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Pulmonary Rehabilitation PowerPoint Presentation

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Description : Check out this medical presentation on Physiotherapy and Physical Rehabilitation, which is titled "Pulmonary Rehabilitation", to know about Pulmonary Rehabilitation.

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Published on : Aug 02, 2021 | Views : 70 | Downloads : 0

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Pulmonary Rehabilitation Presented by Wyatt E. Rousseau, MD
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Background COPD is 4th leading cause of death 13% of total hospitalizations Second to CAD for payment of Social Security disability benefits Exercise intolerance – dyspnea/fatigue
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Pathophysiology Severity of lung disease Extrapulmonary manifestations thought to be due to deconditioning* Skeletal muscle dysfunction: decreased aerobic enzyme activity, low fraction of aerobic fibers, decreased capillarity, inflammatory cells, and increased apoptosis. All lead to early onset of lactic acidosis, decreasing aerobic activity. *Wagner, PD. Skeletal muscles in chronic obstructive pulmonary disease: deconditioning or myopathy? Respirology 2006; 11:681-686.
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Pulmonary Rehabilitation Evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily activities. It is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs by stabilizing or reversing systemic manifestations of the disease. Nici, L et.al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006; 173: 1390.
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Pulmonary Rehabilitation Candidates Any patient with impairment because of lung disease and who is motivated should be a candidate for pulmonary rehabilitation.
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Pulmonary Rehabilitation Common Indications for Referral to Pulmonary Rehabilitation Anxiety engaging in activities Breathlessness with activities Limitations – Social, Leisure, Chores, ADL’s Loss of Independence Especially those whose dyspnea is out of proportion to lung function or those with primarily leg fatigue limiting exercise
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Pulmonary Rehabilitation Common conditions leading to referral to pulmonary rehabilitation COPD Bronchiectasis Chronic Asthma Post surgery ILD Neuromuscular Disease Cystic Fibrosis Exacerbations
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Pulmonary Rehabilitation Contraindications PSYCHIATRIC Dementia Organic Brain Syndrome MEDICAL Unstable cardiac Substance abuse Cancer (relative) Liver Failure Neurologic or Orthopedic condition preventing ambulation
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Pulmonary Rehabilitation Effect on Exercise Capacity from Lacasse,Y et.al. Lancet 1996; 348:1115
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Pulmonary Rehabilitation Education Exercise
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Pulmonary Rehabilitation Education Diagnosis Smoking Cessation Pharmacology Respiratory Therapy Physical Therapy Occupational Therapy Therapeutic Recreation Nutrition Psychosocial
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Pulmonary Rehabilitation Exercise Physical Therapy Occupational Therapy Respiratory Therapy
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Pulmonary Rehabilitation-Education Diagnosis Physician Pulmonary Function Tests Spirometry ABG’s Diffusing Capacity Inhalation Challenge Exercise Testing Cardiac Tests
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Pulmonary Rehabilitation-Education Smoking Cessation Counseling (Ask, Advise, Assess, Assist, Arrange F/U) Nicotine Replacement Anxiolytic/Antidepressant Varenicline Support (Quit date, past quit experience, challenges, other smokers)
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Pulmonary Rehabilitation-Education Pharmacology OXYGEN BRONCHODILATORS Beta-agonists, LA and SA Anticholinergics, LA and SA Theophylline, other PDEI’s ANTI-INFLAMMATORY Corticosteroids Leukotriene Antagonists
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Pulmonary Rehabilitation-Education & Exercise Respiratory Therapy Breathing Techniques Pursed lip Diaphragmatic Medication Delivery Systems Peak Flow Measurement Self Management
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Pulmonary Rehabilitation-Education & Exercise Physical Therapy MAXIMIZE FUNCTIONAL INDEPENDENCE Exercise Energy conservation Oxygen Adaptive devices
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Exercise - Heliox Eves ND, Sandmeyer LC, Wong EY, et. Al. Helium-Hyperoxia: A Novel Intervention to Improve the Benefits of Pulmonary Rehabilitation for Patients with COPD. Chest. 2009:135:609-618. Breathing helium-hyperoxia (60% He-40% O2) during pulmonary rehabilitation increases the intensity and duration of exercise training that can be performed and results in greater constant-load exercise time for patients with COPD.
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Exercise - Heliox Chiappa GR, Queriroga F, Meda, E. Heliox Improves Oxygen Delivery and Utilization During Dynamic Exercise in Patients with COPD. Am J Respir Crit Care Med 2009; Heliox (79% He-21%O2) increases lower limb O2 delivery and utilization during dynamic exercise in patients with moderate-to-severe COPD. These effects contribute to enhance exercise tolerance in this patient population.
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Pulmonary Rehabilitation-Education & Exercise Occupational Therapy MAXIMIZE FUNCTIONAL INDEPENCENCE Exercise Energy conservation Self care Adaptive devices
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Pulmonary Rehabilitation-Education Nutrition WEIGHT MANAGEMENT DIETS Supplements Restrictions VITAMINS/ADDITIVES
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Pulmonary Rehabilitation-Education Psychosocial Issues INSURANCE/REIMBURSEMENT QUALITY OF LIFE CONCERNS SOCIAL SITUATION CHAPLAIN CONSULTATION ETHICS ISSUES
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Pulmonary Rehabilitation INPATIENT ADVANTAGES 24 hour nursing care Sicker patients No transportation problems Family participation Best for ventilator, tracheostomy patients DISADVANTAGES Cost and insurance difficulties Not suitable for less severe patients Family transportation problems
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Pulmonary Rehabilitation OUTPATIENT ADVANTAGES Widely available Less costly Least intrusive to family Efficient use of staff DISADVANTAGES Potential transportation problems Cannot observe home activities
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Pulmonary Rehabilitation HOME - BASED ADVANTAGES Convenience to patient Transportation no issue Exercise in familiar environment may lead to better adherence long term DISADVANTAGES Cost/insurance issues Lack of group support Lack of full spectrum of multidisciplinary personnel
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Pulmonary Rehabilitation Adverse Effects Musculoskeletal injury Exercise-induced bronchospasm Cardiovascular event (increased risk among COPD patients)
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Pulmonary Rehabilitation Exercise Effect Data from Am J Respir Crit Care Med 1999; 159;321
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Effect of Therapy- Does Not improve lung mechanics or gas exchange, but optimizes other body systems* Muscle biochemistry-higher work rates with less lactic acidosis leading to decreased carotid-body stimulation Reduced dynamic hyperinflation through reduced ventilatory demand Desensitization to dyspnea: antidepressant effect, social interaction, self management, and adaptive behaviors *Casaburi, R and ZuWallack. Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease. N Engl J Med 2009; 360:1329-1335.
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Pulmonary Rehabilitation Benefits in COPD Improves exercise capacity - Evidence A Improves perceived breathlessness - Evidence A Improves quality of life – Evidence A Reduces hospitalizations and LOS – Evidence A Reduces anxiety and depression – Evidence A UBE improves arm function – Evidence B Benefits extend beyond training period – Evidence B Improves survival – Evidence B