Pulmonary Rehabilitation Health Article

KEY TERMS

ADL—Activity of daily living.

COPD—Chronic obstructive pulmonary disease. Included are such conditions as chronic bronchitis and emphysema.

Dyspnea—Difficulty breathing or shortness of breath

Spirometer—A device used to measure lung performance.

tasks. Some of the muscle groups used in arm and upper torso positioning serve respiratory functions, and thus upper extremity conditioning can also have a beneficial effect on ventilation.

The aerobic exercise component comprises such activities as walking or using a stationary bicycle, treadmill, or other equipment. Exercise is monitored by physical therapists, respiratory nurses, or other qualified health care providers. Blood pressure, heart rate, oxygen saturation, and dyspnea levels are evaluated to determine the appropriate exercise prescription, and may be monitored during exercise sessions. Ventilatory training may also be included in the exercise program for certain patients. This therapy involves controlled breathing exercises; such chest physical therapy techniques as postural drainage, chest percussion, directed cough, and vibration; and training of the inspiratory muscles.

The educational component of the rehabilitation program consists of classes, reading materials, and counseling or training sessions that cover various specific subjects, procedures, and issues of importance to patients with chronic pulmonary disease. Education is provided by a variety of professionals, including respiratory nurses, respiratory therapists, occupational therapists, physical therapists, social workers, and dieticians. A psychologist or other mental health professional may provide counseling to address depression, anxiety, social isolation, or other psychosocial symptoms related to COPD.

Some of the educational subjects covered include anatomy and physiology related to pulmonary function and disease; exercise theory; nutrition; techniques for using oxygen and inhalers; and ways to conserve energy. Education related to good nutrition and weight management can be helpful, because patients may be undernourished and have muscle wasting of the respiratory muscles, which can make breathing more difficult. If anemia is present, it can decrease oxygen-carrying capacity. Electrolyte imbalances affect cardiopulmonary performance, so these and other deficiencies should be treated in order to improve functioning. If patients are overweight, the extra weight increases oxygen and energy demands and may increase fatigue. Patients who have not yet stopped smoking should be strongly encouraged to do so.

Preparation

Examination and referral by a physician are generally required before a patient begins pulmonary rehabilitation. A medical history should be provided to the rehabilitation team. Some tests that may be administered prior to the patient's entry into a rehabilitation program include pulmonary function tests (PFTs), chest x-rays, arterial blood gas (ABG) analysis, pulse oximetry, and sputum examination. PFTs are performed with a spirometer to measure lung performance and determine the presence and extent of lung disease. A chest x-ray can detect emphysema and other lung disease, including lung cancer, for which there is increased risk among smokers with COPD. Pulse oximetry measures oxygen in the blood and helps determine when supplemental oxygen is required. Exercise tests may be used to determine the length and intensity of the exercise prescription.

Aftercare

Patients may be able to participate in various follow-up or maintenance programs or support groups, as well as check-ins with their physician, in order to maintain benefits and continue monitoring their condition.

Complications

Risk of such complications as muscle injury or cardiac reactions is always present with exercise, but will be minimized by careful exercise prescription and monitoring. Disease-related complications that should be watched for include fever, unusual or extreme shortness of breath, irregular pulse, unanticipated weight changes, gastric complaints, or any other change that is unusual for the patient.

Results

The primary goals of cardiac rehabilitation are to reduce symptoms and respiratory impairment, and to improve the patient's quality of life and possibly prolong their life. Some of the specific changes that affect overall improvement in health, functioning and quality of life include: improvement in pulmonary function, reduction of the work involved in breathing, increased efficiency of energy use, improved exercise performance, increased function in activities of daily living, alleviation of dyspnea,

nutritional correction, and improved emotional state. Other possible results are a decrease in frequency and duration of hospital stays and decrease in use of other health care resources.

Health care team roles

The various educational and therapeutic components of a comprehensive pulmonary rehabilitation program are best addressed by a variety of health care professionals. The team may include respiratory nurses; respiratory, physical and occupational therapists; psychologists or other mental health professionals; exercise specialists; and dieticians, as well as a program director. The physical therapist may be involved in exercise prescription and monitoring; providing education in areas related to anatomy, physiology, exercise, and physical therapy; and providing such other therapeutic treatments as chest physical therapy.