This document provides a review of post-COVID pulmonary rehabilitation. It begins with an abstract that outlines the background and aims to bring a pulmonary rehabilitation perspective to multidisciplinary COVID-19 treatment. The review analyzes prior studies on pulmonary rehabilitation to understand its potential benefits for COVID-19 patients suffering from long-term effects. It provides definitions of pulmonary rehabilitation and discusses considerations for both inpatient and outpatient rehabilitation programs with a focus on exercise recommendations.
Outcome study of pulmonary telerehab - respirehab for post COVID patientsSubodh Gupta
Respirehab's case paper of telerehab of post COVID patients for improving breathing capacity, physical endurance and patient well being. The online pulmonary rehab delivered excellent gains on various parameters like SGRQ, MMRC and SPO2. This would be very helpful for COPD patients suffering from shortness of breath (Dyspnea).
This document reviews treatment and management strategies for chronic obstructive pulmonary disease (COPD). It finds that inhaled bronchodilators are the primary treatment for COPD patients. Pulmonary rehabilitation, including exercise and education, and smoking cessation are also important non-pharmacological strategies. For more severe COPD, guidelines recommend combination drug therapies using long-acting bronchodilators and inhaled corticosteroids to improve lung function and reduce exacerbations. Proper treatment and management can slow disease progression and improve quality of life for COPD patients.
Impact of pulmonary rehabilitation program on health outcomes of patients wit...Alexander Decker
The study assessed the impact of a two-month home-based pulmonary rehabilitation program on health outcomes of patients with chronic obstructive pulmonary disease (COPD). 27 COPD patients received the rehabilitation program in addition to usual hospital care. The program consisted of education sessions and home exercises. Health outcomes were measured before and after the program using questionnaires, pulmonary function tests, and exercise tests. The results showed that the rehabilitation program significantly improved quality of life, functional capacity, and dyspnea for patients with moderate and severe COPD, but had less impact on patients with very severe COPD. The study concluded that pulmonary rehabilitation can effectively manage COPD symptoms and health outcomes.
A Quasi Experimental Study to Assess the Effectiveness of Selected Nursing In...iosrjce
A study to assess the effectiveness of selected nursing interventions on health related quality of life
and activities of daily living among COPD patients in selected tertiary hospital, Chennai, Tamilnadu, India.
The aim of the study was to impart the selected nursing interventions applied to the COPD patients in medical
and pulmonary wards. The conceptual framework used in this study was Widenbach’s Helping art Theory. An
Evaluative approach was used for the present study. Using purposive sampling technique 50 samples were
selected from Chettinad Hospital and Research Institute, Tamil Nadu, India. The tool used was self
administered questionnaire. The collected data was analyzed using descriptive and inferential statistics. The
findings of the study revealed a significantly increase in the COPD patients health related quality of life and
activities of daily living after given the selected nursing interventions. The mean pre test score was 1867 and
the mean post test score was 1861 and the difference between pre test and post test knowledge score was 5.54.
Based on the objectives of the study the findings of the level of health related quality of life and activities of
daily living among COPD patients shows that increased health related quality of life and activities of daily
living. The study shows that the COPD patients in post test were having post score1861 mean difference
5.54.standard deviation 2.35.p value (0.02). Selected nursing interventions are effective in increasing the health
related qualityof life and activities of daily living among COPD patients.. The findings of the study revealed that
a significantly increased in the post test health related quality of life and activities of daily living after given the
selected nursing interventions
The document provides guidelines for diagnosing and assessing chronic obstructive pulmonary disease (COPD). Key points include:
- COPD is characterized by persistent airflow limitation associated with inflammation. A clinical diagnosis requires symptoms and risk factors plus spirometry showing airflow limitation.
- Tobacco smoking is the most common risk factor worldwide. Other risks include indoor and outdoor air pollution.
- Assessment of COPD involves evaluating symptoms, degree of airflow limitation via spirometry, risk of exacerbations, and comorbidities.
- Treatment aims to reduce symptoms and exacerbations while improving health status. Non-pharmacological and pharmacological options are outlined.
