Download - Pulmonary Rehabilitation In COPD
Pulmonary Rehabilitation In COPD
BY
Prof . Mohammad El- Desouky Abo- ShehataProf . Of Thoracic Medicine
Mansoura University
Chronic Obstructive Pulmonary Disease
Definition COPD is a common preventable and treatable disease ,
characterized by persistant airflow limitation that is usually progressive and associated with an enhanced inflammatory response in the airway and the lung to noxiouse particles or gases .
Exacerbations and co-morbidities contributes to overall severity in individuals patients
( GOLD
( 2011 )
Prevalence Of COPD
COPD is one of the most common diseases affecing elderly people allover the world
COPD affects approximately16% of people over the age of 65 years worldwide
COPD is ranked the fourth cause of death of people over the age of 65 years
(WHO) estmated that by the year 2020 (COPD) will be the third leading cause of deaths and the fifth cause of disability worldwide
According to WHO ; the estimated death rate in Egypt was 35,9/100.000 and the estimated disability associated with COPD was 302/100.000
Buist et al (2007): International variation in the prevalence of COPD . Lancet; 370:
741-749 Viegi G, et al. (2001): Epidemiology of chronic obstructive pulmonary disease
(COPD). Respiration; 68 (1): 4-19.
Impact of COPD ON (QOL)
Quality of life is a feeling of overall life satisfaction It is primary a subjective sense of well being ; including
physical, psychological, social and spiritual dimensions COPD and its progression promote a cycle of physical,
psychological, and social consequences, All which interrelated and have a negative impact on quality of life
Peruzza et al ; (2003 )
Pulmonary rehabilitation In COPD
The principal goal of rehabilitation are to reduce symptoms , improve quality of life , and increase physical and emotional participation in every day activities
Pulmonary rehabilitation covers a range of non - pulmonary problems that may not be adequately addressed by medical therapy of COPD, including exercise de-conditioning, altered mood state (especially depression ), muscle wasting , weight loss.
NICI .L. et al. ATS/ERS . Statement of pulmonary rehabilitation .Am J
Resp And Crit Care Med . 2006 ; 173 : 1390 - 413
Pulmonary Rehab Program
Exercise training Nutritional counseling Education on lung disease or condition and how
to manage it Energy-conserving techniques Breathing strategies Psychological counseling and/or group support
Effect of a Pulmonary Rehabilitation Program on the Quality of Life In
Elderly Patients with COPD
Mohamed El-Desoky Abou Shehata*, El Sayed Zaki Hatata**,
Amany Mohamed Shebl***, and Doaa El Sayed Fadila***
*Chest Diseases Department, **Internal Medicine DepartmentFaculty of Medicine, Mansoura University
***Adult Nursing Department, ****Gerontological Nursing Department
Faculty of Nursing, Mansoura University
Aim of the study
Objective of this study was to assess the impact
of pulmonary Rehab program on ( QOL ) in elderly COPD patients
Subjects
Setting This study carried out at chest departement ; Mansoura university (from Jan to Dec/ 2011)
Subjects 54 COPD elderly patients were randomly assigned into two equal groups:
Study group : received Rehabilitation program (27 pt) control group : received conventional treatment (27 pt )
Inclusion Criteria
Aged 60 years and above. Clinically stable with no exacerbation in the last month. Had COPD diagnosed according to the criteria of GOLD,
2010 Had COPD staged according to GOLD, 2010 Walk unaided. Not involved in any other respiratory rehabilitation
program. Free from any other respiratory or associated disorders as heart failure Able to communicate and cooperate in program. Accept to participate in the study.
plan of work
Each elderly patient in both control and study groups was interviewed individually
The developed pulmonary rehabilitation program was implemented on study group and conducted in 8 sessions over 2 weeks. Each session took about 30 minutes.
The developed pulmonary rehabilitation program was conducted in small groups (3-5 patients/session )
Each patient in the study group was subjected to two types of sessions: educational and training sessions.
