & CO2

excretion

Exercise limitation ( Aerobic capacity)

CLD

Airway problems

Lung mechanic problems

Chest wall mechanic problems

• Hypersecretion

• Bronchospasm

• Collapsed airway

• Restrictive

• Hyperinflation

• Ineffective cough

• Retained secretion

• Exercise limitation

• Atelectasis

• Recurrent pneumonia

Pulmonary rehabilitation &

Exercise training

PFT at rest ≠ Exercise capacity

Exercise test is helpful in identifying

• pulmonary limitation during exercise

• optimal level of exercise

Exercise capacity in CLD

Question #1

How to assess exercise capacity in children with CLD?

Synonyms of exercise stress test:

- Cardiopulmonary exercise test

- Graded exercise test

Exercise test

VO2

VCO2/VO2>1

Maximum O2 consumption (VO2max)

Work load

Indications for exercise testing

• Clinical assessment

- symptoms or signs induced by exercise

- medical or surgical interventions

- baseline data of rehabilitation programs

• Aerobic fitness evaluation

Contraindications to exercise testing

Absolute contraindications

- active inflammatory heart disease

- active hepatitis

- acute myocardial infarction

- active pneumonia

- severe systemic hypertension

- acute orthopedic injury to an exercise

muscle group

Contraindications to exercise testing

Relative contraindications

- severe left ventricular outflow obs.

- severe right ventricular outflow obs.

- congestive heart failure

- severe mitral stenosis

Lab equipment

• Ergometers

• Respiratory and metabolic/gas

equipment

• Monitoring : EKG, HR, SpO2, BP