pulmonary rehabilitation pp

8/10/2019 Pulmonary Rehabilitation PP

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Pulmonary Rehabilitation

dr. Aminuddin , SpRM


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Definition of pulmonary

rehabilitation

Pulmonary rehabilitation is a

program to people with chronic

lung diseases like COPD,emphysema, and chronic

bronchitis lead full, satisfyinglives and restore them to their

highest functional capacity.


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Pulmonary rehab is aimed to improve

quality of life by:

Decreasing respiratory symptoms and

complications

Encouraging self-management and control

over daily functioning

Improving physical conditioning and exercise

performance

Improving emotional well-being

Reducing hospitalizations


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Components of Pulmonary

Rehab ProgramsMost pulmonary rehab programs include: Medical management

Exercise Breathing retraining

Education

Emotional support

Nutrition counseling


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Team Approach to Pulmonary Rehab

Most formal pulmonary rehab programs include

a team of healthcare providers working

together, like doctors, nurses, rehabilitation

therapists, psychosocial staff and dietitians. The

team evaluates each person's overall physicaland emotional status, and then develops an

individual program for him or her. The doctor, a

specially trained registered nurse, arehabilitation specialist or a respiratory care

practitioner coordinate the program.


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Exercise

Exercise is a key part of a pulmonary

rehab program. Exercise can improve the functionof your heart and lungs.

Exercise can also strengthen the muscles used forbreathing to decrease your shortness of breath. It

is common for people with lung disease to limit

physical activities because they are fearful ofbecoming short of breath - but when you are

inactive, the strength of your muscles and heart

decline.


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Exercise training can take place one to one or

in a group setting. It may include walking,

stationary bicycling, water exercise, or simple

aerobics. Breathing training, relaxation

techniques, and energy conservation for many

daily activities are also addressed.


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Education

Education is an important part of a pulmonaryrehab program for both the person and family.

Education may include one-to-one teaching,

written materials and group classes. Videos

and other visual aides may also be used.

Teaching sessions with a healthcare provider

are very important. The sessions will help

provide you with information about yourspecific medications, treatments and self-

management at home.


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Emotion Management

A number of emotions can interfere with dailyliving. These include anxiety and depression.They can also increase shortness of breath.

Studies show that depression is commonbecause of the limitations caused by the chroniclung disease. Counseling can help you and yourfamily cope with the chronic disease. Classes on

managing stress, relaxation and coping withchronic illness may be offered. Some pulmonaryrehab programs may also have a support group

for you and your family.


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Nutrition

Weight management and nutrition are importantissues for people with chronic lung disease.

Shortness of breath and fatigue can interfere with

your ability to eat a balanced diet. The amount andtype of food, as well as the timing of meals can cause

increased shortness of breath. A dietitian can offer

practical suggestions for healthy nutrition, food

selection and preparation. Individualized diet plansmay be developed when problems such as fatigue,

shortness of breath, swallowing, or poor appetite

interfere with good nutrition.


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Consequences of respiratory disease

Peripheral muscle dysfunction

Respiratory muscle dysfunction

Nutritional abnormalities Cardiac impairment

Skeletal disease

Sensory deficits Psychosocial dysfunction


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Mechanisms for these morbidities

Deconditioning

Malnutrition Effects of hypoxemia

Steroid myopathy or intensive care unit (ICU)neuropathy

Hyperinflation

Diaphragmatic fatigue

Frequent hospitalizations

Effects of various medications Psychosocial dysfunction resulting from anxiety,

depression, guilt, dependency, and sleepdisturbance


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Principal goals of pulmonary

rehabilitation Pulmonary rehabilitation aims to reduce

symptoms, decrease disability, increaseparticipation in physical and social activities, andimprove the overall quality of life (QOL) for

patients with chronic respiratory disease.1

These goals are achieved through patient and

family education, exercise training, psychosocialand behavioral intervention, and outcome

assessment. The rehabilitation intervention is geared toward

the unique problems and needs of each patientand is implemented by a multidisciplinary teamof health care professionals.


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Disease, impairment, disability, and

handicap Disease is a pathologic condition of the body with a unique set

of symptoms and signs, often resulting in impairment. Theimpairment may lead to functional deficit.

Impairment is any loss or abnormality of psychological, physical,or anatomic structure or function.

Disability is any restriction or lack of ability (as a result of animpairment) with regard to the performance of an activity in themanner or within the range that is considered normal for ahuman being. Impairment of activities of daily living (ADL) hasan impact on the capacity of the individual to liveindependently.

A handicap is a disadvantage for a given individual, resultingfrom an impairment or a disability that limits or prevents thefulfillment of a role that is normal for that individual.


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For patients with pulmonary impairment,

disability can be due to muscle dysfunction,

primary skeletal or cardiopulmonary

pathology, poor endurance, or somecombination of impairments. The patient can

be handicapped further by inadequate

finances, inadequate family support oreducation, and various public policies.


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Components of Comprehensive

Pulmonary Rehabilitation

Comprehensive pulmonary rehabilitation

programs generally have the following 4 major

components:

Exercise training

Education

Psychosocial/behavioral intervention

Outcome assessment.


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Education

1. Energy conservation and work simplification.

2. Medications and other therapies.3. End-of-life education.


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Chest physical therapy and breathing

techniques

Pursed-lip breathing

Posture techniques

Diaphragmatic breathing


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Measures of disability

Exercise testing

Walking tests

Exertion and overall dyspnea Respiratory specific functional status

pulmonary rehabilitation pp

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