Pulmonary rehabilitation is an integral part of clinical management for patients with chronic respiratory diseases who remain symptomatic despite medical treatment. It involves education, exercise training, breathing techniques, nutrition counseling, and psychological support delivered by a multidisciplinary team. Pulmonary rehabilitation can increase patients' knowledge, improve quality of life, reduce symptoms like dyspnea and fatigue, and increase exercise performance.

1. Contoso Ltd.
Pulmonary
Rehabilitation
Alyaa zaki
67028

2. Contoso Ltd.
○ is an integral part of the clinical management and health maintenance of those patients with chronic respiratory disease
who remain symptomatic or continue to have decreased function despite standard medical treatment
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Pulmonaryrehabilitation
Indication Contraindication
Chronic obstructive pulmonary disease Ischemic cardiac disease
Bronchial asthma Acute corepulmonare
Cystic fibrosis Sever pulmonary hypertension
Chronic respiratory insufficiency from any
cause
Hepatic dysfunction
Lung transplantation Metastasis
Sleep respiratory disorders Renal failure

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Benefit of pulmonaryrehabilitation
○ Increase knowledge
about pulmonary
disease and it is
management
○ Improve health-
related quality of life
○ Reduce patient
symptoms e.g.( dyspnea
and fatigue)
○ Increase exercise
performance
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○ The care of pulmonary rehabilitation team consists of at least three to four rehabilitation specialists with varied
experience
1) The patient
2) The medical director
3) Physical therapist
4) Counselling or behaviour manager
5) Pharmacologist
6) Education therapist
7) Vocational therapist
Selection patient criteria
1) Age
2) Nutritional status
3) Different characteristics of body composition
4) Severity of respiratory impairment
5) The level of disability
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 Membersinvolvedinpulmonaryrehabilitationprogram

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Pulmonaryrehabilitationcomponent
Education
General exercise training
Breathing training
Nutritional support
Psychological support
Outcome assessment

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○ EXAMPLES OF EDUCATIONAL training
I. Breathing Strategies
II. Normal Lung Function and Pathophysiology of Lung Disease
III. Proper Use of Medications, including Oxygen
IV. Bronchial Hygiene Techniques
V. Benefits of Exercise and Maintaining Physical Activities
VI. Energy Conservation and Work Simplification Techniques Eating Right
VII. Irritant Avoidance, including Smoking Cessation Prevention
VIII. Anxiety and Panic Control, including Relaxation Techniques and Stress Management
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Education

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Exercisetraining
Components of exercise
training:
A. Lower extremity exercises
B. Arm exercise
C. Ventilatory muscle training
Types of exercise A. Endurance or aerobic
B. Strength or resistance

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 Treadmill
 Stationary bicycle
 Walking
 Stair climbing
 Sit & Stand
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Exercisetraining
Lower extremity exercise
Arm exercise training
 Arm cycle ergometer
 Unsupported arm lifting
 Lifting weight Strength
. Ventilatory muscle
training
 Resistive IMT:
 Patient breaths through hand held Patient breaths
through a device which resistance flow can be
increased gradually
 Difficult to standardize the load
 Patients may hypoventilate
 Threshold IMT:
 device equipped with a valve opens at a given
pressure.
 Easily quantitated and standardized

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Chest PhysicalTherapy& Breathing Retraining
Pursed Lip
Breathing
Posture
techniques
Diaphragm
Breathing
Postural Draining

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 In moderate to severe COPD, weight loss is common and is related to decreased exercise capacity and health status and
increased morbidity and mortality.
 Nutritional supplementation
 Energy dense foods
 Well distributed during the day
 No evidence of advantage of high fat diet
 Patients experience less dyspnea after carbohydrate rich supplement than fat rich supplement
(probably due to delayed gastric emptying)
 Daily protein intake should be 1.5 gm/kg for positive balance
Psychological considerations
 Screening for anxiety and depression should be part of the initial assessment
 Mild or moderate levels of anxiety or depression related to the disease process may improve with pulmonary rehabilitation
 Patients with significant psychiatric disease should be referred for appropriate professional care (ATS/ERSSTATEMENT)
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Nutritionalsupport

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○ Providing patients with an opportunity to give feedback about the program is a useful measure of quality control.
○ Patient feedback also allows coordinators to evaluate the components of pulmonary rehabilitation that patients find
most useful.
○ The questionnaire should also provide patients with a variety of answering options Exercise capacity measurement
Oxygen Therapy
○ Long-term oxygen therapy (LTOT), provided more than 15 hr/day, improves survival and quality of life in COPD if
hypoxemia is present with arterial oxygen saturation (Spo2) less than 88%
○ It can also increase exercise tolerance and cognitive outcomes.
○ LTOT is also needed if the patient’s Spo2 is less than 89% along with pulmonary hypertension or peripheral edema,
suggesting congestive cardiac failure
○ Oxygen concentrators have become the most popular method of providing oxygen in the home.
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OutcomeAssessment

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○ Inhale through your nose and keeping your mouth closed
○ Exhale through pursed lips this permits more complete lung action
○ Inhale for two seconds and exhale for four seconds
○ Start with a short walk
○ Stop and rest whenever you are short of breath #exercise must not harm a patient lung
○ Start walking with ashort walk
○ Count the number of steps you take while you inhale
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Guidelinesduringrehabilitationprogram

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