Three months of aerobic exercise training reduces depressive symptoms in pregnant women. A randomized trial assigned 80 nulliparous pregnant women to either a 3-month supervised aerobic exercise program or their usual activities. The exercise program consisted of walking, aerobic exercise, stretching, and relaxation 3 times per week. After the intervention, women in the exercise group reported fewer depressive symptoms on a depression questionnaire compared to the control group. Supervised aerobic exercise during pregnancy may help reduce symptoms of depression.
Pulmonary rehab is part of global standard of care for patients suffering from chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), persistent bronchial asthma and other lung manifestations.
Respirehab makes pulmonary rehab accessible, convenient and cost effective by taking it digital & online.
home based pulmonaRY REHABILITATION IN COPDSurendra Ojha
This randomized study evaluated the impact of a home-based pulmonary rehabilitation program for subjects with COPD compared to a control group. The home-based program consisted of walking, stair climbing, and arm exercises performed 3 times per week for 24 sessions. The home-based group showed significant improvements in the 6-minute walk test distance (65m increase) and treadmill endurance time (316m increase) compared to no significant changes in the control group. The home-based group also had improvements in all domains of a quality of life questionnaire, while the control group did not change. The study demonstrates that a simple, low-cost home-based pulmonary rehabilitation program can improve exercise capacity and quality of life for subjects with COPD
Outcome study of pulmonary telerehab - respirehab for post COVID patientsSubodh Gupta
Respirehab's case paper of telerehab of post COVID patients for improving breathing capacity, physical endurance and patient well being. The online pulmonary rehab delivered excellent gains on various parameters like SGRQ, MMRC and SPO2. This would be very helpful for COPD patients suffering from shortness of breath (Dyspnea).
This document reviews treatment and management strategies for chronic obstructive pulmonary disease (COPD). It finds that inhaled bronchodilators are the primary treatment for COPD patients. Pulmonary rehabilitation, including exercise and education, and smoking cessation are also important non-pharmacological strategies. For more severe COPD, guidelines recommend combination drug therapies using long-acting bronchodilators and inhaled corticosteroids to improve lung function and reduce exacerbations. Proper treatment and management can slow disease progression and improve quality of life for COPD patients.
Impact of pulmonary rehabilitation program on health outcomes of patients wit...Alexander Decker
The study assessed the impact of a two-month home-based pulmonary rehabilitation program on health outcomes of patients with chronic obstructive pulmonary disease (COPD). 27 COPD patients received the rehabilitation program in addition to usual hospital care. The program consisted of education sessions and home exercises. Health outcomes were measured before and after the program using questionnaires, pulmonary function tests, and exercise tests. The results showed that the rehabilitation program significantly improved quality of life, functional capacity, and dyspnea for patients with moderate and severe COPD, but had less impact on patients with very severe COPD. The study concluded that pulmonary rehabilitation can effectively manage COPD symptoms and health outcomes.
A Quasi Experimental Study to Assess the Effectiveness of Selected Nursing In...iosrjce
A study to assess the effectiveness of selected nursing interventions on health related quality of life
and activities of daily living among COPD patients in selected tertiary hospital, Chennai, Tamilnadu, India.
The aim of the study was to impart the selected nursing interventions applied to the COPD patients in medical
and pulmonary wards. The conceptual framework used in this study was Widenbach’s Helping art Theory. An
Evaluative approach was used for the present study. Using purposive sampling technique 50 samples were
selected from Chettinad Hospital and Research Institute, Tamil Nadu, India. The tool used was self
administered questionnaire. The collected data was analyzed using descriptive and inferential statistics. The
findings of the study revealed a significantly increase in the COPD patients health related quality of life and
activities of daily living after given the selected nursing interventions. The mean pre test score was 1867 and
the mean post test score was 1861 and the difference between pre test and post test knowledge score was 5.54.
Based on the objectives of the study the findings of the level of health related quality of life and activities of
daily living among COPD patients shows that increased health related quality of life and activities of daily
living. The study shows that the COPD patients in post test were having post score1861 mean difference
5.54.standard deviation 2.35.p value (0.02). Selected nursing interventions are effective in increasing the health
related qualityof life and activities of daily living among COPD patients.. The findings of the study revealed that
a significantly increased in the post test health related quality of life and activities of daily living after given the
selected nursing interventions
The document provides guidelines for diagnosing and assessing chronic obstructive pulmonary disease (COPD). Key points include:
- COPD is characterized by persistent airflow limitation associated with inflammation. A clinical diagnosis requires symptoms and risk factors plus spirometry showing airflow limitation.
