pulmonary rehabilitation in copd

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Pulmonary Rehabilitation In COPD BY Prof . Mohammad El- Desouky Abo- Shehata Prof . Of Thoracic Medicine Mansoura University

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Pulmonary Rehabilitation In COPD . BY Prof . Mohammad El- Desouky Abo - Shehata Prof . Of Thoracic Medicine Mansoura University. Chronic Obstructive Pulmonary Disease. Definition - PowerPoint PPT Presentation

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Page 1: Pulmonary Rehabilitation In COPD

Pulmonary Rehabilitation In COPD

BY

Prof . Mohammad El- Desouky Abo- ShehataProf . Of Thoracic Medicine

Mansoura University

Page 2: Pulmonary Rehabilitation In COPD

Chronic Obstructive Pulmonary Disease

Definition COPD is a common preventable and treatable disease ,

characterized by persistant airflow limitation that is usually progressive and associated with an enhanced inflammatory response in the airway and the lung to noxiouse particles or gases .

Exacerbations and co-morbidities contributes to overall severity in individuals patients

( GOLD

( 2011 )

Page 3: Pulmonary Rehabilitation In COPD

Prevalence Of COPD

COPD is one of the most common diseases affecing elderly people allover the world

COPD affects approximately16% of people over the age of 65 years worldwide

COPD is ranked the fourth cause of death of people over the age of 65 years

(WHO) estmated that by the year 2020 (COPD) will be the third leading cause of deaths and the fifth cause of disability worldwide

According to WHO ; the estimated death rate in Egypt was 35,9/100.000 and the estimated disability associated with COPD was 302/100.000

Buist et al (2007): International variation in the prevalence of COPD . Lancet; 370:

741-749 Viegi G, et al. (2001): Epidemiology of chronic obstructive pulmonary disease

(COPD). Respiration; 68 (1): 4-19.

Page 4: Pulmonary Rehabilitation In COPD

Impact of COPD ON (QOL)

Quality of life is a feeling of overall life satisfaction It is primary a subjective sense of well being ; including

physical, psychological, social and spiritual dimensions COPD and its progression promote a cycle of physical,

psychological, and social consequences, All which interrelated and have a negative impact on quality of life

Peruzza et al ; (2003 )

Page 5: Pulmonary Rehabilitation In COPD

Pulmonary rehabilitation In COPD

The principal goal of rehabilitation are to reduce symptoms , improve quality of life , and increase physical and emotional participation in every day activities

Pulmonary rehabilitation covers a range of non - pulmonary problems that may not be adequately addressed by medical therapy of COPD, including exercise de-conditioning, altered mood state (especially depression ), muscle wasting , weight loss.

NICI .L. et al. ATS/ERS . Statement of pulmonary rehabilitation .Am J

Resp And Crit Care Med . 2006 ; 173 : 1390 - 413

Page 6: Pulmonary Rehabilitation In COPD

Pulmonary Rehab Program

Exercise training Nutritional counseling Education on lung disease or condition and how

to manage it Energy-conserving techniques Breathing strategies Psychological counseling and/or group support

Page 7: Pulmonary Rehabilitation In COPD

Effect of a Pulmonary Rehabilitation Program on the Quality of Life In

Elderly Patients with COPD

Mohamed El-Desoky Abou Shehata*, El Sayed Zaki Hatata**,

Amany Mohamed Shebl***, and Doaa El Sayed Fadila***

*Chest Diseases Department, **Internal Medicine DepartmentFaculty of Medicine, Mansoura University

***Adult Nursing Department, ****Gerontological Nursing Department

Faculty of Nursing, Mansoura University

Page 8: Pulmonary Rehabilitation In COPD

Aim of the study

Objective of this study was to assess the impact

of pulmonary Rehab program on ( QOL ) in elderly COPD patients

Page 9: Pulmonary Rehabilitation In COPD

Subjects

Setting This study carried out at chest departement ; Mansoura university (from Jan to Dec/ 2011)

Subjects 54 COPD elderly patients were randomly assigned into two equal groups:

Study group : received Rehabilitation program (27 pt) control group : received conventional treatment (27 pt )

Page 10: Pulmonary Rehabilitation In COPD

Inclusion Criteria

Aged 60 years and above. Clinically stable with no exacerbation in the last month. Had COPD diagnosed according to the criteria of GOLD,

2010 Had COPD staged according to GOLD, 2010 Walk unaided. Not involved in any other respiratory rehabilitation

program. Free from any other respiratory or associated disorders as heart failure Able to communicate and cooperate in program. Accept to participate in the study.

Page 11: Pulmonary Rehabilitation In COPD

plan of work

Each elderly patient in both control and study groups was interviewed individually

The developed pulmonary rehabilitation program was implemented on study group and conducted in 8 sessions over 2 weeks. Each session took about 30 minutes.

