Management of stable COPD: Pulmonary Rehabilitation. Sheena Radford Rehabilitation Physiotherapist ARCaRe Team, Tower Hamlets

Transcription

1 Management of stable COPD: Pulmonary Rehabilitation Sheena Radford Rehabilitation Physiotherapist ARCaRe Team, Tower Hamlets

2 Summary of this talk What is COPD like? What is Pulmonary rehabilitation? The exercise component The education component Information about referring

3 Imagine a typical COPD patient What does it feel like to have COPD?? iw

4 The Vicious cycle Reduced exercise tolerance Fear of breathlessness Muscle weakness Fatigue, anxiety, isolation Inactivity/Immobility

5 What can the patient do about it? Ignore it that s just the way it is Keep trying different medication Have a serious go at smoking cessation Do something POSITIVE! This is not going to go away, but there is something that I can do to help myself and it will be worth putting in the effort

6 Pulmonary rehabilitation Is an evidence based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualised treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimise functional status, increase participation, and reduce health care costs through stabilising or reversing systemic manifestations of the disease ATS/ERS statement on pulmonary rehabilitation (2006) American journal of respiratory and critical care medicine, 173:

7 WHAT IS PR? A Multidisciplinary programme of care for patients with chronic respiratory impairment that is individually tailored and designed to optimise physical and social performance and autonomy. BTS statement 2001

8 How do you explain it? 8 week course, attending twice a week Only for people with breathing problems Run as a group (max 10) Gentle exercise to work on your fitness Lots of advice about self-management Choose your venue

9 Exercise The BTS statement on pulmonary rehabilitation (BTS, 2001) recommends that pulmonary rehabilitation must contain aerobic exercise, and may contain upper and lower limb strength exercises. The BTS also recommend that exercise frequency should be three times a week for 30 minutes. Intensity should be set at least 60% of maximum oxygen uptake; this can be derived from an exercise capacity test.

10 The Exercise Component Circuit of 8 exercises Mixture of strength training, endurance training and cardiovascular work Work on pacing breathing Work on recognising safe dyspnoea Encouraged to write down and progress each class Adapted to comorbidities and goal

11 Let s have a go!

12 Limiting symptoms in COPD patients at peak exercise Dyspnoea and leg fatigue 31% Dyspnoea 26% Leg fatigue 43% Killian KJ, et al

13 Skeletal muscle dysfunction Average reduction in quadriceps strength is 20-30% in moderate to severe COPD Change in muscle fibre type Reduced capacity of oxidative enzymes Reduced number of capillaries Inflammatory state Nutrition/ body mass + Respiratory muscle dysfunction

14 The Education Component What is COPD? Medications and Inhaler technique Managing breathlessness Chest Clearance techniques Energy conservation (OT) Emotions and breathlessness (psychologist) Healthy eating (dietician) Plan of Action for exacerbations

15 K6Gzs

16 What do we do in Tower Hamlets? 7 choices of venue Tai Chi as alternative to circuit training Bengali rehab support workers Heart failure patients included Maintenance programme for further 8 weeks Home exercise programme (limited)

17 Referring for Pulmonary rehabilitation Fill in referral form Fax it to number on form Inclusion criteria: Stable chronic lung disease Limited functional ability due to breathlessness Motivated to exercise Optimised respiratory management

18 Exclusion criteria Unstable angina/hypertension Angina more than once weekly Angina at rest/at night Uncontrolled cardiac arrhythmias Severe heart failure Cardiac event within past 6 weeks

19 In summary.for the patient Improve independence in daily functioning Improve knowledge of lung condition and promote self-management Increase muscle strength and endurance (peripheral and respiratory) Increase exercise tolerance and reduce dyspnoea Reduce length of hospital stay Improve health related quality of life Promote long term commitment to exercise. Garrod 2003 (Chartered society of Physiotherapy briefing)

20 Any Questions? Thank you!

21 References ATS/ERS statement on pulmonary rehabilitation (2006). American Journal of Respiratory and Critical Care Medicine, 173, Bernard et al. (1998). Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 158(2), BTS statement (2001). British Thoracic Society standards of care subcommittee on pulmonary rehabilitation. Thorax, 56, Foglio et al. (1999). Long term effectiveness of pulmonary rehabilitation in patients with chronic airway obstruction. European Respiratory Journal, 13(1), Griffiths et al. (2001). Cost-effectiveness of an outpatient mulit-disciplinary pulmonary rehabilitation programme. Thorax, 56(10), Guell et al. (2000). Long term effects of outpatient rehabilitation of COPD: A randomised trial. Chest, 117(4),

22 References Killian, KJ et al. (1992). Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation. The American Review of Respiratory Disease, 146(4), Jobin et al. (1998). COPD: capillarity and fiber-type characteristics of skeletal muscle. Journal of Cardiopulmonary Rehabilitation, 18(6), NICE CG101 Chronic obstructive pulmonary disease (update) Sala (1999). Effects of endurance training on skeletal muscle bioenergetics in COPD. American Journal of Respiratory and Critical Care Medicine, 159(6),