Presentation on theme: "Pulmonary Rehabilitation In COPD"— Presentation transcript:
1 Pulmonary Rehabilitation In COPD BYProf . Mohammad El- Desouky Abo- ShehataProf . Of Thoracic MedicineMansoura University
2 Chronic Obstructive Pulmonary Disease DefinitionCOPD 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 )
3 Prevalence Of COPDCOPD is one of the most common diseases affecing elderly people allover the worldCOPD affects approximately16% of people over the age of 65 years worldwideCOPD 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 worldwideAccording to WHO ; the estimated death rate in Egypt was 35,9/ and the estimated disability associated with COPD was 302/Buist et al (2007): International variation in the prevalence of COPD . Lancet; 370:Viegi G, et al. (2001): Epidemiology of chronic obstructive pulmonary disease (COPD). Respiration; 68 (1): 4-19.ths
4 Impact of COPD ON (QOL) Peruzza et al ; (2003 ) Quality of life is a feeling of overall life satisfactionIt is primary a subjective sense of well being ; including physical, psychological, social and spiritual dimensionsCOPD and its progression promote a cycle of physical, psychological, and social consequences, All which interrelated and have a negative impact on quality of lifePeruzza et al ; (2003 )
5 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 activitiesPulmonary 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 ; 173 :
6 Pulmonary Rehab Program Exercise trainingNutritional counselingEducation on lung disease or condition and how to manage itEnergy-conserving techniquesBreathing strategiesPsychological counseling and/or group support
7 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 Department Faculty of Medicine, Mansoura University ***Adult Nursing Department, ****Gerontological Nursing Department Faculty of Nursing, Mansoura University
8 Aim of the studyObjective of this study was to assess the impact of pulmonary Rehab program on ( QOL ) in elderly COPD patients
9 SubjectsSettingThis study carried out at chest departement ; Mansoura university (from Jan to Dec/ 2011)Subjects54 COPD elderly patients were randomly assigned into two equal groups:Study group : received Rehabilitation program (27 pt) control group : received conventional treatment (27 pt )
10 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, 2010Had COPD staged according to GOLD, 2010Walk unaided.Not involved in any other respiratory rehabilitation program.Free from any other respiratory or associated disorders asheart failureAble to communicate and cooperate in program.Accept to participate in the study.
11 plan of workEach elderly patient in both control and study groups was interviewed individuallyThe 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.
12 Plan of work ( cont )Control group was subjected to educational session onlyPatients of the study group were taught to perform these exercises and instructed to do them at home after discharge from the hospital for 2 monthTelephone 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.
13 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'):
14 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):
15 Inspiratory Muscle Training Incentive Spirometry
21 Outcomes measurementAfter 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 TestSix minutes walk test (6 MWT)Modified Borg Dyspnea Scale
22 Tool III Saint's George Respiratory Questionnaire Study ToolsTool III Saint's George Respiratory QuestionnaireIt 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:SymptomsActivitiesImpact of disease on daily life
23 Tool VI Clinical COPD Questionnaire Study ToolsTool VI Clinical COPD QuestionnaireCCQ 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.
