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Restrictive Lung Disease and Breathing Retraining

Restrictive Lung Disease and Breathing Retraining

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Restrictive Lung Disease and Breathing Retraining

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  1. Restrictive Lung Disease and Breathing Retraining Counce, Hirsch, Plummer, Reid

  2. PICO • PPatients with restrictive lung disease • I Standard treatment + breathing retraining • C Standard treatment • O Reducing dyspnea

  3. Restrictive Lung Disease/Dysfunction • Reduced • Pulmonary ventilation (air in/out) • Lung expansion • Hallmark symptoms: • Dyspnea: • Subjective perception of breathlessness (Hillegass, 2011) • Most limiting symptom of RLD (O'Donnell, 1998) • Irritating, dry, non-productive cough • Wasted, emaciated appearance

  4. Restrictive Lung Disease/Dysfunction • Diagnostic criteria • PFT • Chest X-ray • ABG • Breath sounds • Cardiovascular http://medlibes.com/entry/spirometry

  5. Standard Pulmonary Rehabilitation • Exercise program • Peripheral muscle training • Stair climbing • Treadmill walking • Bicycle training • Resistance training http://www.uofmmedicalcenter.org/healthlibrary/Article/82065 Salhi, 2010

  6. Breathing Retraining • Diaphragmatic breathing • Improve dyspnea • Decrease WOB, accessory muscle activity, RR • Pursed lip breathing • Improve dyspnea • Decrease RR http://jpmc.org/pages/pulmonary-rehab Hillegass, 2011

  7. Breathing Retraining in COPD • Pursed lip breathing • Effective self-management strategy to improve dyspnea • Diaphragmatic breathing • Not effective for individuals with hyper-inflated lungs Facchiano, 2011

  8. Breathing Retraining in RLD

  9. Breathing Retraining in RLD

  10. Conclusion • Effective in COPD • Inconclusive in restrictive lung disease • Benefits gained with standard pulmonary rehab • Further research needed • The American Lung Association

  11. References • Brack T, Jubran, Tobin MJ. Dyspnea and decreased variability of breathing in patients with restrictive lung disease. Am J Respir Crit Care Med. 2002;165:1260-1264. • Facchiano L, Snyder C, Núñez D. A literature review on breathing retraining as a self-management strategy operationalized through Rosswurm and Larrabee's evidence-based practice model. Journal Of The American Academy Of Nurse Practitioners [serial online]. August 2011;23(8):421-426. Available from: CINAHL with Full Text, Ipswich, MA. Accessed November 19, 2013. • Hillegass E. Essentials of Cardiopulmonary Physical Therapy. 3rd edition. St. Louis, MO: Elsevier Saunders; 2011. • Nishiyama O, Kondoh Y, Kimura T, et al. Effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Respirology. 2008;13(3):394–399. • O'Donnell D, Chau L, Webb K. Qualitative aspects of exertional dyspnea in patients with interstitial lung disease. Journal Of Applied Physiology. 1998;84(6):2000-2009. • Salhi B, Troosters T, Behaegel M, Joos G, Derom E. Effects of pulmonary rehabilitation in patients with restrictive lung diseases. CHEST. 2010;137(2):273-279.

  12. Questions