An integral part of the clinical management and health maintenance of patients with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment.
Patients with chronic respiratory disease typically experience dyspnea, fatigue, exercise intolerance, impaired quality of life, and impaired ability to perform activities of daily living.
Pulmonary rehabilitation, also known as respiratory rehabilitation.
Extra pulmonary manifestations of chronic respiratory disease include: limb muscle weakness, nutritional disturbances, anxiety, depression, cardiovascular deconditioning, poor self management skills, all of which contribute to functional limitation and additional impaired lung function.
Pulmonary rehabilitation address is pulmonary and extrapulmonary features of chronic respiratory disease by adding benefits of pharmacotherapy and improving patient outcomes.
It is part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment.
It is interventions for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities.
It is comprehensive intervention for patients with chronic respiratory diseases who are symptomatic.
Unlike the cardiovascular or musculoskeletal systems, the pulmonary system shows minimal to no improvement with physical training.
They are services administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient.
Pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD.
Refers to a series of services that are administered to patients of respiratory disease and their families.
There is a reduction in exacerbations in COPD patients who perform daily exercise when compared to those who did not exercise.
Exercise is the primary factor in pulmonary rehabilitation programs.
Exercise improves physical conditioning.
Aerobic exercise tends to improve the body’s ability to use oxygen by decreasing the heart rate and blood pressure.
Resistance exercises can help build strength in the respiratory muscles.
Stretching and flexibility exercises enhance breathing coordination.
It is generally specific to the individual patient’s needs.
Additionally drug interventions may be used in pulmonary rehabilitation including: anti-inflammatory agents,bronchodilators, long-acting bronchodilators, beta-2 agonists, anticholinergic agents, oral steroids, antibiotics, mucolytic agents, and oxygen therapy.
Core components of pulmonary rehabilitation include supervised multi modality exercise training, education, optimization of self management, and psychosocial support.
Patients undergo endurance and strength training to improve capacity.
Exercise modalities include walking, cycling, free or machine-based weights, and stair climbing.
Participants or trained to practice energy conversation conservation, and breathing techniques.
Supplemental oxygen is administered as needed.
Education focuses on self management of disease and promotion of health enhancing behaviors, including smoking cessation, proper use of neck medication and oxygen, healthy nutrition and weight management, physical activity and exercise routines and the early recognition and management of respiratory exacerbations.
Attempts to improve the quality of life.
May be carried out in a variety of settings, and may or may not include pharmacologic intervention.
PR SHould be offered to all patients disabled by COPD.
It is indicated not only in patients with COPD but:
Cystic fibrosis
Bronchitis
Sarcoidosis
Idiopathic pulmonary fibrosis
Before and after lung surgery
Interstitial lung disease
Goals of pulmonary rehabilitation:
To reduce symptoms
To improve knowledge of lung condition.
To promote self-management.
To increase muscle strength and endurance
To increase exercise tolerance
To reduce length of hospital stay
To help to function better in day-to-day life
To help in managing anxiety and depression
They are services administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient.
Pulmonary rehabilitation should be offered to all patients who consider themselves functionally disabled by COPD.
Pulmonary rehabilitation is one of the most effective treatments for COPD and other chronic respiratory diseases including interstitial lung disease, bronchiectasis, cystic fibrosis, asthma, pulmonary hypertension, and lung cancer.
Pulmonary rehabilitation involves supervised exercise training of the upper and lower extremities, education, collaborative self management training, psychosocial intervention in patients who are medically stable.
Pulmonary rehabilitation is effective when provided early after COPD exacerbation, and is associated with improved exercise tolerance and quality-of-life and reduced risk of subsequent hospitalization.
Aims of PR:
To reduce symptoms
To improve knowledge of lung condition
To promote self-management
To increase muscle strength and endurance
To increase exercise tolerance
To reduce length of hospital stay
To help to function better in day-to-day life
To help in managing anxiety and depression
PR results in:
Reduction in number of days spent in hospital one year following pulmonary rehabilitation.
Reduction in the number of exacerbations
COPD associated with the following:
Ventilatory limitation
Increased dead space ventilation
Impaired gas exchange
Increased ventilatory demands due to peripheral muscle dysfunction
Gas exchange limitation
Compromised functional inspiratory muscle strength
Compromised inspiratory muscle endurance
Cardiac dysfunction
Increase in right ventricular afterload due to increased peripheral vascular resistance.
Skeletal muscle dysfunction
Average reduction in quadriceps strength decreased by 20-30% in moderate to severe COPD
Reduction in the proportion of type I muscle fibres and an increase in the proportion of type II fibres compared to age matched normal subjects
Reduction in capillary to fiber ratio and peak oxygen consumption
Reduction in oxidative enzyme capacity and increased blood lactate levels at lower work rates compared to normal subjects
Prolonged periods of under nutrition which results in a reduction in strength and endurance
Respiratory muscle dysfunction
Pulmonary rehabilitation is generally specific to the individual patient.
The setting of pulmonary rehabilitation include inpatient care, outpatient care, physician’s office or the patient’s home.
PR includes: – Medication management, Exercise training, Breathing retraining, Education about the patient’s lung disease and how to manage it, Nutrition counseling and Emotional support.
Pharmacologic medications may be used in the process of pulmonary rehabilitation include Anti-inflammatory agents such as inhaled steroids, Bronchodilators, Long-acting bronchodilators, Beta-2 agonists, Anticholinergic agents, Oral steroids, Antibiotics, Mucolytic agents, Oxygen therapy, or Preventative therapy such as vaccination.
Exercise is the cornerstone of pulmonary rehabilitation programs,athough it does not directly improve lung function.
Exercise causes physiological adaptations which can improve physical condition.
Aerobic exercise improves the body’s ability to use oxygen by decreasing the heart rate and blood pressure.
Strengthening or resistance exercises can help build strength in the respiratory muscles.
Stretching and flexibility exercises enhance breathing coordination.
It is important to build up the level of exercise gradually.
Pursed lip breathing can be used to increase oxygen level in patient’s body.
Pursed lip breathing can increase oxygen levels
The exclusion criteria for pulmonary rehabilitation: consists of the following:
Unstable cardiovascular disease
Orthopaedic contraindications
Neurological contraindication
Unstable pulmonary disease
Clinical improvement in outcomes due to pulmonary rehabilitation is measured by:
Exercise testing using exercise time.
Walk test using the 6-minute walk test.
Exertion and overall dyspnea assessment.
Respiratory functional tests
Among patients hospitalized for COPD the initiation of pulmonary rehabilitation within 90 days of discharge from the hospital showed a reduction in all-cause mortality at one year.
Initiation of pulmonary rehabilitation within 90 days was associated with a 7.3% lower risk of death than patients who initiated such therapy after 90 days or not at all (19.6%).
Pulmonary rehabilitation is associated with improvement in symptoms, physical, emotional, and social functioning and overall quality of life.
Pulmonary rehabilitation improves the mean six minute walk distance and decreases COPD exacerbations, rehospitalizations and reduces mortality.
Pulmonary rehabilitation benefits typically last 8 to 12 months.