- Tobacco smoking is the most common risk factor worldwide. Other risks include indoor and outdoor air pollution.
- Assessment of COPD involves evaluating symptoms, degree of airflow limitation via spirometry, risk of exacerbations, and comorbidities.
- Treatment aims to reduce symptoms and exacerbations while improving health status. Non-pharmacological and pharmacological options are outlined.
Three months of aerobic exercise training reduces depressive symptoms in pregnant women. A randomized trial assigned 80 nulliparous pregnant women to either a 3-month supervised aerobic exercise program or their usual activities. The exercise program consisted of walking, aerobic exercise, stretching, and relaxation 3 times per week. After the intervention, women in the exercise group reported fewer depressive symptoms on a depression questionnaire compared to the control group. Supervised aerobic exercise during pregnancy may help reduce symptoms of depression.
Pulmonary rehab is part of global standard of care for patients suffering from chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), persistent bronchial asthma and other lung manifestations.
Respirehab makes pulmonary rehab accessible, convenient and cost effective by taking it digital & online.
home based pulmonaRY REHABILITATION IN COPDSurendra Ojha
This randomized study evaluated the impact of a home-based pulmonary rehabilitation program for subjects with COPD compared to a control group. The home-based program consisted of walking, stair climbing, and arm exercises performed 3 times per week for 24 sessions. The home-based group showed significant improvements in the 6-minute walk test distance (65m increase) and treadmill endurance time (316m increase) compared to no significant changes in the control group. The home-based group also had improvements in all domains of a quality of life questionnaire, while the control group did not change. The study demonstrates that a simple, low-cost home-based pulmonary rehabilitation program can improve exercise capacity and quality of life for subjects with COPD
Evaluation of Empirical Usage of Respiratory Medications in Treatment of Pati...DR. SUJOY MUKHERJEE
1) The study evaluated the empirical use of respiratory medications in 550 patients presenting with chronic lower respiratory symptoms who were referred for spirometric screening.
2) It was found that empirical usage of medications without spirometry was widespread, with the potential for future adverse outcomes from misdiagnoses.
3) The study concluded that all patients with chronic lower respiratory symptoms should have their diagnoses confirmed with spirometry testing before receiving medications to avoid incorrect diagnoses and unwanted side effects from unnecessary treatments.
This pilot study assessed the effects of an Iyengar yoga program (IYP) on 25 patients with chronic lung diseases like pulmonary arterial hypertension and chronic obstructive pulmonary disease. Patients participated in a 12-week IYP involving biweekly 2-hour classes. Questionnaires assessing health-related quality of life, anxiety, depression, and functional mobility were completed at baseline and after 12 weeks. Statistically significant improvements were seen in anxiety and fatigue scores. Clinically important improvements were observed in mobility, pain, emotion, and overall health scores. Patients' journals also reported enhancements in breathing, energy, sleep, and overall well-being. The findings suggest yoga may provide benefits and warrant further exploration in a larger study.
The document discusses the current status, pathophysiology, and principles of COVID-19 management and implications for physiotherapy. It provides details on the origin and spread of COVID-19, the virus's structure and mechanism of entering host cells, and the impact on multiple organ systems. Recommendations are made for personal protective equipment when performing respiratory physiotherapy techniques that produce aerosols, such as airway clearance and coughing exercises. Developing vaccines and treatments are important areas of research given the lack of existing prophylactics or therapeutics for COVID-19.
Pulmonary Rehab: impact on lung function and breathlessnessSubodh Gupta
This presentation is for patient education so that they can make informed choices while evaluating options for post COVID recovery or any other lung disease. This is specially meant for caretakers whose patients suffer from breathing issues or are on supplemental oxygen (oxygen concentrator or oxygen cylinder).
This explains how RespiRehab works and helps patients recover.
Comparative effect of 12 weeks of slow and fast pranayama training on pulmona...Yogacharya AB Bhavanani
Comparative effect of 12 weeks of slow and fast pranayama training on pulmonary function in young, healthy volunteers: A randomized controlled trial
T Dinesh, GS Gaur, VK Sharma, T Madanmohan, KT Harichandra Kumar, AB Bhavanani
Abstract
Context: Pranayamas are breathing techniques that exert profound physiological effects on pulmonary, cardiovascular, and mental functions. Previous studies demonstrate that different types of pranayamas produce divergent effects.