Plan of work ( cont )
Control group was subjected to educational session only
Patients of the study group were taught to perform these exercises and instructed to do them at home after discharge from the hospital for 2 month
Telephone visits were provided twice a week during 2 months after discharge from hospital by the researcher for the study group to check with them their consistency with program.
Educational sessions:
were carried out in 4 sessions. They included the following:
First session (Respiratory system and COPD nature):
Second session (COPD medications): Third session (Behavior and lifestyle modification
'Part 1'): Fourth session (Behavior and lifestyle
modification 'Part 2'):
Training sessions:
Carried out in 4 sessions. Training sessions included the following:
First session (Inspiratory muscle training): Second session( Breathing retraining): Third session (Upper and lower extremities
exercise): Fourth session (Airway clearance techniques):
Inspiratory Muscle Training Incentive Spirometry
Breathing retraining (pursed lip breathing )
Breathing retraining (diaphragmatic breathing)
Upper Extremities Exercise
Stretching and strengthening exercise for upper and lower extremities with using metal weights (1 and 2 Kgs).
6 - minute walk test
Outcomes measurement
After two months ( post – 1 ) of discharge from the hospital and applying the pulmonary rehabilitation program sessions, evaluation for both study and control groups was done and repeated after 4 months ( post 2 ) to determine the effect of program using the study tools:
Saint's George Respiratory Questionnaire (SGRQ) Clinical COPD Questionnaire (CCQ) Pulmonary Function Test Six minutes walk test (6 MWT) Modified Borg Dyspnea Scale
Study ToolsTool III
Saint's George Respiratory Questionnaire
It was used to measure health related quality of life in patients with COPD. It provides an overall measure for the quality of life with subscale
scores in three dimensions:
Symptoms Activities Impact of disease on daily life
Study ToolsTool VI
Clinical COPD Questionnaire
CCQ was used to evaluate the health status in patients with COPD. It includes 10 questions in three domains: symptoms, functional state and mental state during the previous week.
Study ToolsTool VI
Six minutes walk test
It is a global objective indicator of functional capacity. It is used by measuring the distance (by miters) that the elderly patient covered in 6 minutes
Study ToolsTool VII
Modified Borg Dyspnea Scale
It is a numerical scale for rating perceived dyspnea immediately after a 6 min walk test
ItemsStudy group Control group
Pearson Chi-Square χ2 test (P)N= (27) % N= (27) %
Age (in years) 60- 65- 75+
11115
40.740.718.5
1575
55.625.918.5
1.504 (0.471)
Mean SD 65.26 4.40 64.81 5.23
Sex Male female
234
85.214.8
22 5
81.518.5
0.133 (0.715)
Marital status Married Widow Divorced
2241
81.514.83.7
2160
77.822.20.0
1.423 (0.491)
Educational level Illiterate Read and write Primary Secondary & over
20322
74.111.17.47.4
21123
77.83.77.4
11.1
1.358 (0.929)
Socio-demographic characteristics of the study and control groups
Quality of life
(SGRQ)#
Study group Control group
t-test (P)a
t-test (P)b
t-test (P)c
Pre-rehab.2 months
Post rehab. (post 1)
6 monthsPost rehab.
(post 2)Pre-rehab.
2 monthsPost rehab.
(post 1)
6 monthsPost rehab.
(post 2)
Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD
Symptoms 59.1617.35
53.8118.63
54.3319.02
56.7818.63
55.7718.27
55.3318.01 0.486
(0.629)0.391
(0.697)0.198
(0.844)t-test (P)1 4.987 (0.000) 2.245 (0.033)t-test (P)2 4.404 (0.000) 2.865 (0.008)
Activities 55.5014.51
44.0614.00
46.9115.84
53.6818.26
54.1718.38
56.0220.01 0.406
(0.686)2.274 (0.027
1.854 (0.050)t-test (P)1 10.098 (0.000) 0.812 (0.424)
t-test (P)2 6.982 (0.000) 2.285 (0.031)
Impact 56.6913.12
47.8014.44
46.3315.81
58.3012.68
59.0113.50
58.8314.85 0.458
(0.649)2.947
(0.005)2.995
(0.004)t-test (P)1 12.987 (0.000) 2.306 (0.029)t-test (P)2 11.243 (0.000) 1.071 (0.294)
Total 56.7413.64
47.7114.28
47.8715.51
56.6614.64
57.0014.99
57.4116.17 0.019
(0.985)2.333
(0.024)2.212
(0.031)t-test (P)1 24.395 (0.000) 1.338 (0.193)t-test (P)2 14.674 (0.000) 1.671 (0.107)
Quality of life of the study and control groups pre and post pulmonary rehabilitation program
Health status (CCQ)#
Study group Control group
t-test (P)a
t-test (P)b
t-test (P)cPre-rehab.