The developed pulmonary rehabilitation program was conducted in small groups (3-5 patients/session )

Each patient in the study group was subjected to two types of sessions: educational and training sessions.

Page 12: Pulmonary Rehabilitation In COPD

Plan of work ( cont )

Control group was subjected to educational session only

Patients of the study group were taught to perform these exercises and instructed to do them at home after discharge from the hospital for 2 month

Telephone visits were provided twice a week during 2 months after discharge from hospital by the researcher for the study group to check with them their consistency with program.

Page 13: Pulmonary Rehabilitation In COPD

Educational sessions:

were carried out in 4 sessions. They included the following:

First session (Respiratory system and COPD nature):

Second session (COPD medications): Third session (Behavior and lifestyle modification

'Part 1'): Fourth session (Behavior and lifestyle

modification 'Part 2'):

Page 14: Pulmonary Rehabilitation In COPD

Training sessions:

Carried out in 4 sessions. Training sessions included the following:

First session (Inspiratory muscle training): Second session( Breathing retraining): Third session (Upper and lower extremities

exercise): Fourth session (Airway clearance techniques):

Page 15: Pulmonary Rehabilitation In COPD

Inspiratory Muscle Training Incentive Spirometry

Page 16: Pulmonary Rehabilitation In COPD

Breathing retraining (pursed lip breathing )

Page 17: Pulmonary Rehabilitation In COPD

Breathing retraining (diaphragmatic breathing)

Page 18: Pulmonary Rehabilitation In COPD

Upper Extremities Exercise

Page 19: Pulmonary Rehabilitation In COPD

Stretching and strengthening exercise for upper and lower extremities with using metal weights (1 and 2 Kgs).

Page 20: Pulmonary Rehabilitation In COPD

6 - minute walk test

Page 21: Pulmonary Rehabilitation In COPD

Outcomes measurement

After two months ( post – 1 ) of discharge from the hospital and applying the pulmonary rehabilitation program sessions, evaluation for both study and control groups was done and repeated after 4 months ( post 2 ) to determine the effect of program using the study tools:

Saint's George Respiratory Questionnaire (SGRQ) Clinical COPD Questionnaire (CCQ) Pulmonary Function Test Six minutes walk test (6 MWT) Modified Borg Dyspnea Scale

Page 22: Pulmonary Rehabilitation In COPD

Study ToolsTool III

Saint's George Respiratory Questionnaire

It was used to measure health related quality of life in patients with COPD. It provides an overall measure for the quality of life with subscale

scores in three dimensions:

Symptoms Activities Impact of disease on daily life

Page 23: Pulmonary Rehabilitation In COPD

Study ToolsTool VI

Clinical COPD Questionnaire

CCQ was used to evaluate the health status in patients with COPD. It includes 10 questions in three domains: symptoms, functional state and mental state during the previous week.

Page 24: Pulmonary Rehabilitation In COPD

Study ToolsTool VI

Six minutes walk test

It is a global objective indicator of functional capacity. It is used by measuring the distance (by miters) that the elderly patient covered in 6 minutes

Page 25: Pulmonary Rehabilitation In COPD

Study ToolsTool VII

Modified Borg Dyspnea Scale

It is a numerical scale for rating perceived dyspnea immediately after a 6 min walk test

Page 26: Pulmonary Rehabilitation In COPD

ItemsStudy group Control group

Pearson Chi-Square χ2 test (P)N= (27) % N= (27) %

Age (in years) 60- 65- 75+

11115

40.740.718.5

1575

55.625.918.5

1.504 (0.471)

Mean SD 65.26 4.40 64.81 5.23

Sex Male female

234

85.214.8

22 5

81.518.5

0.133 (0.715)

Marital status Married Widow Divorced

2241

81.514.83.7

2160

77.822.20.0

1.423 (0.491)

Educational level Illiterate Read and write Primary Secondary & over

20322

74.111.17.47.4

21123

77.83.77.4

11.1

1.358 (0.929)

Socio-demographic characteristics of the study and control groups

Page 27: Pulmonary Rehabilitation In COPD

Quality of life

(SGRQ)#

Study group Control group

t-test (P)a

t-test (P)b

t-test (P)c

Pre-rehab.2 months

Post rehab. (post 1)

6 monthsPost rehab.

(post 2)Pre-rehab.

2 monthsPost rehab.

(post 1)

6 monthsPost rehab.