Aim: The aim was to compare the effect of 12 weeks of slow and fast pranayama training on pulmonary function in young, healthy volunteers.
Settings and Design: This study was carried out in Departments of Physiology and ACYTER, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry in 2011.
Subjects and Methods: Ninety one healthy volunteers were randomized into slow pranayama group (SPG), n =29, fast pranayama group (FPG), n = 32 and control groups (CG) (n = 30). Supervised pranayama training (SPG: Nadisodhana, Pranav pranayama and Savitri pranayama; FPG: Kapalabhati, Bhastrika and Kukkriya pranayama) was given for 30 min/day, thrice/week for 12 weeks by certified yoga instructors. Pulmonary function parameters (PFT) such as forced vital capacity (FVC), forced expiratory volume in first second (FEV 1 ), ratio between FEV 1 and FVC (FEV 1 /FVC), peak expiratory flow rate (PEFR), maximum voluntary ventilation (MVV), and forced expiratory flow 25-75 (FEF 25-75 ), were recorded at baseline and after 12 weeks of pranayama training using the computerized spirometer (Micro laboratory V1.32, England).
Results: In SPG, PEFR, and FEF 25-75 improved significantly (P < 0.05) while other parameters (FVC, FEV 1 , FEV 1 /FVC, and MVV) showed only marginal improvements. In FPG, FEV 1 /FVC, PEFR, and FEF 25-75 parameters improved significantly (P < 0.05), while FVC, FEV 1 , and MVV did not show significant (P > 0.05) change. No significant change was observed in CG.
Conclusion: Twelve weeks of pranayama training in young subjects showed improvement in the commonly measured PFT. This indicates that pranayama training improved pulmonary function and that this was more pronounced in the FPG.
This document provides information on Gurmeet Singh's education and employment history as well as his organizational memberships. It then summarizes his presentation on the role of small airways in COPD. The presentation discusses how small airway inflammation and remodeling can contribute to COPD progression and airflow limitation. It also reviews techniques for assessing small airway dysfunction like spirometry, imaging, and forced oscillation. The importance of targeting small airways with therapies like bronchodilators and anti-inflammatories is also highlighted.
1) Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that causes shortness of breath. It includes emphysema, chronic bronchitis, and chronic asthma. Cigarette smoking is the primary cause.
2) Exercise can help people with COPD by improving cardiovascular health, reducing symptoms like breathlessness, and enhancing quality of life. Aerobic exercise, strength training, flexibility, and neuromuscular exercises are all beneficial.
3) Pulmonary rehabilitation including ongoing exercise is effective for improving quality of life and managing COPD symptoms. An individualized exercise program tailored to a person's capabilities is important.
This document summarizes a literature review on the effects of physical training on asthma in adults. The review analyzed 6 studies that involved a physical training intervention for adults with asthma, measuring effects on physical fitness, pulmonary function, asthma control, and quality of life. The studies generally found that physical training significantly improved measures of physical fitness like VO2max, but results on lung function were inconclusive. Some individual studies reported improvements in asthma control, severity, and quality of life with training, but overall the evidence is insufficient to conclude on effects in those areas. No studies reported any negative effects of exercise on asthma.
This randomized clinical trial investigated whether acetazolamide reduces the duration of mechanical ventilation among patients with chronic obstructive pulmonary disease (COPD) and metabolic alkalosis. The study assigned 382 COPD patients receiving invasive mechanical ventilation to receive either acetazolamide or placebo. The primary outcome was duration of invasive mechanical ventilation. While acetazolamide significantly reduced serum bicarbonate levels and days of metabolic alkalosis, it did not result in a statistically significant reduction in the duration of mechanical ventilation compared to placebo, though the difference was clinically important. Secondary outcomes like weaning time and respiratory parameters also did not differ significantly between groups.
