Pulmonary Rehab Flashcards
Describe restrictive lung disease in general
- Alveoli unable to expand due to lung scarring, fibrosis or mechanics resulting in inability to “get air in”
Common symptoms of restrictive lung disease
- Shortness of breath (especially during exertion)
- Limited chest wall mobility
- Dry cough
- Rapid, shallow breathing
Generally describe obstructive lung disease
- Airways become narrow & blocked due to a thickening of the tissues, inflammation, alveolar hyperinflation and/or secretions resulting in air trapping & difficulty “getting air out”
Common symptoms of obstructive lung disease
- Shortness of breath
- Wheezing
- Chronic cough
- Prolonged exhalation
Why do pulmonary rehab or physical therapy
- Loss of muscle mass
- Decrease in function
- Increase in body fat (associated with comorbid conditions)
- Dyspnea/breathlessness
- Cognitive deficits
Benefits and downfalls of pulmonary rehab
- Improves patient outcomes & reduces hospital readmissions
- Less than 2% of pts receive PR within 6 mo after a hospitalization
- Only 6% of Medicare beneficiaries actually attend PR programs
- Race/socioeconomic status are strongly associated with PR participation
What are the 4 essential areas of pulmonary rehab that require outcome measurements
- Exercise capacity
- Symptoms (dyspnea and fatigue)
- Health related QoL
- Psychosocial status
A physical therapist makes the greatest contributions in which areas of pulmonary rehab
- Evaluation
- Outcome measurement
- Exercise & functional training
- Airway clearance
- Education
What are the most commonly used exercise tests for pulmonary rehab
- CPET
- Shuttle test
- 6 minute walk test
What to look for on a breathing pattern assessment
- Nose or mouth breathing: nasal health and structural issues
- Apical (upper chest) vs diaphragmatic
- Hyperventilation
- Breath holding
- Frequent yawning, sighs
Describe a breathing check in
- When in doubt, breathe out
- Posture check: jaw open, shoulders down, and belly relaxed
- One hand on chest, one hand over belly button
- Try breathing in through your nose, out through the mouth
- Which hand moves more, top hand, bottom hand
Absolute contraindications to exercise testing
- Acute MI within 2 days
- Ongoing unstable angina
- Uncontrolled cardiac arrhythmia with hemodynamic compromise
- Active endocarditis
- Symptomatic severe aortic stenosis
- Decompensated HF
- Acute PE, pulmonary infarction, or DVT
- Acute myocarditis or pericarditis
- Acute aortic dissection
- Physical disability that precludes safe and adequate exercise testing
Is oxygen within the physical therapy scope to titrate as needed in order for patients to safely perform exercise (True/False)
- True
Intervention strategies for pulmonary rehab
- Breathing pattern re-training: nose, low and slow; focus on exhale vs inhale
- Airway clearance: active cycle of breathing; flutter valve
- CV exercise
- Inspiratory muscle training
- Functional resistance training: STS, push/pull, and lift/carry
Educational topics for pulmonary rehab patietns
- Disease specific information (basic pathophysiology)
- medication adherence
- Symptom monitoring
- Smoking cessation
- Mental heath resources
- Nutritional support
- Local or web-based support groups
Risk factors for long covid
- Lower socioeconomic positioning
- Inability to convalesce (recover)
What is included in the post acute sequelae of covid-19 (PASC)
- Hx of probable or confirmed SARS-CoV-2 infection
- Usually 3 mo from the onset of covid-19
- Sx that last for at least 2 mo
- Cannot be explained by an alternative diagnosis
Hypothesized mechanisms of long covid
- Immune dysregulation
- Microbiota dysbiosis
- Autoimmunity and immune priming
- Blood clotting and endothelial abnormalities
- Dysfunctional neurological signaling
Describe post exertion symptom exacerbation (PESE) and post exertion malaise (PEM)
- Sx are made worse by physical, cognitive, or emotional effort
- Sx include: fatigue, exhaustion, pain, exercise intolerance, brain fog
- May occur immediately or within 24072 hrs of activity/event
- Recovery may take days/weeks
- Results from the energy systems’ inability to recover/replenish after an effort
- Screening for PEM/PESE is crucial in determination of safe rehab strategies
What are the key symptoms of immediate, short term, and long term post exertion symptoms
- Immediate: out of breath
- Short term: brain fog
- Long term: flu-like sx
Using CPET to reliably detect small changes in cardiac, pulmonary, and metabolic status between days has been demonstrated in the following clinical populations:
- PAH
- HF
- Cystic fibrosis
- Stable angina
- End stage renal disease
- Fibrotic interstitial pneumonia
- Valvular heart disease
Post-Exertional Physiology in People with PESE all of the following decrease at peak exertion and at ventilatory anaerobic threshold
- Volume of O2 consumed
- Workload
- Heart rate
- volume of air cleared per minute
Screening tools for PEM/PESE
- DePaul Symptom Questionnaire
Screening tools for dyautonomia
- Malmo POTS Symptom Score
- Compass 31
- 10 minute stand test
- Tilt table test
Screening tools for joint hypermobility
- Beighton assessment tool
Diagnostic criteria for POTS
- Sustained HR increase of ≥30 bpm or ≥40 bpm if pt is 12-19 y/o within 10 min of upright posture
- Absence of significant OH Drop in BP by ≥20/10)
- Frequent sx of OH that are worse while upright with rapid improvement upon return to supine
- Sx duration ≥3 mo
- Absence of other conditions that could explain sinus tachycardia
PTOS management
- 3L of water per day
- 8-12g of sodium chloride per day
- 30-40 mmHg waist high compression garments
- 10 mmHg abdominal binder
- Recumbent exercise and strength training
- Mdications
PT interventions for POTS
- Energy conservation strategies
- Symptom journals
- HR biofeedback is available to determine energy envelope
- Patient education: path to improvement may not be linear
Describe how to stay in your energy envelope
- Pace: to have better energy, protect energy systems that don’t appear to be working well
- Project: determine top 3 sx limiting you, monitor them, and pay attention to your triggers
- Plan: call for support, modify your ADLs, and break tasks into smaller parts all to conserve your energy