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Definition
Pulmonary rehabilitation is a multidisciplinary, individually designed intervention program, including exercise and education, that helps patients with chronic lung disorders manage the physiological and psychosocial symptoms of their condition and improve their level of daily functioning and well-being.
Purpose
The purpose of a pulmonary rehabilitation program is to help patients with chronic obstructive pulmonary disease (COPD) or other chronic lung conditions manage their condition. Exercise and education are provided to help increase the patient's level of fitness and independent functioning; reduce dyspnea and psychological symptoms (anxiety, depression, social isolation); slow down or prevent the progression of disease; and improve quality and possibly length of life.
Pulmonary rehabilitation has not been found to improve pulmonary function, and that is not its goal. Other measures of physiologic improvement such as improved muscle function, cardiac function, and aerobic function have been found, and the main purpose of cardiac rehabilitation is to "reverse the deconditioning and psychosocial accompaniments of pulmonary disability." Pulmonary rehabilitation is also increasingly recognized as valuable in preparation for lung transplantation and lung volume-reduction surgery, which require patients to have good physical conditioning.
Precautions
Patients should be examined by a physician before beginning rehabilitation. Certain coexisting medical conditions, especially those that preclude or limit exercise, may contraindicate pulmonary rehabilitation, or require
| Essentials of pulmonary therapy | |||
| Treatment components | Purpose | How to perform | When to use |
| SOURCE: Mackenzie, C.F., et al. Chest Physiotherapy in the Intensive Care Unit. Baltimore, MD: Williams & Wilkins, 1981. | |||
| Breathing exercises | Assists in removing secretions; | Patient is taught to produce a full inspiration | When patients are breathing |
| relaxation; and used to increase | followed by a controlled expiration; use hand | spontaneously | |
| thoracic cage mobility and tidal volume | placement for sensory feedback | ||
| Coughing | Removal of secretions from the larger | Steps: (1) Inspiratory gasp; | When patients are breathing |
| airways | (2) Closing of the glottis; | spontaneously | |
| (3) Contraction of expiratory muscles; | |||
| (4) Opening of the glottis | |||
| Percussion | Used with postural drainage for | Rhythmic clapping of cupped hands over bare | When coughing or suctioning, |
| mobilization of secretions | skin or thin material covering area of lung | breathing exercises, and patient | |
| involvement; performed during inspiration | mobilization are not adequate | ||
| and expiration | to clear retained secretions | ||
| Postural drainage | Mobilize retained secretions through | Patient positioned so that involved segmental | Same as above |
| assistance of gravity | bronchus is uppermost | ||
| Vibration | Used with postural drainage for mobilization | Intermittent chest wall compression over area | Same as above |
| of secretions | of lung involvement; performed during | ||
| expiration only | |||
modification and special precautions. Since treatment is individualized, any special needs will be addressed in the exercise prescription and program design. Some particular conditions that may contraindicate participation in pulmonary rehabilitation include acute respiratory infection, ischemic cardiac disease, congestive heart failure, serious liver dysfunction, disabling stroke, severe psychiatric or cognitive disorders, acute cor pulmonale, severe pulmonary hypertension, and metastatic cancer.
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Author Info: Diane Fanucchi B.A., C.M.T., The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Nursing and Allied Health, 2002 |
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