This document provides a summary of selected new evidence relevant to the NICE clinical guideline on the management of chronic obstructive pulmonary disease (COPD) in adults. It discusses 27 pieces of new evidence identified since the literature search was last conducted for the guideline. The evidence is grouped into the following sections: managing stable COPD, management of exacerbations, and areas not currently covered by NICE guidance. For stable COPD, the evidence discusses topics like smoking cessation, inhaled therapy, pulmonary rehabilitation, and vaccination. It finds that smoking cessation benefits may extend to more severe COPD, and counseling plus nicotine replacement or antidepressants can help patients stop smoking. For inhaled therapy, combinations of long-acting beta-
1. Several therapeutic options for bronchiolitis have been studied but none have been shown to alter the course of the disease or its major outcomes.
2. The most promising combination to date appears to be oral dexamethasone and inhaled epinephrine, but many issues around this need further clarification.
3. Future research should focus on detailed characterization of infants most likely to benefit from specific interventions for bronchiolitis.
This document provides an introduction to the dissertation which aims to develop and evaluate a tool called the Assessment of Burden of COPD (ABC) tool. It first defines key concepts related to chronic disease management including health, chronic obstructive pulmonary disease (COPD), and the chronic care model. It emphasizes the importance of a holistic, patient-centered approach for COPD that incorporates patient-reported outcomes and self-management support. The document then states the need for a tool that can measure integrated health status, provide insight into a patient's disease, and facilitate shared decision making. The aim of the research is to develop and evaluate the effectiveness of such a tool focused on measuring and treating the experienced burden of COPD.
Effects of souvenaid on plasma micronutrient levels and fatty acid profiles i...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
Role of cardiopulmonary physiotherapy in covid 19 pptxQuratBenu1
This document discusses the role of cardiopulmonary physiotherapists in treating patients with COVID-19. It notes that COVID-19 causes respiratory illness and complications like pneumonia in many patients. While most cases are mild, moderate to severe cases require hospitalization and oxygen support. The document outlines physiotherapy recommendations for oxygen therapy, including cautious use of high flow nasal oxygen. It stresses close monitoring of patients and timely escalation of care if respiratory function worsens.
This document summarizes evidence on the use of noninvasive ventilation (NIV) in acute respiratory failure. It finds that NIV is an effective first-line treatment for moderate-to-severe exacerbations of chronic obstructive pulmonary disease (COPD) and acute cardiogenic pulmonary edema, reducing the need for invasive mechanical ventilation and improving outcomes. It also discusses how NIV is used in other clinical settings such as postoperative care, pneumonia, asthma, and palliative care. The document concludes that appropriate patient selection and technique are important for the successful use of NIV.
2018 GOLD POCKET GUIDE
Evidence-based strategy document for COPD diagnosis, management, and prevention, with citations from the scientific literature.
2018 GOLD POCKET GUIDE
http://goldcopd.org/gold-reports/
This document provides an updated global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD) from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). It discusses definitions of COPD, the disease burden, pathogenesis and pathophysiology. Guidelines are provided on diagnosis, assessment of symptoms and risk, therapeutic options including pharmacologic and non-pharmacologic treatments, management of stable COPD and exacerbations, and management of COPD comorbidities. The document is intended as a tool for healthcare professionals to implement effective COPD management programs.
Pulmonary rehabilitation is a multidisciplinary treatment for chronic respiratory diseases like COPD. It addresses the respiratory limitations and systemic consequences of the disease through exercise training, education, psychosocial support, and nutrition intervention. Studies show pulmonary rehabilitation improves outcomes like dyspnea, exercise capacity, and quality of life. It is now a standard treatment for COPD alongside bronchodilator therapy.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It includes chronic bronchitis and emphysema. The main risk factor is exposure to tobacco smoke, which accounts for 80-90% of COPD cases. Patients experience symptoms of cough, sputum production, and dyspnea on exertion. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy to relieve symptoms and reduce exacerbations. Nursing care includes education on disease management, breathing exercises, medication administration, and promoting lifestyle changes to improve quality of life.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It includes chronic bronchitis and emphysema. The main risk factor is exposure to tobacco smoke, which accounts for 80-90% of COPD cases. Patients experience symptoms of cough, sputum production, and dyspnea on exertion. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy to relieve symptoms and reduce exacerbations. Nursing care includes education on disease management, breathing exercises, medication administration, and promoting lifestyle changes to improve quality of life.
