Transcript COPD Rehabilitation

Pulmonary Rehabilitation In
COPD
BY
Prof . Mohammad El- Desouky Abo- Shehata
Prof . Of Thoracic Medicine
Mansoura University
Chronic Obstructive Pulmonary Disease
Definition
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COPD is a common preventable and treatable disease ,
characterized by persistant airflow limitation that is usually
progressive and associated with an enhanced inflammatory
response in the airway and the lung to noxiouse particles or gases .
Exacerbations and co-morbidities contributes to overall severity in
individuals patients
( GOLD ( 2011 )
Prevalence Of COPD
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COPD is one of the most common diseases affecing elderly people allover the
world
COPD affects approximately16% of people over the age of 65 years
worldwide
COPD is ranked the fourth cause of death of people over the age of 65 years
(WHO) estmated that by the year 2020 (COPD) will be the third leading cause
of deaths and the fifth cause of disability worldwide
According to WHO ; the estimated death rate in Egypt was 35,9/100.000 and
the estimated disability associated with COPD was 302/100.000
Buist et al (2007): International variation in the prevalence of COPD . Lancet; 370: 741-749
Viegi G, et al. (2001): Epidemiology of chronic obstructive pulmonary disease (COPD). Respiration;
68 (1): 4-19.
Impact of COPD ON (QOL)
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Quality of life is a feeling of overall life satisfaction
It is primary a subjective sense of well being ; including
physical, psychological, social and spiritual dimensions
COPD and its progression promote a cycle of physical,
psychological, and social consequences, All which interrelated
and have a negative impact on quality of life
Peruzza et al ; (2003 )
Pulmonary rehabilitation In COPD
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The principal goal of rehabilitation are to reduce symptoms ,
improve quality of life , and increase physical and emotional
participation in every day activities
Pulmonary rehabilitation covers a range of non - pulmonary
problems that may not be adequately addressed by medical
therapy of COPD, including exercise de-conditioning, altered
mood state (especially depression ), muscle wasting , weight
loss.
NICI .L. et al. ATS/ERS . Statement of pulmonary rehabilitation .Am J Resp And Crit
Care Med . 2006 ; 173 : 1390 - 413
Pulmonary Rehab Program
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Exercise training
Nutritional counseling
Education on lung disease or condition and how to manage it
Energy-conserving techniques
Breathing strategies
Psychological counseling and/or group support
Effect of a Pulmonary Rehabilitation Program on the
Quality of Life In Elderly Patients with COPD
Mohamed El-Desoky Abou Shehata*, El Sayed Zaki Hatata**,
Amany Mohamed Shebl***, and Doaa El Sayed Fadila***
*Chest Diseases Department, **Internal Medicine Department
Faculty of Medicine, Mansoura University
***Adult Nursing Department, ****Gerontological Nursing Department
Faculty of Nursing, Mansoura University
Aim of the study
Objective of this study was to assess the impact of pulmonary
Rehab program on ( QOL ) in elderly COPD patients
Subjects
Setting
This study carried out at chest departement ; Mansoura
university (from Jan to Dec/ 2011)
Subjects
 54 COPD elderly patients were randomly assigned into two
equal groups:
Study group : received Rehabilitation program (27 pt)
control group : received conventional treatment (27 pt )
Inclusion Criteria
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Aged 60 years and above.
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Clinically stable with no exacerbation in the last month.
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Had COPD diagnosed according to the criteria of GOLD, 2010
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Had COPD staged according to GOLD, 2010
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Walk unaided.
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Not involved in any other respiratory rehabilitation program.
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Free from any other respiratory or associated disorders as
heart failure
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Able to communicate and cooperate in program.
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Accept to participate in the study.
plan of work
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Each elderly patient in both control and study groups was
interviewed individually
The developed pulmonary rehabilitation program was
implemented on study group and conducted in 8 sessions over
2 weeks. Each session took about 30 minutes.
The developed pulmonary rehabilitation program was
conducted in small groups (3-5 patients/session )
Each patient in the study group was subjected to two types of
sessions: educational and training sessions.
Plan of work ( cont )
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Control group was subjected to educational session only
Patients of the study group were taught to perform these
exercises and instructed to do them at home after discharge
from the hospital for 2 month
Telephone visits were provided twice a week during 2 months
after discharge from hospital by the researcher for the study
group to check with them their consistency with program.
Educational sessions:
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were carried out in 4 sessions. They included the following:
First session (Respiratory system and COPD nature):
Second session (COPD medications):
Third session (Behavior and lifestyle modification 'Part 1'):
Fourth session (Behavior and lifestyle modification 'Part 2'):
Training sessions:
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Carried out in 4 sessions. Training sessions included the
following:
First session (Inspiratory muscle training):
Second session( Breathing retraining):
Third session (Upper and lower extremities exercise):
Fourth session (Airway clearance techniques):
Inspiratory Muscle Training
Incentive Spirometry
Breathing retraining (pursed lip breathing )
Breathing retraining (diaphragmatic breathing)
Upper Extremities Exercise
Stretching and strengthening exercise for upper and lower
extremities with using metal weights (1 and 2 Kgs).
6 - minute walk test
Outcomes measurement
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After two months ( post – 1 ) of discharge from the hospital
and applying the pulmonary rehabilitation program sessions,
evaluation for both study and control groups was done and
repeated after 4 months ( post 2 ) to determine the effect of
program using the study tools:
Saint's George Respiratory Questionnaire (SGRQ)
Clinical COPD Questionnaire (CCQ)
Pulmonary Function Test
Six minutes walk test (6 MWT)
Modified Borg Dyspnea Scale
Socio-demographic characteristics of the study and
control groups
Quality of life of the study and control groups pre
and post pulmonary rehabilitation program
Health status of the study and control groups pre
and post pulmonary rehabilitation program
Functional capacity and perceived dyspnea of the
study and control groups pre and post pulmonary
rehabilitation program
CONCLUSION
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The supervised, two-month home-based pulmonary
rehabilitation program is an effective non pharmacological
intervention in the management of stable COPD elderly
patients and maintained for 6 month
Pulmonary rehabilitation programs should be integrated
within the plan of care for COPD elderly patients
COPD elderly patients should be given a written instruction
plan for daily self-management measures
CONCLUSION
(cont )
These programs should emphasize
patient education about the disease process
 COPD medication, behavior and lifestyle modification
 Inspiratory muscles training, breathing retraining, upper
and lower extremities exercise,
 Airway clearance techniques,
 psychosocial support, different relaxation techniques
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