Presentation Transcript
Pulmonary rehabilitation for people with COPD :Pulmonary rehabilitation for people with COPD Kola Akinlabi
Specialist Respiratory Physiotherapist and pulmonary rehabilitation
Chronic Respiratory Team, Haringey NHS
Presented at West Haringey Collaborative, 19/03/09
Definition :ATS/ERS statements 2006:
‘’Pulmonary rehabilitation is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities.’’ Definition
How we came about pulmonary rehab :PR started in most centres in UK in 2002 following BTS statement released in Thorax 2001, pointed out that ‘’ PR services in the UK is very poor’’.
According to BTS /BLF PR survey 2003 ‘’PR is still not available in most areas in the UK and when available are underused’’.
In Feb 2004 NICE published CG which spelt out management of COPD in adults in primary and secondary care and 1.2.10.2 of the guideline stated that PR should be offered to all patients who consider themselves functionally disabled by COPD (usually MRC 3 and above.
Since then we’ve had several guidelines, systemic review and evidences as seen in
AACP/AACVPR 2007
ATS/ERS 2006
Cochrane Review 2006
NICE 2004
BTS 2001 How we came about pulmonary rehab
2009 Cochrane Review :A systemic review of evidence on the effectiveness of pulmonary rehabilitation.
Concluded that there were large effects of pulmonary rehabilitation in the improvement of exercise capacity, health related quality of life and substantial reduction in the number of unplanned admission and mortality.
Cochrane database of systemic reviews, issue 1, 2009. intervention review- pulmonary rehabilitation following exacerbation of COPD 2009 Cochrane Review
Overview – rationale :Quads weakness and reduced CSA are correlated
with severity of obstruction (FeV1)
with VO2 peak
And Exercise capacity
(Bernand et al, 1998 Am J Respir Crit Care Med, 158: 629-34
Reduction in % of type 1 muscle fibre ( fatigue resistant)
Increased in type IIX fibres ( fast twitch) Overview – rationale
Quads CSA- normal and COPD Bernand et al, 1998 Am J Respir Crit Care Med, 158: 629-34 :Quads CSA- normal and COPD Bernand et al, 1998 Am J Respir Crit Care Med, 158: 629-34
CSA strength normal and COPD :CSA strength normal and COPD
Comparison of normal and COPD muscle strength :Comparison of normal and COPD muscle strength
Quads and FEV1 relationship :Quads and FEV1 relationship
ACCP/AACVPR,1997, BTS guidelines 2001 rated Reis et al work grade A evidence to support the role exercise training in rehabilitation.Reis et al: Annals of Internal Medicine 1995,112(11): 823-31 :ACCP/AACVPR,1997, BTS guidelines 2001 rated Reis et al work grade A evidence to support the role exercise training in rehabilitation.Reis et al: Annals of Internal Medicine 1995,112(11): 823-31
Reis et al 1995 :Reis et al 1995
Component of Pulmonary rehabilitation :Exercise training
Endurance/ strength /RMT/upper and lower limb weight
Optimal pharmacological management
Bronchodilators /steroids/O2/ immunisation/NIV
Education
Medical management, energy conservation, smoking cessation, self management etc
Psychosocial support
Antidepressants/CBT/relaxation/counselling/motivation Component of Pulmonary rehabilitation
Haringey NHS Pulmonary rehabilitation :Location: Lordship lane Health centre gymnasium
Staff:
Consultant respiratory Physician- Dr Ian Moosie NMH
Specialist Respiratory Physiotherapist –Kola Akinlabi
Respiratory Nurse Specialist- Beverley Kowlessa
Respiratory Assistant- Deniz Dilaver
Clinical Psychologist- Ruth Marks
Occupational Therapist- Beverly Johnson
Dietician- Coletta Dornely
Duration: 2hours exercise and educational sessions, Twice weekly Tuesdays and Fridays, for 8 week
Referral system: through adult and older people central referral system online, or our service’s pulmonary rehab referral (fax or posted to SAH)
Information: we encourage referral to have full consent of patient before referring and give out patient information leaflet Haringey NHS Pulmonary rehabilitation
Referral criteria, clinical guidance and referral pathways :http://www.haringey.nhs.uk/services/specialist/care_pathways_and_guidelines/respiratory_disease/index.shtm
Please see the above for Haringey NHS Clinical guidelines and referral pathways for COPD
Inclusion criterial
Haringey resident, or registered with Haringey GP and able to travel to the course.
MRC 3,4 and 5
Diagnosed with COPD (moderate- severe) and function limited by dyspnoea.
Stable and optimal medical and pharmacological management in place.
Patient motivated to complete the entire 8-week programme. Referral criteria, clinical guidance and referral pathways
Exclusions: - :Unstable cardiac disease: -
Unstable angina
Aortic stenosis
Aortic valve disease
Recent myocardial infarction/ CVA (6 wks)
Uncontrolled hypertension
Uncontrolled cardiac arrhythmias
Uncompensated LVF
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2. Unable to carry out exercises/walk due to severe arthritis, dementia, alcoholism, or poor motivation. Exclusions: -
Assessment and outcomes :Screening of referral
Patient is contacted for an appointment
Assessment take place
Outcome measures
(CRDQ, HAD, ISWT, predicted VO2 peak)
Patient is entered into 8 week rehab if receiving optimum medical management and does not have any of the exclusions. Assessment and outcomes
Discharge and info :Discharge letters are written to referrers and patients are given information about exercise programme with 60+, leisure centre, EPP and breath easy group.
6months and 1 yr follow up for a review and inclusion into rehab. Discharge and info
Service info :Community Respiratory team
St Ann’s Hospital
L1 Block
Tel: 02084426144
Fax: 02084426588
Contacts: Kola Akinlabi(Team Lead) or Beverley Kowlessa Service info
Questions ? :Questions ?