Pulmonary Rehabilitation

Pulmonary Rehabilitation

 

 

 

 

                                                                                                                                                                 Dr Kripesh Ranjan Sarmah

Consultant pulmonologist and sleep specialist

kripeshdoc@gmail.com                                                                                         

Pulmonary rehabilitation is an evidence-based, multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Pulmonary Rehabilitation is the medical art and science by which people disabled with lung disease is returned to a more active and enjoyable life style.

Three important features of successful rehabilitation are:

1.Multidisciplinary: Pulmonary rehabilitation programs utilize expertise from various health-care disciplines that is integrated into a comprehensive, cohesive program tailored to the needs of each patient.

2.Individual: Patients with disabling lung disease require individual assessment of needs, individual attention, and a program designed to meet realistic individual goals.

3.Attention to physical and social function: To be successful, pulmonary rehabilitation pays attention to psychological, emotional, and social problems as well as physical disability, and helps to optimize medical therapy to improve lung function and exercise tolerance.

The aims of pulmonary rehabilitation are-

•         To reduce disability and handicap of persons with chronic respiratory impairments.

•         To restore patients to the highest possible level of independent functioning.

Goals are integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to

–        Increase exercise tolerance in order to reduce impairment.

–        Improve compliance to recommended treatments.

–        Reduce frequency and severity of symptoms.

–        Improve mood and motivation.

–        Reduce dependency.

–        Enhance participation in therapy decisions by building self-management capacity.

–        Increase participation in everyday activities.

–        Improve quality of life.

–        Reduce health care burden for patients, families and communities.

–        Improve survival.

Multidisciplinary Rehabilitation Team provide the services

Core Team includes pulmonologists, respiratory therapists, physiotherapists, occupational therapists, nurses, care coordinators, rehabilitation assistants and nutrisonist.

 Consultation is required in PFT/ Sleep Lab, exercise Lab, dietician, pharmacist, recreation therapist, social worker, psychologist, psychiatrist, priest/ chaplain etc as needed.

The types of patients who need pulmonary rehabilitation

Patients with stable COPD (moderate – severe), Bronchiectasis, Emphysema, IPF or any chronic respiratory diseases can be included in the training programme. The patients should have -

• Persistent symptoms, limited activity, and/or are unable to adjust to illness despite of optimal medical management
• Motivated to regain energy for ADL and functional ability and good quality of life

Following types of patients were excluded from exercise component:

•         Patients who have severe cognitive impairment, severe psychotic disturbance and have a relevant infectious disease are not included in the programme.

•         Musculoskeletal or neurological disorders that prevent gentle exercise.

•         Unstable cardiovascular disease (e.g. unstable angina, aortic valve disease, unstable pulmonary hypertension).

•         Known metastatic cancer

Indications for Referral to pulmonary rehabilitation

Patients at certain stage of their disease benefit most from pulmonary rehabilitation. Therefore timely referral is necessary. The following are the criteria based on which a patient can be referred for pulmonary rehabilitation ---

•         Dyspnea at rest or on exertion

•         Decreased exercise tolerance or difficulty performing activities of daily living

•         Oxygen evaluation

•         Pre-operative rehabilitation to maximize medical status prior to lung surgery

•         Evaluation of respiratory failure and the elective initiation of mechanical ventilation

•         Unexpected deterioration / worsening of symptoms

•         COPD patients at stage 2 or 3 who are limited in their activity.

Duration of training

In case of In-patient duration of 6 –7 weeks is required but for out-patient 14-17 weeks is essential

Designing and Prescribing an Exercise Program

Designing of program depends on the capacity, limitation and goal. Patient is offered customized as well as generalized rehabilitation program. After completion of training patients’ are given advice regarding home rehabilitation program.

Follow-Up

Scheduled follow up is advised after 1-3 months of training program. Subsequent appointments are scheduled every 3 months for the first year, and then frequency is reduced to biannual/annual if stable.

Conclusion

Rehabilitation programs for patients with chronic lung diseases are well-established as a means of enhancing standard therapy in order to control and alleviate symptoms and optimize functional capacity. The primary goal is to restore the patient to the highest possible level of independent function. This goal is accomplished by helping patients become more physically active, and to learn more about their disease, treatment options, and how to cope. Patients are encouraged to become actively involved in providing their own health care, more independent in daily activities, and less dependent on health professionals and expensive medical resources. Rather than focusing solely on reversing the disease process, rehabilitation attempts to reduce symptoms and reduce disability from the disease. Pulmonary rehabilitation is appropriate for any stable patient with a chronic lung disease who is disabled by respiratory symptoms. Patients with advanced disease can benefit if they are selected appropriately and if realistic goals are set. Pulmonary rehabilitation provides a multidisciplinary care to chronic lung diseases and help to lead a comfortable life with their limitations due to underlying disease.

References

o   American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med Vol 173. pp 1390–1413, 2006

o   American College of Chest Physicians, American Association of Cardiovascular and Pulmonary Rehabilitation. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines. ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. Chest 1997;112:1363– 1396

o   Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 2007; 131; 4-42