24 Tool VI Six minutes walk test Study ToolsTool VI Six minutes walk testIt 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
25 Tool VII Modified Borg Dyspnea Scale Study ToolsTool VII Modified Borg Dyspnea ScaleIt is a numerical scale for rating perceived dyspnea immediately after a 6 min walk test
26 Socio-demographic characteristics of the study and control groups ItemsStudy groupControl groupPearson Chi-Square χ2 test (P)N= (27)%Age (in years)60-65-75+11540.718.515755.625.91.504 (0.471)Mean SD65.26 4.4064.81 5.23SexMalefemale23485.214.82281.50.133 (0.715)Marital statusMarriedWidowDivorced13.721677.822.20.01.423 (0.491)Educational levelIlliterateRead and writePrimarySecondary & over2032220.127.116.11.358 (0.929)
27 2 months Post rehab. (post 1) Quality of life of the study and control groups pre and post pulmonary rehabilitation programQualityof life(SGRQ)#Study groupControl groupt-test(P)a(P)b(P)cPre-rehab.2 months Post rehab. (post 1)6 monthsPost rehab.(post 2)2 monthsPost rehab. (post 1)Mean SDSymptoms59.1617.3553.8118.6354.3319.0256.7818.6355.7718.2755.3318.010.486 (0.629)0.391 (0.697)0.198 (0.844)t-test (P)14.987 (0.000)2.245 (0.033)t-test (P)24.404 (0.000)2.865 (0.008)Activities55.5014.5144.0614.0046.9115.8453.6818.2654.1718.3856.0220.010.406 (0.686)2.274 (0.0271.854 (0.050)(0.000)0.812 (0.424)6.982 (0.000)2.285 (0.031)Impact56.6913.1247.8014.4446.3315.8158.3012.6859.0113.5058.8314.850.458 (0.649)2.947 (0.005)2.995 (0.004)(0.000)2.306 (0.029)(0.000)1.071 (0.294)Total56.7413.6447.7114.2847.8715.5156.6614.6457.0014.9957.4116.170.019 (0.985)2.333 (0.024)2.212 (0.031)(0.000)1.338 (0.193)(0.000)1.671 (0.107)
28 2 months Post rehab. (post 1) Health status of the study and control groups pre and post pulmonary rehabilitation programHealth status (CCQ)#Study groupControl groupt-test(P)a(P)b(P)cPre-rehab.2 months Post rehab. (post 1)6 monthsPost rehab.(post 2)Mean SDSymptoms3.13 1.362.63 1.332.85 1.323.00 1.242.93 1.182.95 1.190.366 (0.716)0.864 (0.392)0.298 (0.767)t-test (P)15.586 (0.000)1.494 (0.147)t-test (P)22.994 (0.006)0.667 (0.510)Functional state2.84 1.292.39 1.172.54 1.232.72 1.032.76 1.202.87 1.210.378(0.707)1.149 (0.256)1.003 (0.320)(0.000)0.679 (0.503)(0.000)1.925 (0.065)Mental state2.59 1.442.35 1.362.50 1.432.43 1.522.43 1.212.31 1.300.414 (0.681)0.211 (0.833)0.497 (0.621)3.118 (0.004)0.000 (1.000)1.044 (0.306)0.972 (0.340)Total CCQ mean score0.86 0.410.74 0.380.79 0.390.81 0.380.81 0.350.81 0.360.390 (0.698)0.747 (0.459)0.244 (0.808)7.325 (0.000)0.270 (0.789)3.611 (0.001)0.052 (0.959)
29 2 months Post rehab. (post 1) 2months Post rehab. (post 1) Functional capacity and perceived dyspnea of the study and control groups pre and post pulmonary rehabilitation programItemsStudy groupControl groupt-test (P)at-test (P)bt-test(P) CPre-rehab.2 months Post rehab. (post 1)6 monthsPost rehab.(post 2)2months Post rehab. (post 1)MeanSDFunctional capacity6MWT (miter)283.8156.97334.5262.90324.7864.26290.5243.32286.5944.78281.2644.200.487(0.629)3.225(0.002)2.900(0.006)t-test (P)1(0.000)3.128 (0.004)t-test (P)2(0.000)6.625 (0.000)Perceived dyspnea(Borg Scale)#5.152.783.042.193.892.264.932.455.112.365.932.230.312(0.757)3.3473.3318.563 (0.000)2.431 (0.022)5.625 (0.000)9.367 (0.000)
30 CONCLUSIONThe 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 monthPulmonary rehabilitation programs should be integrated within the plan of care for COPD elderly patientsCOPD elderly patients should be given a written instruction plan for daily self-management measures
31 CONCLUSION (cont ) These programs should emphasize patient education about the disease processCOPD medication, behavior and lifestyle modificationInspiratory muscles training, breathing retraining, upper and lower extremities exercise,Airway clearance techniques,psychosocial support, different relaxation techniques