Pulmonary Rehabilitation Flashcards
COPD
respiratory disorder caused largely by smoking, characterized by PROGRESSIVE partially reversible airway obstruction and lung hyperinflation, systematic manifestations, and increase freq/sev of exacerbations
Premature infants
80% predicted FEV1 because lungs are not developed.
Age of exacerbation symptoms
50-55 years
Top reason for hospitalization/ambulatory care sensitive conditions
COPD
- 1/3 COPD pt will revise the ED within 30 days in AB
COPD exercise limitation: Gas exchange efficiency
Gas exchange = PAO2 - PaO2
- we want little to no pressure difference between alveolar and arterial
COPD exercise limitation: What determines VO2max?
Thick Equation
VO2 = (HR x SV) x (CaO2-CvO2)
- stroke volume response (the bigger the larger the response)
COPD exercise limitation: exercise stress on gas exchange
PAO2-PaO2 = VO2/DLO2
- during exercise VO2 increases
- we need to increase diffusion capacity ignorer to keep arterial and alveolar pressure difference close
hyperventilation results in what in the brain?
hypocapnia
(ventilation is greater than metabolic demand)
- rate of CO2 removal from blood increases
PETO2 (alveolar PO2/end tidal) during exercise
will increase as we need to breathe more (exercise = ventilation)
- accumulate lactic results in hyper ventilation as we pass the anaerobic threshold
limitation: out of breath - what stops us from exercise
cardiovascular system (not lungs)
Breathing reserve
- should be 30% VE reserve
EILV and EELV compensation for ventilation needed for exercise
- EILV will increase and EELV will decrease in response to exercise
Tidal volume & resp response to exercise
Healthy FEV1 = 100% predicted
Ventilatory Response in obstructive disease
- cannot ventilate as much, DEV1 = 40% predicted
- dynamic hyperinflation: deep breath-in and prolonged expiration, but brain wants us to keep breathing so we take a breath in
Rehabilitation of lung function
- pulmonary rehab does not improve lung function, rather we get adaptation through cardiac function, muscle strengthening, produce less lactic acid, ventilate less
- maximal ability to ventilate doesn’t change
Exercise training - MMV pre- and post-rehab
exercise training decreases ventilatory response to exercise
5 year survival in COPD based on peak VO2
Grade I: > 995mL/min 99% survival rate after 5 years
Grade IV: < 650mL/min 40% survival rate after 5 years
What is pulmonary rehabilitation?
multidisciplinary: comprehensive intervention (optimize physiological, psychological, and social outcome) for COPD patients followed by patient tailored therapies (behaviour change, education, exercise training, support/teach medications)
PR has been shown to ↑ health outcomes in: • Asthma
• Bronchiectasis
• Cystic Fibrosis
• Interstitial Lung Disease • Lung Cancer
Goals of COPD management
- Prevent disease progression (smoking cessation)
- Reduce the frequency and severity of exacerbations
- Alleviate breathlessness & symptoms
- Improve exercise tolerance
- Improve quality of life
- Reduce mortality
COPD: downward spiral
lose 50% of lung function during first hospital visit
- COPD, dyspnea, inactivity, decondtioning, psychological, QOL
Pulmonary rehab: upward spiral
COPD - Dyspnea - Rehab program - improve activity/conditioning - decrease dyspnea and psychological conditions
Goal of pulmonary rehab
increase their capacity to self-manage
COPD: Exercise training goals
- Flexibility exercises
- Strengthening exercises
- Endurance exercises
- Breathing exercises
Exercise Action Plan: Individual Session
Utilizes FITT (Frequency, Intensity, Time, Type) to set targets/goals for long term maintenance
- Endurance, Strength, Breathing, Flexibility
- Create a “Good day plan”, “Bad day plan” and a “Re-integration plan”
- Must include location of exercise
