Pulmonary Rehabilitation In COPD

1. Pulmonary Rehabilitation In COPD BY Prof . Mohammad El- DesoukyAbo- Shehata Prof . Of Thoracic Medicine Mansoura University

2. Chronic Obstructive Pulmonary Disease Definition • 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 )

3. Prevalence Of COPD • 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.

4. Impact of COPD ON (QOL) • 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 )

5. Pulmonary rehabilitation In COPD • 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

6. Pulmonary Rehab Program • 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

7. Effect of a Pulmonary Rehabilitation Program on the Quality of Life In Elderly Patients with COPDMohamed El-DesokyAbouShehata*, El SayedZakiHatata**,Amany Mohamed Shebl***, and Doaa El SayedFadila****Chest Diseases Department, **Internal Medicine DepartmentFaculty of Medicine, Mansoura University***Adult Nursing Department, ****Gerontological Nursing DepartmentFaculty of Nursing, Mansoura University

8. Aim of the study Objective of this study was to assess the impact of pulmonary Rehab program on ( QOL ) in elderly COPD patients

9. 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 )

10. Inclusion Criteria • Aged 60 years and above. • Clinically stable with no exacerbation in the last month. • Had COPD diagnosed according to the criteria of GOLD, 2010 • Had COPD staged according to GOLD, 2010 • Walk unaided. • Not involved in any other respiratory rehabilitation program. • Free from any other respiratory or associated disorders as heart failure • Able to communicate and cooperate in program. • Accept to participate in the study.

11. plan of work • 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.

12. Plan of work ( cont ) • 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.

13. Educational sessions: 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'):

14. Training sessions: 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):

15. Inspiratory Muscle Training Incentive Spirometry

16. Breathing retraining (pursed lip breathing )

17. Breathing retraining (diaphragmatic breathing)

18. Upper Extremities Exercise

19. Stretching and strengthening exercise for upper and lower extremities with using metal weights (1 and 2 Kgs).

20. 6 - minute walk test

21. Outcomes measurement • 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

22. Study Tools Tool III Saint's George Respiratory Questionnaire It was used to measure health related quality of life in patients with COPD. It provides an overall measure for the quality of life with subscale scores in three dimensions: • Symptoms • Activities • Impact of disease on daily life

23. Study Tools Tool VIClinical COPD Questionnaire • CCQ was used to evaluate the health status in patients with COPD. It includes 10 questions in three domains: symptoms, functional state and mental state during the previous week.

24. Study Tools Tool VI Six minutes walk test It is a global objective indicator of functional capacity. It is used by measuring the distance (by miters) that the elderly patient covered in 6 minutes

25. Study Tools Tool VII Modified Borg Dyspnea Scale It is a numerical scale for rating perceived dyspnea immediately after a 6 min walk test

26. Socio-demographic characteristics of the study and control groups

27. Quality of life of the study and control groups pre and post pulmonary rehabilitation program

28. Health status of the study and control groups pre and post pulmonary rehabilitation program

29. Functional capacity and perceived dyspnea of the study and control groups pre and post pulmonary rehabilitation program

30. CONCLUSION • 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

31. 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

32. Thank you