Rehabilitation for Individuals with Pulmonary Conditions

Respiratory diseases are among the leading causes of death and disability in the United States. In 2019, chronic lower respiratory disease including asthma, but predominately chronic obstructive pulmonary disease (COPD), was the 4th leading cause of death and influenza and pneumonia the 9th leading cause of death (Kochanek et al., 2020). The ranking for 2020 will likely change due to COVID-19-related deaths at greater than 500,000.

Individuals with COPD and other respiratory diseases/infections have difficulty breathing resulting in poor gas exchange and the body’s impaired ability to deliver oxygen and remove carbon dioxide. This may lead to the need for supplemental oxygen and hospitalization. These individuals tend to have weakness and reduced activity tolerance leading to limited function, increased dependency, and difficulty participating in therapy.

• More days of early pulmonary rehab after hospitalization for COPD exacerbation resulted in reduced risk of hospital re-admission and improved physical performance on a Shuttle Walk Test by 8 meters per session and Endurance Shuttle Walk Test by 44 seconds per session (Kjӕrgaard et al., 2020).

In rehabilitation of individuals with respiratory disease/infections, it is important to assess the pulmonary condition, the impairments and functional limitations in order to target the interventions accordingly (ACP, 2020).

⊲ Pulmonary assessment during evaluation may include: Ventilation/Respiration measures; Breathing rate and pattern; Auscultation (lung sounds); Spirometry
⊲ Pulmonary interventions may include: Positioning for dyspnea; Ventilatory strategies; Breathing exercises; Airway clearance techniques

Biophysical Agents and Advanced Technologies may play an integral role in motivating and facilitating participation in therapy and achieving superior outcomes.

• Physical fitness improvements with arm curl, chair stand, and 6-Minute Walk Test were superior in patients with COPD receiving virtual reality training compared to endurance exercise (Rutkowski et al., 2020).
• Training including NMES better improved static and dynamic balance, exercise tolerance, and lower limb strength compared to endurance training and resistance training without NMES in patients with COPD (Acheche, 2020).
• Twice a week lower-limb stationary cycle endurance training for one month improved dyspnea and pulmonary function test in patients with COPD (Tarigan et al., 2018).

References:
Accelerated Care Plus (ACP). (2020). ACP Accelerated Clinical Practice Course – Pulmonary Essentials Assessment and Interventions.
Acheche, A., Mekki, M., Paillard, T., Tabka, Z., & Trabelsi, Y. (2020). The Effect of Adding Neuromuscular Electrical Stimulation with Endurance and Resistance Training on Exercise Capacity and Balance in Patients with
Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Canadian Respiratory Journal. 2020:9826084. http://doi.org/10.1155/2020/9826084 
Kjӕrgaard, J., Juhl, C. B., Lange, P., & Wilcke, T. (2020). Adherence to early pulmonary rehabilitation after COPD exacerbation and risk of hospital readmission: a secondary analysis of the COPD-EXA-REHAB study.
BMJ Open Respiratory Research, 7(1):e000582. https://doi.org/10.1136/bmjresp-2020-000582 
Kochanek, K. D., Xu, J., & Arias, E. (2020). Mortality in the United States, 2019. NCHS Data Brief, PMID: 33395387
Rutkowski, S., Rutkowska, A., Kiper, P., Jastrzebski, D., Racheniuk, H., Turolla, A., Szczegielniak, J., Casaburi, R. (2020). Virtual Reality Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized
Controlled Trial. International Journal of Chronic Obstructive Pulmonary Disease. 15, 117-124. https://doi.org/10.2147/COPD.S223592 
Tarigan, A. P., Pandia, P., Pradana, A., Rhinsilva, E., & Efriyandi, E. (2018). Impact of Lower-Limb Endurance Training on Dyspnea and Lung Functions in Patients with COPD. Macedonian Journal of Medical Sciences.
6(12), 2354-2358.