pulmonary rehabilitation in copd

drmosharraf_hossain

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Pulmonary Rehabilitation In COPD :

Pulmonary Rehabilitation In COPD Dr. AKM Mosharraf Hossain Internist & Pulmonologist Drmosharraf_hossain@yahoo.com 06/11/2010 Mosharraf Hossain

What is Pulmonary Rehabilitation? :

What is Pulmonary Rehabilitation? 06/11/2010 Mosharraf Hossain

Global impact of copd :

Global impact of copd 06/11/2010 Mosharraf Hossain

Percent Change in Age-Adjusted Death Rates, U.S., 1965-1998 :

Percent Change in Age-Adjusted Death Rates, U.S., 1965-1998 0 0.5 1.0 1.5 2.0 2.5 3.0 Proportion of 1965 Rate 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 –59% –64% –35% +163% –7% Coronary Heart Disease Stroke Other CVD COPD All Other Causes Source: NHLBI/NIH/DHHS

Copd is a treatable disease :

Copd is a treatable disease 06/11/2010 Mosharraf Hossain

GOLD Therapy at Each Stage of COPD :

GOLD Therapy at Each Stage of COPD FEV1/FVC <0.70 FEV1 ≥80% predicted I: Mild II: Moderate III: Severe IV: Very Severe FEV1/FVC <0.70 50% ≤FEV1 <80% predicted FEV1/FVC <0.70 30% ≤FEV1 <50% predicted FEV1/FVC <0.70 FEV1 <30% predicted or FEV1 <50% predicted plus chronic respiratory failure Global Initiative for Chronic Obstructive Lung Disease (GOLD). NHLBI/WHO Workshop report. www.goldcopd.com

benefits :

benefits 06/11/2010 Mosharraf Hossain

Development of Disability in COPD :

Development of Disability in COPD 06/11/2010 Mosharraf Hossain

Vicious cycle of Disability :

Vicious cycle of Disability 06/11/2010 Mosharraf Hossain

Slide 10:

06/11/2010 Mosharraf Hossain

Exercise Training :

Exercise Training Pulmonary rehabilitation general exercise training include: a) Upper limb endurance training, b) Upper limb strenthening training, c) Lower limb endurance training, d) Lower limb strenthening training, e) Flexibility and stretching exercise f) Balancing exercise Usually 4-10 weeks, daily to weekly Lower limb training improves exercise tolerance though no effect on measured lung function Upper limb training improves arm strength and reduces ventilatory demand 06/11/2010 Mosharraf Hossain

Flexibility exercise :

Flexibility exercise 06/11/2010 Mosharraf Hossain

Stretching pectoral muscles :

Stretching pectoral muscles 06/11/2010 Mosharraf Hossain

Stretching hamstring muscles :

Stretching hamstring muscles 06/11/2010 Mosharraf Hossain

Stretching triceps :

Stretching triceps 06/11/2010 Mosharraf Hossain

Upper limb endurance training :

Upper limb endurance training 06/11/2010 Mosharraf Hossain

Upper limb endurance training :

Upper limb endurance training 06/11/2010 Mosharraf Hossain

Upper limb strength exercise :

Upper limb strength exercise 06/11/2010 Mosharraf Hossain Fig 1: Arm exercise

Upper limb strength exercise :

Upper limb strength exercise 06/11/2010 Mosharraf Hossain Fig2: Biceps

Upper limb strength exercise :

Upper limb strength exercise 06/11/2010 Mosharraf Hossain Fig3: Arm exercise

Lower limb endurance training :

Lower limb endurance training 06/11/2010 Mosharraf Hossain

Lower limb strength training :

Lower limb strength training 06/11/2010 Mosharraf Hossain

Lower limb strength exercise :

Lower limb strength exercise Knee extension sitting Sit in a chair. Straighten your knee. Hold the knee straight for five seconds, and then relax. Repeat for other leg. Progression: Add weights to legs. Squats Lean your back against a wall. Squat down until your thighs are parallel with floor. Slide up the wall to a standing position. Start with only sliding down a short way. Progression: Increase depth of slide down. 06/11/2010 Mosharraf Hossain

Breathing retrainig :

Breathing retrainig Retraining with breathing techniques which decrease breathing frequency, such as Yoga and pursed lip breathing, have in some studies led to increases in tidal volume and oxygen saturation, and a reduction in dyspnea. Diaphragmatic breathing strenghthens diaphragm, reduces energy of breathimg; but conflicting evaluation shows increase work of breathing and dyspnoea 06/11/2010 Mosharraf Hossain

Purse lip breathing :

Purse lip breathing 06/11/2010 Mosharraf Hossain

Diaphragmatic breathing :

Diaphragmatic breathing 06/11/2010 Mosharraf Hossain

yoga :

yoga The "complete breath" in yoga incorporates all three areas of your lungs, which helps 1)diaphragmatic breathing, 2) oxygenation of blood, 3) prevent air trapping in the lungs, and 4) relaxes the mind and body. 06/11/2010 Mosharraf Hossain

Location of training :

Location of training 06/11/2010 Mosharraf Hossain

Hospital-based programs :

Hospital-based programs Hospital based programs has the advantage of providing direct communication with respiratory physicians and other healthcare professionals. This may be the most appropriate option for patients with very severe disease and/or complex comorbid conditions. Sometimes provided for patients recovering from an acute exacerbation. 06/11/2010 Mosharraf Hossain

Community-based programs :

Community-based programs Community-based programs are centre-based programs run in community settings (eg leisure centres; halls, health or rehabilitation centres; senior citizens centres or private practices). These programs may be run by hospital/community health staff, or may use clinicians in community practices (eg GPs, practice nurses, private practice clinicians). 06/11/2010 Mosharraf Hossain

Home training :

Home training Started within 1-2 weeks after commencing the supervised training program to allow any difficulties undertaking the home program to be discussed and resolved during the supervised period. Performed on 2 or 3 days per week (i.e. in addition to the 2 or 3 days that the patient is attending the supervised training program). In total, the patient should exercise 4 or 5 days per week Walking for 30 minutes at the same pace as in the supervised program. 06/11/2010 Mosharraf Hossain