(post 2)

Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

Symptoms 59.1617.35

53.8118.63

54.3319.02

56.7818.63

55.7718.27

55.3318.01 0.486

(0.629)0.391

(0.697)0.198

(0.844)t-test (P)1 4.987 (0.000) 2.245 (0.033)t-test (P)2 4.404 (0.000) 2.865 (0.008)

Activities 55.5014.51

44.0614.00

46.9115.84

53.6818.26

54.1718.38

56.0220.01 0.406

(0.686)2.274 (0.027

1.854 (0.050)t-test (P)1 10.098 (0.000) 0.812 (0.424)

t-test (P)2 6.982 (0.000) 2.285 (0.031)

Impact 56.6913.12

47.8014.44

46.3315.81

58.3012.68

59.0113.50

58.8314.85 0.458

(0.649)2.947

(0.005)2.995

(0.004)t-test (P)1 12.987 (0.000) 2.306 (0.029)t-test (P)2 11.243 (0.000) 1.071 (0.294)

Total 56.7413.64

47.7114.28

47.8715.51

56.6614.64

57.0014.99

57.4116.17 0.019

(0.985)2.333

(0.024)2.212

(0.031)t-test (P)1 24.395 (0.000) 1.338 (0.193)t-test (P)2 14.674 (0.000) 1.671 (0.107)

Quality of life of the study and control groups pre and post pulmonary rehabilitation program

Page 28: Pulmonary Rehabilitation In COPD

Health status (CCQ)#

Study group Control group

t-test (P)a

t-test (P)b

t-test (P)cPre-rehab.

2 months Post rehab.

(post 1)

6 monthsPost rehab.

(post 2)Pre-rehab.

2 months Post rehab.

(post 1)

6 monthsPost rehab.

(post 2)

Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

Symptoms 3.13 1.36 2.63 1.33 2.85 1.32 3.00 1.24 2.93 1.18 2.95 1.190.366

(0.716)0.864

(0.392)0.298

(0.767)t-test (P)1 5.586 (0.000) 1.494 (0.147)t-test (P)2 2.994 (0.006) 0.667 (0.510)

Functional state 2.84 1.29 2.39 1.17 2.54 1.23 2.72 1.03 2.76 1.20 2.87 1.21

0.378(0.707)

1.149 (0.256)

1.003 (0.320) t-test (P)1 10.234 (0.000) 0.679 (0.503)

t-test (P)2 5.848 (0.000) 1.925 (0.065)Mental state 2.59 1.44 2.35 1.36 2.50 1.43 2.43 1.52 2.43 1.21 2.31 1.30

0.414 (0.681)

0.211 (0.833)

0.497 (0.621)t-test (P)1 3.118 (0.004) 0.000 (1.000)

t-test (P)2 1.044 (0.306) 0.972 (0.340)

Total CCQ mean score 0.86 0.41 0.74 0.38 0.79 0.39 0.81 0.38 0.81 0.35 0.81 0.36

0.390 (0.698)

0.747 (0.459)

0.244 (0.808)t-test (P)1 7.325 (0.000) 0.270 (0.789)

t-test (P)2 3.611 (0.001) 0.052 (0.959)

Health status of the study and control groups pre and post pulmonary rehabilitation program

Page 29: Pulmonary Rehabilitation In COPD

Items

Study group Control group

t-test (P)a

t-test (P)b

t-test(P) C

Pre-rehab.2 months

Post rehab. (post 1)

6 monthsPost rehab.

(post 2)Pre-rehab.

2months Post rehab.

(post 1)

6 monthsPost rehab.

(post 2)

MeanSD

MeanSD

MeanSD

MeanSD

MeanSD

MeanSD

Functional capacity6MWT (miter)

283.81

56.97

334.52

62.90

324.78

64.26

290.52

43.32

286.59

44.78

281.26

44.20 0.487(0.629)

3.225(0.002)

2.900(0.006)

t-test (P)1 16. 612 (0.000) 3.128 (0.004)

t-test (P)2 11.523 (0.000) 6.625 (0.000)

Perceived dyspnea (Borg Scale)#

5.15

2.78

3.04

2.19

3.89

2.26

4.93

2.45

5.11

2.36

5.93

2.23 0.312(0.757)

3.347(0.002)

3.331(0.002)

t-test (P)1 8.563 (0.000) 2.431 (0.022)

t-test (P)2 5.625 (0.000) 9.367 (0.000)

Functional capacity and perceived dyspnea of the study and control groups pre and post pulmonary

rehabilitation program

Page 30: Pulmonary Rehabilitation In COPD

CONCLUSION

The supervised, two-month home-based pulmonary rehabilitation program is an effective non pharmacological intervention in the management of stable COPD elderly patients and maintained for 6 month

Pulmonary rehabilitation programs should be integrated within the plan of care for COPD elderly patients

COPD elderly patients should be given a written instruction plan for daily self-management measures

Page 31: Pulmonary Rehabilitation In COPD

CONCLUSION (cont )

These programs should emphasize patient education about the disease process COPD medication, behavior and lifestyle

modification Inspiratory muscles training, breathing

retraining, upper and lower extremities exercise,

Airway clearance techniques, psychosocial support, different relaxation

techniques

Page 32: Pulmonary Rehabilitation In COPD

Thank you