COPD

Question 1

Etiology of COPD

Answer 1

Chronic bronchitis: airway inflammation –> narrowed airway + increase airway resistance
Emphysema: reduce air sac’s surface area + decrease elasticity –> slow down gaseous exchange

Question 2

Clinical presentation of COPD

Answer 2

SOB, chronic coughing, sputum

Question 3

Determine what information needs to be collected in the assessment (PEO-Person)

Answer 3

1. OT profile (medical history, e.g. easily get anxious)
2. baseline functional disability due to dyspnoea
3. self-perceived exertion level during activity

Question 4

Determine what information needs to be collected in the assessment (PEO-Environment)

Answer 4

1. Home and work environment (risk factor, home O2, stairs, ramp)
2. Risk factor hx (smoking, pollution)

Question 5

Determine what information needs to be collected in the assessment (PEO-Occupation)

Answer 5

1. Premorbid ADL IADL performance
2. Work/school/community participation

Question 6

What and how to asses baseline functional disability due to dyspnoea

Answer 6

mMRC Dyspnoea Scale

Question 7

What and how to asses self-perceived exertion level during activity

Answer 7

Borg’s Rating of Perceived Exertion

Question 8

What and how to asses functional performance

Answer 8

• MFTE (simulated functional task (indoor mobility, sit-stand transfer, lifting, carrying, stepping
  → any dyspnea on strenuous activities/basic ADL/ home bound?)
• COPD Assessment Test (CAT): An 8-item measure of health status impairment in COPD

Question 9

Occupational performance issues

Answer 9

1. insufficient tolerance/ strength in ADL= fatigue
2. SOB in ADL/ IADL/ on exertion; lack of knowledge in coping and managing disease
3. Exposure to risk factors
4. Home O2 therapy

Question 10

Tx goal and plan
(insufficient tolerance/ strength in ADL)

Answer 10

Tx goal:
max. activity tolerance in ADL/ IADL

Tx plan:
- Use of O2 and inhaler (increase O2 flow/ extra puff during energy demanding activity e.g. bathing)

• adaptive equipment and environment modification
• energy conservation

Question 11

Tx goal and plan
(SOB in ADL/ IADL/ on exertion; lack of knowledge in coping and managing disease)

Answer 11

Tx goal:
education on proper breathing techniques & coping skills in ADL

Tx plan:
- Relieving posture (forward leaning, elbow supported)
- Coordinate breathing w/ movement (inhale with trunk extension; exhale with trunk flexion)
- Progressive muscle relaxation

Question 12

Tx goal and plan
(Exposure to risk factors)

Answer 12

Tx goal:
reduce exposure to risk factors

Tx plan:
- Smoking cessation
- monitor environment by
1. temp and humidity
too cold and dry: broncho-constriction
too hot and humid: concentration of pollutants
2. maintain ventilation

Question 13

Tx goal and plan
(Home O2)

Answer 13

A low flow oxygen system for use by patients with chronic conditions at HOME

Home O2 therapy procedures
1. Validate pt and therapy regime
2. Recommend flow-rate (rest, seep, ADL)
3. Gain consensus 共識 and participation from pt/ care-giver
4. Select equipment to fit home environ + lifestyle
5. Explore need for financial assistance
6. Educate and train on operation, maintenance, precaution
7. Contact delivery on discharge
8. Monitor and arrange follow-up service
9. Documentation

Home Visit
- identify any potential environment. concern and hazard
- advice the location of O2 concentrator
- provide onsite ADL advice + evaluation
- Educate usage of home O2 device
- Modified fx ADL training