Pulmonary Rehabilitation for Lung Diseases

Pulmonary Rehabilitation for Obstructive and Restrictive Lung Diseases

• The presentation focuses on pulmonary rehabilitation for obstructive and restrictive lung diseases.
• The presenter is Dr. Eman Rashad, a lecturer at Horus University in Egypt.

Restrictive Lung Diseases

• Problems in restrictive lung diseases include decreased inspiratory capacity, making it difficult to inflate the lungs, and decreased exercise tolerance.
• Pneumonia patients with restrictive lung disease often have secretions.
• The main issues in restrictive lung diseases are decreased inspiratory capacity and decreased exercise tolerance, along with secretions.

How to Treat Restrictive Lung Disease

• Diaphragmatic breathing, segmental breathing (apical, lateral costal, posterior basal), and breathing exercises to mobilize the chest are used to improve lung inflation.
• Assistive devices, such as incentive spirometers and inspiratory muscle trainers, can also help.

Increasing Exercise Tolerance

• Patients should be mobilized and gradually increase the length of walking.
• Breathing control exercises are taught to patients for walking on flat surfaces and climbing stairs.
• Exercise programs should be adjusted with the patient's progress to improve exercise tolerance.
• Exercise testing is done to determine appropriate exercise intensity for each patient.

Types of Restrictive Lung Diseases

• Pneumonia, pleurisy, pleural effusion, pneumothorax, acute respiratory distress syndrome (ARDS), and fibrosing alveolitis are examples of restrictive lung diseases.

Pneumonia

• Pneumonia is an acute inflammation of the lung tissue.
• Pneumonia can be classified based on the anatomical location (lobar, bronchopneumonia, segmental), the causative organism (bacterial, viral, fungal, protozoal, atypical), or how it was acquired (hospital-acquired, community-acquired, or in immunocompromised patients)
• Common clinical features of pneumonia include cough, sputum production, dyspnea, pleuritic chest pain, wheezing, crepitations, fever, malaise, and rigors.

Physiotherapy for Pneumonia

• The goal of physiotherapy for pneumonia is to reduce bronchospasm, clear lung secretions, regain full lung expansion, and restore exercise tolerance.
• Techniques may include humidification, percussion, shaking, vibration, and breathing exercises.
• Postural drainage may be necessary, along with suction, if coughing/expectorating is not possible.

Pleurisy

• Pleurisy involves inflammation of the visceral and parietal pleura, leading to pain.
• Common clinical features include pleuritic pain, pleural rub, cough, possibly tachycardia and pyrexia.

Physiotherapy for Pleurisy

• Physiotherapy is often not needed in the early stages of pleurisy but is useful during recovery.
• Treatment focuses on regaining full thoracic expansion, minimizing pleural adhesions, and mobilizing the thorax.
• This is done by localized, segmental expansion exercises using manual resistance to help with rib movement and ease pain.

Pleural Effusion

• Pleural effusion involves excessive fluid accumulation in the pleural cavity.
• Common causes include malignancy of the lungs or bronchi, pneumonia, tuberculosis, pulmonary infarction, bronchiectasis, lung abscess, blockage of lymph vessels, rupture of blood vessels, or left ventricular failure.
• Clinical features of pleural effusion include breathlessness, cyanosis, pyrexia, lethargy, and pain.

Physiotherapy for Pleural Effusion

• The physiotherapy aims to prevent the formation of adhesions between pleural layers, regain full expansion of the affected lung, improve lung ventilation, and increase exercise tolerance.
• Breathing exercises and mobilization are important techniques

Empyema

• Empyema is a collection of pus within the pleural cavity.
• It often arises as a complication of pre-existing lung infections, such as bacterial pneumonia, tuberculosis, lung abscess, or bronchiectasis.
• It may also be caused by trauma like stab wounds or thoracic incisions.

Physiotherapy for Empyema

• The physiotherapy goals include minimizing pleural adhesions, regaining full lung expansion, clearing lung fields, maintaining thoracic mobility, and improving exercise tolerance.
• These aims are achieved by breathing exercises, postural drainage, coughing/huffing techniques, and assistive devices as needed.

Obstructive Lung Diseases (COPD)

• COPD is a common disease entity encompassing chronic bronchitis and emphysema.
• Other names include chronic obstructive pulmonary disease (COPD), chronic obstructive airways disease (COAD), chronic obstructive lung disease (COLD), chronic airflow obstruction (CAO), or chronic airflow limitation (CAL).

COPD Problems

• Problems associated with COPD include secretions in the airways, difficulty in exhaling (deflating the lungs), episodes of dyspnea (shortness of breath), and increased work of breathing due to use of accessory muscles.
• Exercise tolerance is decreased.

COPD Interventions

• Physiotherapy interventions include clearing lung secretions, improving expiratory function, improving breathing control and exercise tolerance, and teaching the patient pacing strategies for activities.
• Techniques used include postural drainage, percussion, vibration, shaking, coughing, huff techniques, assistive devices (positive expiratory pressure (PEP), flutter device, vest), pursed-lip breathing, paced activity, and aerobic exercise.

COPD Management

• Patient education is crucial to help patients understand COPD, self-management, smoking cessation, medications, nutrition, weight control, general health, activity pacing, and infection control.
• The goal of long-term management is to improve quality of life, general health, and well-being.

COPD Physiotherapy Aims

• Facilitating mucociliary transport, optimizing secretion clearance, optimizing alveolar ventilation, optimizing lung volumes/capacities, optimizing ventilation/perfusion, reducing work of breathing, and reducing work of the heart.
• Maximizing aerobic capacity and efficiency of oxygen transport, optimizing physical endurance, maximizing muscle strength, and improving respiratory muscle efficiency.

Additional Points Relevant To Different Conditions

• Patients with different respiratory conditions often alter their breathing patterns, such as using prolonged expiratory phases to improve gas exchange.