pulmonary disorders
Pulmonary Rehabilitation
Procedure
Pulmonary rehabilitation is best administered as part of an integrated program of Exercise training Education Psychosocial and behavioral interventions Pulmonary rehabilitation is delivered by a team of physicians, nurses, respiratory therapists, physical and occupational therapists, and psychologists or social workers. The intervention should be individualized and targeted to the patient's needs. Pulmonary rehabilitation can be started at any stage of disease with the goal of minimizing disease burden and symptoms. Exercise traininginvolves aerobic exercise and respiratory muscle and upper and lower extremity strength training. There is increasing evidence to support doing both strength training and interval training of the extremities. Interval training is alternating short bursts (eg, 30 seconds) of intense activity with longer periods (eg, 2 minutes) of less intense activity. (IMT) is often a component of pulmonary rehabilitation. IMT uses devices that impose a resistive load that is set at a fraction of an individual's maximal inspiratory pressure. When combined with pulmonary rehabilitation, IMT may improve a patient's inspiratory muscle pressure, but this improvement does not result in decreased shortness of breath, or in improvements in quality of life or functional parameters ( General references ). (NMES) uses a device that applies transcutaneous electrical impulses to selected muscles to stimulate contraction. NMES can be effective in patients with severe lung disease because it minimizes circulatory demand and does not cause the dyspnea that often limits these patients from participating in typical exercise training. Thus, neuromuscular electrical stimulation is uniquely suited for patients with significant deconditioning or for patients with an acute exacerbation of respiratory failure. Small prospective studies have demonstrated functional benefit of combining NMES with traditional pulmonary rehabilitation ( General references ). has many components. Counseling about the need for Smoking Cessation is important. Nutritional counseling can be given if needed. Teaching breathing strategies (such as pursed-lip breathing, in which exhalations are begun against closed lips to decrease respiratory rate, thereby decreasing gas trapping) and the principles of conserving physical energy are helpful. Explaining treatment, including using drugs correctly and planning for involve counseling and feedback for the depression, anxieties, and fear that hinder the patient’s full participation in activities. Behavioral modification strategies and an emphasis on self-management are critical components of pulmonary rehabilitation. Strategies include techniques for goal-setting and problem solving, decision-making, medication adherence, and the maintenance of routine exercise and physical activity ( General references ). Although the most optimal maintenance strategy is unknown, continued participation in an exercise program is essential to maintain the benefits of pulmonary rehabilitation. 