N Engl J Med. The functional consequences of these impairments are addressed so that the person with chronic respiratory impairment is returned to the fullest possible physical, mental, social, and economic independence. Courtesy of D. Sciberras.  The minimal increase that is clinically meaningful in 6-minute walking distance is about 54 meters. Controlled trials have shown a decrease in health care resource use after rehabilitation, indicated by reduction in the number of hospitalizations and emergency department or physician office visits. 1) Symptomatic Pt. Mueller RE, Petty TL, Filley GF. Oxygen supplementation during exercise can reduce dyspnea, improve exercise tolerance, and prevent increases in pulmonary artery pressure. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Reduction in hospitalisation following pulmonary rehabilitation in patients with COPD. Because the performance of many ADL involves the use of the arms, endurance training of the upper extremities to improve arm function is important. There are two primary exclusion criteria for pulmonary rehabilitation: 1. Understanding the physiologic basis for the patient’s inability to exercise is an important aspect in prescribing effective therapy (i.e., cardiac or pulmonary rehabilitation). Pulmonary rehabilitation. Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important 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. These goals are achieved through patient and family education, exercise training, psychosocial and behavioral intervention, and outcome assessment. The response to theophylline therapy may vary among patients with severe COPD. The usual drug-dosing schedule is the same for all 3 brands. The effectiveness of a comprehensive pulmonary rehabilitation program has been established by controlled clinical trials. The patient is taught to employ only the diaphragm during inspiration and to maximize abdominal protrusion. Pulmonary rehabilitation improves symptoms, quality of life, pulmonary function, and health care utilization in patients with chronic respiratory disease. 2008 Jul. Depression is often comorbid with COPD.  Supported arm exercises are prescribed with ergometry or unsupported arm exercises by lifting free weights or stretching armbands. Importance: Meta-analyses have suggested that initiating pulmonary rehabilitation after an exacerbation of chronic obstructive pulmonary disease (COPD) was associated with improved survival, although the number of patients studied was small and heterogeneity was high. Revised interim recommendations for antiviral treatment and prophylaxis of influenza were issued by the US Centers for Disease Control and Prevention (CDC). C. Nationally Non-Covered Indications. These questions should be assessed in future investigations. This assessment does not take account of lean body mass, although serial follow-up measurements are useful. Several complications, including pneumonia and prolonged air leaks, have been observed. Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, World Medical AssociationDisclosure: Nothing to disclose. Giant bullectomy can produce subjective and objective improvement in selected patients who have bullae that compress the adjacent lung and that occupy at least 30% (but preferably, 50%) of the hemithorax, who have an FEV1 of less than 50% predicted, and who otherwise have relatively preserved lung function. Significant increases in maximal exercise capacity, as measured during exercise testing, have been observed. Perhaps for selected patients with stable but advanced chronic obstructive pulmonary disease (COPD), noninvasive positive pressure ventilation could be used to help patients exercise more. [Medline]. Please confirm that you would like to log out of Medscape. Chest physical therapy remains an essential component of therapy for bronchiectasis and cystic fibrosis. Nutrition counseling to address the planning and preparation of a nutritionally adequate meal plan, the adequacy of the food supply, the use of nutritional supplements, and other details is essential to the success of any intervention program. Oxygen therapy generally is safe. Ries AL, Kaplan RM, Limberg TM, et al. Medscape Education. [Medline]. 2006. Gray-Donald K, Gibbons L, Shapiro SH, et al. During expiration, the patient may contract the abdominal wall muscles to displace the diaphragm more cephalad. An individual who smokes 1 pack per day should use 4-mg pieces. In the United States, 4 prescription antiviral medications (oseltamivir, zanamivir, amantadine, rimantadine) have been approved for the treatment and chemoprophylaxis of influenza. Supplemental oxygen therapy for patients with severe hypoxemia at rest or with exercise has shown to be beneficial. Little is known about the long-term effects of low-flow oxygen. Nicotine polacrilex is a chewing gum with better quit rates than counseling alone. Because of the progressive nature of COPD, risk of respiratory failure increases over time. . The value of this therapy in stable patients with COPD and in acute COPD exacerbation is uncertain. Amarjit Arneja, MD Director of Amputee Rehabilitation Program, Associate Professor, Department of Medicine, Section of Rehabilitation Medicine, University of Manitoba, Canada 2002
This test is reproducible and is sensitive to improvements from pulmonary rehabilitation. QOL may be considered a balance between what is desired in life and what is achieved (although these indicators are difficult to measure). Despite a substantial variability in program structure, the efficacy of pulmonary rehabilitation performed in inpatient, outpatient, or home settings has been documented. However, these indicators generally are not reliable in identifying inadequate nutrition. In patients with COPD, chronic infection or colonization of the lower airways is common from Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Pulmonary rehabilitation programs use multidisciplinary teams to optimize physical and social functioning of patients with chronic respiratory impairment. Nutritional status and mortality in chronic obstructive pulmonary disease. Adding theophylline to the combination of bronchodilators can be of further benefit to patients with stable COPD. O6.1 Pulmonary rehabilitation Non-pharmacological strategies (such as pulmonary rehabilitation and regular exercise) should be provided to all patients with COPD [evidence level I, strong recommendation] Pulmonary rehabilitation programs involve patient assessment, supervised exercise training, education, behaviour change, nutritional intervention and psychosocial support (Spruit 2013). The influenza vaccines are inactivated preparations of the virus or the split products. Therefore, pulmonary rehabilitation is effective for patients with disability due to any chronic respiratory disease, not just COPD. These programs provide rehabilitation in inpatient, outpatient, or home settings, using at least three sessions weekly (one … Treatment with aerosolized anticholinergic agents (eg, ipratropium bromide) may be more effective than a beta-2 agonist would be in patients with COPD. Patients treated with a double lung transplant tolerate bronchiolitis obliterans syndrome better than do patients with a single transplant. The indications and patient selection criteria for LVRS have not been rigorously defined. [Medline]. Pulmonary rehabilitation is the use of exercise, education, and behavioral intervention to improve functional capacity and enhance quality of life in patients with chronic respiratory disorders. [Medline]. The 6-minute and 12-minute walk tests, as well as shuttle walk tests, correlate positively to peak exercise performance on graded exercise tests. Several impairments, such as weakness, dysfunction of peripheral and respiratory muscles, anxiety and depression, and abnormalities of nutrition, have responded to treatment. Most of the medications employed are directed at 4 potentially reversible causes of airflow limitation in a disease state with largely fixed obstruction. Body composition can be evaluated using anthropometry, bioelectrical impedance analysis, or dual-energy radiographic absorptiometry (DRA), which estimates lean body mass. Pursed lip breathing may help to decrease dynamic hyperinflation, particularly during exercise. B. Oxygen was used from 15-19 hours per day. 1993 Sep. 48(9):936-46. This technique relieves dyspnea by increasing expiratory airway pressure, thereby inhibiting dynamic expiratory airway collapse. [Full Text]. 2016. The benefits of respiratory muscle rest with noninvasive, positive-pressure mechanical ventilation need to be further explored. 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