Pulmonary Rehabilitation

dr. Aminuddin , SpRM

Definition of pulmonary
rehabilitation

Pulmonary rehabilitation is a
program to people with chronic
lung diseases like COPD,
emphysema, and chronic
bronchitis lead full, satisfying
lives and restore them to their
highest functional capacity.

Pulmonary rehab is aimed to improve

quality of life by:
Decreasing respiratory symptoms and
complications
Encouraging self-management and control
over daily functioning
Improving physical conditioning and exercise
performance
Improving emotional well-being
Reducing hospitalizations

Components of Pulmonary
Rehab Programs
Most pulmonary rehab programs include:

Medical management
Exercise
Breathing retraining
Education
Emotional support
Nutrition counseling

Team Approach to Pulmonary Rehab

Most formal pulmonary rehab programs include
a team of healthcare providers working
together, like doctors, nurses, rehabilitation
therapists, psychosocial staff and dietitians. The
team evaluates each person's overall physical
and emotional status, and then develops an
individual program for him or her. The doctor, a
specially trained registered nurse, a
rehabilitation specialist or a respiratory care
practitioner coordinate the program.

Exercise

Exercise is a key part of a pulmonary

rehab program. Exercise can improve the function
of your heart and lungs.
Exercise can also strengthen the muscles used for
breathing to decrease your shortness of breath. It
is common for people with lung disease to limit
physical activities because they are fearful of
becoming short of breath - but when you are
inactive, the strength of your muscles and heart
decline.

 Exercise training can take place one to one or

in a group setting. It may include walking,
stationary bicycling, water exercise, or simple
aerobics. Breathing training, relaxation
techniques, and energy conservation for many
daily activities are also addressed.

Education
Education is an important part of a pulmonary
rehab program for both the person and family.
Education may include one-to-one teaching,
written materials and group classes. Videos
and other visual aides may also be used.
Teaching sessions with a healthcare provider
are very important. The sessions will help
provide you with information about your
specific medications, treatments and selfmanagement at home.

Emotion Management
A number of emotions can interfere with daily
living. These include anxiety and depression.
They can also increase shortness of breath.
Studies show that depression is common
because of the limitations caused by the chronic
lung disease. Counseling can help you and your
family cope with the chronic disease. Classes on
managing stress, relaxation and coping with
chronic illness may be offered. Some pulmonary
rehab programs may also have a support group
for you and your family.

Nutrition
Weight management and nutrition are important
issues for people with chronic lung disease.
Shortness of breath and fatigue can interfere with
your ability to eat a balanced diet. The amount and
type of food, as well as the timing of meals can cause
increased shortness of breath. A dietitian can offer
practical suggestions for healthy nutrition, food
selection and preparation. Individualized diet plans
may be developed when problems such as fatigue,
shortness of breath, swallowing, or poor appetite
interfere with good nutrition.

Consequences of respiratory disease

Peripheral muscle dysfunction

Respiratory muscle dysfunction
Nutritional abnormalities
Cardiac impairment
Skeletal disease
Sensory deficits
Psychosocial dysfunction

Mechanisms for these morbidities

Deconditioning
Malnutrition
Effects of hypoxemia
Steroid myopathy or intensive care unit (ICU)
neuropathy
Hyperinflation
Diaphragmatic fatigue
Frequent hospitalizations
Effects of various medications
Psychosocial dysfunction resulting from anxiety,
depression, guilt, dependency, and sleep
disturbance

Principal goals of pulmonary

rehabilitation

Pulmonary rehabilitation aims to reduce

symptoms, decrease disability, increase
participation in physical and social activities, and
improve the overall quality of life (QOL) for
patients with chronic respiratory disease.1
These goals are achieved through patient and
family education, exercise training, psychosocial
and behavioral intervention, and outcome
assessment.
The rehabilitation intervention is geared toward
the unique problems and needs of each patient
and is implemented by a multidisciplinary team
of health care professionals.

Disease, impairment, disability, and

handicap
Disease is a pathologic condition of the body with a unique set
of symptoms and signs, often resulting in impairment. The
impairment may lead to functional deficit.
Impairment is any loss or abnormality of psychological, physical,
or anatomic structure or function.
Disability is any restriction or lack of ability (as a result of an
impairment) with regard to the performance of an activity in the
manner or within the range that is considered normal for a
human being. Impairment of activities of daily living (ADL) has
an impact on the capacity of the individual to live
independently.
A handicap is a disadvantage for a given individual, resulting
from an impairment or a disability that limits or prevents the
fulfillment of a role that is normal for that individual.

For patients with pulmonary impairment,

disability can be due to muscle dysfunction,
primary skeletal or cardiopulmonary
pathology, poor endurance, or some
combination of impairments. The patient can
be handicapped further by inadequate
finances, inadequate family support or
education, and various public policies.

Components of Comprehensive
Pulmonary Rehabilitation
Comprehensive pulmonary rehabilitation
programs generally have the following 4 major
components:

Exercise training
Education
Psychosocial/behavioral intervention
Outcome assessment.

 Education
1. Energy conservation and work simplification.
2. Medications and other therapies.
3. End-of-life education.

Chest physical therapy and breathing

techniques
Pursed-lip breathing
Posture techniques
Diaphragmatic breathing

Measures of disability

Exercise testing
Walking tests
Exertion and overall dyspnea
Respiratory specific functional status