The document discusses physiotherapy management for Chronic Obstructive Pulmonary Disease (COPD) and emphasizes the goals of maximizing patients' quality of life and health through education, exercise, and monitoring. It outlines primary interventions, including aerobic and strengthening exercises, breathing techniques, and patient education on self-management and lifestyle factors. Additionally, it highlights the importance of assessing patients' respiratory function and tailoring exercise intensity based on individual responses.

1. PHYSIOTHERAPY
MANAGEMENT
FOR COPD
T.SUNILKUMAR

2. • The common disease entity of chronic bronchitis and
emphysema is known as
COPD (chronic obstructive pulmonary disease),
COAD (chronic obstructive airways disease),
COLD (chronic obstructive lung disease),
CAO (chronic airflow obstruction) or
CAL (chronic airflow limitation).

3. Principles of physical therapy
management for COPD
The goals for long-term management of the patient
with COPD include the following:
• Maximize the patient's quality of life, general
health, and well-being and hence physiological
reserve capacity
• Educate about COPD, self-management, smoking
reduction and cessation, medications, nutrition,
weight control, other lifestyle factors, infection
control, and the role of a rehabilitation program

4. • Facilitate mucociliary transport
• Optimize secretion clearance
• Optimize alveolar ventilation
• Optimize lung volumes and capacities and
flow rates
• Optimize ventilation and perfusion matching
and gas exchange
• Reduce the work of breathing
• Reduce the work of the heart

5. • Maximize aerobic capacity and efficiency of
oxygen transport
• Optimize physical endurance and exercise
capacity
• Optimize general muscle strength and thereby
peripheral oxygen extraction
• Optimize respiratory muscle strength and
endurance and overall respiratory muscle
efficiency

6. • Patient monitoring includes dyspnea, respiratory
distress, breathing pattern (depth and frequency),
arterial saturation, cyanosis (delayed sign of
desaturation), heart rate and blood pressure.
• Patients with cardiac dysfunction or low arterial
oxygen tensions require ECG monitoring, particularly
during exercise.
• If supplemental oxygen is used, the FIo2 administered
is recorded. Subjectively, breathlessness is assessed
using a modified version of the Borg scale of
perceived exertion.

7. • Patient education focuses on teaching about the
severity of COPD, self-management of the
disease, the effect of smoking and smoking
cessation. nutrition, weight control, hydration,
relaxation, sleep and rest, stress management,
activity pacing, energy conservation, and
prevention (e.g., cold and flu prevention, flu
shots, aerobic exercise, diet, sleep, and stress
management).

8. • The primary interventions for maximizing
cardiopulmonary function and oxygen transport in
patients with COPD include some combination of
education, aerobic exercise, strengthening exercise,
ventilatory muscle training (strength and endurance)
or ventilatory muscle rest, low flow oxygen,
mechanical ventilatory support for home use, chest
wall mobility exercises, range of motion exercises,
body positioning, breathing control and coughing
maneuvers, airway-clearance techniques, relaxation,
activity pacing, and energy conservation.
• An ergonomic assessment of work and home
environments may be indicated to minimize oxygen
demands in these settings.

9. • The benefits of aerobic and strengthening exercise
in the long-term management of airflow limitation
to optimize oxygen transport in patients with
compromised oxygen delivery is well established
• Exercise intensity is prescribed based on rating of
breathlessness (modified Borg scale), in
conjunction with objective and other subjective
responses from the exercise test.

10. • Patients with chronic airflow limitation alter their
breathing patterns so that they tend to breathe with
prolonged expiratory phases to maximize gas
transfer and mixing in the lungs to minimize the
effects of altered ventilatory time constants.
• To facilitate such a breathing pattern, the patient
tends to breathe through pursed lips, which may
create back pressure to maintain the patency of the
airways