A CASE PRESENTATION BENEFITS OF PULMONARY REHABILITATION B Y E S - - PowerPoint PPT Presentation
A CASE PRESENTATION BENEFITS OF PULMONARY REHABILITATION B Y E S T H E R S . A J J A R A P U , M . D , M . B A B U T Y O U B E S T R O N G A N D D O N O T L O S E C O U R A G E , F O R T H E R E I S R E W A R D F O R Y O U
B Y E S T H E R S . A J J A R A P U , M . D , M . B A “ B U T Y O U B E S T R O N G A N D D O N O T L O S E C O U R A G E , F O R T H E R E I S R E W A R D F O R Y O U R W O R K ” .
I have no no actua ual or po potential conf nflict of int nterest i in n relation t to this pres esentation This present ntation n is s strictly y for inf nformationa
ucationa
nly Patient cons nsented to sharing h his i information
I I - Mild CO COPD D < < 0. 0.70 70 FEV1 >80% >80% p pre redicted II II - Moderate CO COPD D < < 0. 0.70 70 FEV1 50% 50% -79% p predicted III III - Severe C COPD < < 0. 0.70 70 FEV1 30% 30% - 49% 49% IV - Very S y Severe C COPD < < 0. 0.70 70 FEV1 <30% <30% OR OR <50% <50% with s signs o
f chroni
respirator
ure
multid idisciplinary progr gram m of c care for patients w with chr hronic r respiratory impairment t that i is i individually lly tailored and designed to optimi mize ze eac each p pat atien ent’s ph physical and nd s social pe performance a and nd a aut utonomy.” ( (NICE CE)
"compr prehensive i int ntervention based on n a thorough pa patient a assessment followed by patient nt-tailored ed therapies es t that i include, , but are not l limi mited ed to, exercise training, g, education, , and b behavior c change, , designed t to
phys ysical a and ps psychological cond ndition o
peopl ple with c chronic r respiratory disease a and nd to pr promote the l long ng-term a adherence t to
nhanc ncing ng b behavior
(ATS) E ERS) Am Amer erican an As Association of Car ardiovas ascular ar an and Pu Pulmonar ary Reh ehab abilitation (AACVPR VPR) American A n Association n for R Respi piratory Ca Care (AARC) Centers f for Medi dicare and d Me Medi dicaid Se Services ( (CMS) S)
Reduced read eadmissions an and hospital alizations
Contraind aindic icat atio ions ns to p pulmonar nary r rehabil ilitat atio ion n inc nclude c cond nditions th that w woul uld pl place t the e pa patien ent a at increased r risk k during e exer ercise or p present obst stacles t s to participation
The ITP mus ust f focus us o
n 4 domains : Ex Exerc rcise Nut utrition Educ ucation Psy sycho-so social well l being of
63 year o
Cauc ucasian m male w with mul ultiple pul pulmonary cond nditions was r referred t to pul pulmonary rehab b by his pul pulmonologist 4 4/2015 Work h history: Wor
the mi mines in u underground m mining Worked f for 20 years as a cont ntinuous m mine ner ope perator and nd an n electrician Disable led i in 1991
Obstructive Sleep Apnea w w/use of
(14 cm 4 cm H2O) 2O) Int nterstitial l lung ung d disease COPD PD Obe besit ity Co Compl plicated Pne neum umoconiosis/Pulmonary fibrosis Hypertens nsion, n, Anxiety, C Chroni
Pain
Lum umbar f fus usion-2002 2002 Ca Carpa pal Tun unnel sur urgery -2004 2004 Prostatectomy d due ue to pr prostate c canc ncer-2005 2005 Socia ial l History: For
mer S Smok moker- Smoked i intermittently for 15 years, ½ ½ to 1ppd ppd
Spiriva— (tio iotropium br bromid ide-anticholinergic-prom
m3 smoo mooth m muscle relaxation
Symbic bicort—QD(budesonide/formotero rol fumarate d dihy hydrate-inh nhaled c corticos
+ long g ac acting g b2 ago agonist) ProAir—PRN(alb lbuterol) l) Ipratro ropium-albu buterol nebs bs (antic icholin inergic ic-bronchodilation) Oral t theop
ne 300m 300mg –BI BID--
ronchodilators O2 O2—cont
nuous at 2L—via ia NC
*rating o
ed exertion
*dysp spnea sc scal ale
Patient t sco cored 30 30 on n CO COPD A D Assessment T Test (CA CAT) This is t the highest you
means that the sym ymptom
experienced b by y the pa patient are severe and nd it a also indicates t that they w woul uld b bene nefit from pul pulmonary reh ehab ab, ad addition o
er med medications, an and man manage age exac xacer erbat ations.
Their condition stops them doing everything they want to do. They never have any good days. If they can manage to take a bath or shower, it takes them a long time. They cannot go out of the house for shopping or recreation, or do their housework. Often, they cannot go far from their bed or chair. They feel as if they have become an invalid.
Midway through, he was a able to
Interval exercises for
By t y the end of
12 w weeks, he w was able t to
12 minute i interval f for r a tota tal o
f 48 minutes up t up to 13 1320 f 0 feet. His RPE PE was as under er 4 4 His D DS S sc scale w was s unde der 2
Pr Preven ent s symptoms an and exac xacer erbations Impr prove A ADL DLs and nd Q QOL. Educate p patient abou
the disease Tobacco c cessation c coun unselling Enc ncourage pa patient to pa participate i in n therapy a and nd c cont ntinue at home a after f formal therapy. y.
2 years later, h his c cond ndition c cont ntinued t to worsen and nd had a doub uble pne pneum umonectomy in n 7/ 7/20 2017 9/ 9/20 2017--
readmitted t to t
hos
grade 2 2 rejection
trans nsplant nt After s stabilization and recovery, he was sent b back to
y rehab for
cond nditioning. Patient i is n now d doing well. ll.
Global l Initiative f for Chronic O Obstructive L Lung Disease ( (GOLD LD): G Global l Str trategy f for th the Diagnosis, Mana nagement, a and nd P Prevention o
COPD 2017. www.goldco dcopd. d.org The a association n betw tween d daily e exacerbation sym ymptoms and nd p phys ysical a activity in n pati tients w with th c chroni nic obstructive pul ulmonary y diseas ase Int J J Chron Obstr truct t Pulmon D
2018 J 8 Jul 18; 8;13:2199 99-22 2206
doi
10.2147/COPD. D.S156986. e eCollection
ATS Committee o
n Proficiency S y Sta tand ndards for Clinical P Pul ulmona nary F y Func unction Lab aboratorie
ATS s S statement: g guid idelines for t the s six ix-mi minute e walk t test.
Am J RespirCritCare M Med 2002; 2002; 1 166: 66:111. COPD spectr trum d m diagram-courtesy o
medscape pe i ima mages.