FINALS: Pulmonary Rehabilitation

Question 1

A multidisciplinary program designed to optimize the physical and social performance of patients with chronic respiratory diseases. It is tailored to individual functional needs and is an integral part of clinical management for symptomatic patients despite standard medical treatment.

Answer 1

pulmonary rehabilitation

Question 2

What is the main goal of pulmonary rehabilitation for COPD patients?

Answer 2

To improve exercise tolerance, muscle strength, reduce dyspnoea, reverse deconditioning, and enhance the patient’s quality of life and ability to self-manage the disease.

Question 2

Who benefits the most from pulmonary rehabilitation?

Answer 2

Patients across all disease severities, especially those with symptoms and disability, typically at MRC grade 3.

Question 2

What are the main components of pulmonary rehabilitation?

Answer 2

Programme setting and staffing (inpatient, outpatient, home)
Exercise training (lower limb, upper limb, respiratory muscles)
Education (breathing control, medication, exercise, etc.)
Psychological interventions

Question 2

How does pursed-lip breathing benefit individuals with COPD?

Answer 2

It helps control exhalation and maintain open airways by lightly pursing the lips during exhalation.

Question 2

What is the role of exercise training in pulmonary rehabilitation?
A:

Answer 2

Lower Limb Training: Improves exercise tolerance
Upper Limb Training: Improves arm strength and reduces ventilatory demand
Respiratory Muscle Training: May influence endurance and dyspnoea (evidence is conflicting)

Question 2

What are some common breathing strategies taught in pulmonary rehabilitation?

Answer 2

Techniques to control breathlessness, improve breathing patterns, and promote relaxation during activity.

Question 3

How does lower limb training benefit patients in pulmonary rehabilitation?

Answer 3

It improves exercise tolerance but has no direct effect on lung function.

Question 3

What is segmental breathing used for?

Answer 3

It expands localized areas of the lungs while keeping other areas quiet to improve ventilation in specific parts of the lungs.

Question 3

What are the precautions to follow when performing breathing exercises?

Answer 3

Never allow a patient to force expiration.
Avoid allowing a patient to take prolonged expirations.
Ensure the patient doesn’t initiate inspiration with accessory muscles or the upper chest.
Perform 3-4 deep breathing cycles at a time.

Question 3

What is the primary goal of diaphragmatic breathing?

Answer 3

To improve the efficiency of ventilation, decrease work of breathing, and increase diaphragm excursion.

Question 4

What is glossopharyngeal breathing, and when is it used?

Answer 4

A technique where 6-10 gulps make one inspiration, used for individuals with severe inspiratory muscle weakness, such as in high cervical spinal cord injuries or polio.

Question 4

What is the importance of manual assisted cough in secretion removal?

Answer 4

Manual assisted cough helps in the effective expulsion of secretions, especially for patients with weak cough mechanisms.

Question 4

What are the techniques used for effective coughing in pulmonary rehab?

Answer 4

Sharp, deep, double cough
Contraction of the abdominal muscles
Huffing

Question 5

What are relative contraindications to postural drainage?

Answer 5

Severe hemoptysis
Untreated acute conditions (e.g., severe pulmonary edema, large pleural effusion, pneumothorax)
Cardiovascular instability, such as cardiac arrhythmias

Question 5

What is the role of postural drainage in secretion removal?

Answer 5

Postural drainage involves positioning the patient in ways that mobilize lung secretions from one or more lung segments to the central airways.

Question 6

What is the purpose of tracheal stimulation in respiratory therapy?

Answer 6

Tracheal stimulation helps initiate a cough in patients who may have difficulty doing so reflexively.

Question 6

What are the main goals of pulmonary rehabilitation?

Answer 6

Improve or redistribute ventilation
Enhance airway clearance and cough mechanism
Prevent post-operative pulmonary complications
Improve ventilatory muscle strength, endurance, and coordination
Maintain or improve chest and thoracic mobility

Question 7

What types of conditions benefit from pulmonary rehabilitation?

Answer 7

Pulmonary rehabilitation is effective for patients with COPD, post-operative pulmonary conditions, and respiratory muscle weaknesses (e.g., high cervical spinal cord injuries).

Question 7

What is incentive spirometry used for in pulmonary rehabilitation?

Answer 7

Incentive spirometry is used to encourage deep breathing, improve lung expansion, and increase inspiratory muscle strength, particularly after surgery or in patients with respiratory muscle weakness.

Question 7

What is the role of respiratory resistance training in pulmonary rehab?

Answer 7

Respiratory resistance training involves inspiratory resistance training and the use of incentive spirometry to strengthen the respiratory muscles.

Question 8

How does postural drainage sequence work in pulmonary rehab?

Answer 8

Identify which lung segment needs drainage.
Check vital signs and breath sounds before positioning.
Position the patient to mobilize the secretions from the segment of interest.

Question 9

How often should postural drainage be performed?

Answer 9

Postural drainage should be performed 2-4 times per day, especially if secretions are thick.

Question 10

What is ventilatory muscle training, and why is it important?

Answer 10

Ventilatory muscle training strengthens the muscles involved in breathing, improving both respiratory function and endurance. It is crucial for patients with weak respiratory muscles due to conditions like COPD or SCI.