2 months Post rehab.
(post 1)
6 monthsPost rehab.
(post 2)Pre-rehab.
2 months Post rehab.
(post 1)
6 monthsPost rehab.
(post 2)
Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD
Symptoms 3.13 1.36 2.63 1.33 2.85 1.32 3.00 1.24 2.93 1.18 2.95 1.190.366
(0.716)0.864
(0.392)0.298
(0.767)t-test (P)1 5.586 (0.000) 1.494 (0.147)t-test (P)2 2.994 (0.006) 0.667 (0.510)
Functional state 2.84 1.29 2.39 1.17 2.54 1.23 2.72 1.03 2.76 1.20 2.87 1.21
0.378(0.707)
1.149 (0.256)
1.003 (0.320) t-test (P)1 10.234 (0.000) 0.679 (0.503)
t-test (P)2 5.848 (0.000) 1.925 (0.065)Mental state 2.59 1.44 2.35 1.36 2.50 1.43 2.43 1.52 2.43 1.21 2.31 1.30
0.414 (0.681)
0.211 (0.833)
0.497 (0.621)t-test (P)1 3.118 (0.004) 0.000 (1.000)
t-test (P)2 1.044 (0.306) 0.972 (0.340)
Total CCQ mean score 0.86 0.41 0.74 0.38 0.79 0.39 0.81 0.38 0.81 0.35 0.81 0.36
0.390 (0.698)
0.747 (0.459)
0.244 (0.808)t-test (P)1 7.325 (0.000) 0.270 (0.789)
t-test (P)2 3.611 (0.001) 0.052 (0.959)
Health status of the study and control groups pre and post pulmonary rehabilitation program
Items
Study group Control group
t-test (P)a
t-test (P)b
t-test(P) C
Pre-rehab.2 months
Post rehab. (post 1)
6 monthsPost rehab.
(post 2)Pre-rehab.
2months Post rehab.
(post 1)
6 monthsPost rehab.
(post 2)
MeanSD
MeanSD
MeanSD
MeanSD
MeanSD
MeanSD
Functional capacity6MWT (miter)
283.81
56.97
334.52
62.90
324.78
64.26
290.52
43.32
286.59
44.78
281.26
44.20 0.487(0.629)
3.225(0.002)
2.900(0.006)
t-test (P)1 16. 612 (0.000) 3.128 (0.004)
t-test (P)2 11.523 (0.000) 6.625 (0.000)
Perceived dyspnea (Borg Scale)#
5.15
2.78
3.04
2.19
3.89
2.26
4.93
2.45
5.11
2.36
5.93
2.23 0.312(0.757)
3.347(0.002)
3.331(0.002)
t-test (P)1 8.563 (0.000) 2.431 (0.022)
t-test (P)2 5.625 (0.000) 9.367 (0.000)
Functional capacity and perceived dyspnea of the study and control groups pre and post pulmonary
rehabilitation program
CONCLUSION
The supervised, two-month home-based pulmonary rehabilitation program is an effective non pharmacological intervention in the management of stable COPD elderly patients and maintained for 6 month
Pulmonary rehabilitation programs should be integrated within the plan of care for COPD elderly patients
COPD elderly patients should be given a written instruction plan for daily self-management measures
CONCLUSION (cont )
These programs should emphasize patient education about the disease process COPD medication, behavior and lifestyle
modification Inspiratory muscles training, breathing
retraining, upper and lower extremities exercise,
Airway clearance techniques, psychosocial support, different relaxation
techniques
Thank you