A Study to Assess the Knowledge Regarding Buteyko Breathing Technique among A...ijtsrd
Asthma is an incurable disease of inflammation of the airways. In affected patients, inflammation causes recurrent episodes of shortness of breath, shortness of breath, chest tightness and coughing, especially at night or very early in the morning. The objectives of the study were to test information on Buteykos respiratory system. The Quantitative test method was adopted in the current study. 60 patients with Bronchial asthma who experienced an inclusive procedure were selected for a simplified procedure. The study was conducted at Medanta Hospital, Lucknow. Data were collected using information questionnaires to assess information on breathing exercises among OPD asthmatic patients. These study results show that out of 60 samples 10 16.6 had sufficient information and 16 26.7 had limited information and 34 56.7 had sufficient information. The study found that the majority of respondents who participated in the study had insufficient knowledge about breathing exercises very few participants are experienced enough. Miss. Gunjan Singh | Mr. Raghavendran M. "A Study to Assess the Knowledge Regarding Buteyko Breathing Technique among Asthma Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47629.pdf Paper URL : https://www.ijtsrd.com/medicine/nursing/47629/a-study-to-assess-the-knowledge-regarding-buteyko-breathing-technique-among-asthma-patients/miss-gunjan-singh
Evaluation of Empirical Usage of Respiratory Medications in Treatment of Pati...DR. SUJOY MUKHERJEE
1) The study evaluated the empirical use of respiratory medications in 550 patients presenting with chronic lower respiratory symptoms who were referred for spirometric screening.
2) It was found that empirical usage of medications without spirometry was widespread, with the potential for future adverse outcomes from misdiagnoses.
3) The study concluded that all patients with chronic lower respiratory symptoms should have their diagnoses confirmed with spirometry testing before receiving medications to avoid incorrect diagnoses and unwanted side effects from unnecessary treatments.
This pilot study assessed the effects of an Iyengar yoga program (IYP) on 25 patients with chronic lung diseases like pulmonary arterial hypertension and chronic obstructive pulmonary disease. Patients participated in a 12-week IYP involving biweekly 2-hour classes. Questionnaires assessing health-related quality of life, anxiety, depression, and functional mobility were completed at baseline and after 12 weeks. Statistically significant improvements were seen in anxiety and fatigue scores. Clinically important improvements were observed in mobility, pain, emotion, and overall health scores. Patients' journals also reported enhancements in breathing, energy, sleep, and overall well-being. The findings suggest yoga may provide benefits and warrant further exploration in a larger study.
The document discusses the current status, pathophysiology, and principles of COVID-19 management and implications for physiotherapy. It provides details on the origin and spread of COVID-19, the virus's structure and mechanism of entering host cells, and the impact on multiple organ systems. Recommendations are made for personal protective equipment when performing respiratory physiotherapy techniques that produce aerosols, such as airway clearance and coughing exercises. Developing vaccines and treatments are important areas of research given the lack of existing prophylactics or therapeutics for COVID-19.
Pulmonary Rehab: impact on lung function and breathlessnessSubodh Gupta
This presentation is for patient education so that they can make informed choices while evaluating options for post COVID recovery or any other lung disease. This is specially meant for caretakers whose patients suffer from breathing issues or are on supplemental oxygen (oxygen concentrator or oxygen cylinder).
This explains how RespiRehab works and helps patients recover.
Comparative effect of 12 weeks of slow and fast pranayama training on pulmona...Yogacharya AB Bhavanani
Comparative effect of 12 weeks of slow and fast pranayama training on pulmonary function in young, healthy volunteers: A randomized controlled trial
T Dinesh, GS Gaur, VK Sharma, T Madanmohan, KT Harichandra Kumar, AB Bhavanani
Abstract
Context: Pranayamas are breathing techniques that exert profound physiological effects on pulmonary, cardiovascular, and mental functions. Previous studies demonstrate that different types of pranayamas produce divergent effects.
Aim: The aim was to compare the effect of 12 weeks of slow and fast pranayama training on pulmonary function in young, healthy volunteers.
Settings and Design: This study was carried out in Departments of Physiology and ACYTER, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry in 2011.
Subjects and Methods: Ninety one healthy volunteers were randomized into slow pranayama group (SPG), n =29, fast pranayama group (FPG), n = 32 and control groups (CG) (n = 30). Supervised pranayama training (SPG: Nadisodhana, Pranav pranayama and Savitri pranayama; FPG: Kapalabhati, Bhastrika and Kukkriya pranayama) was given for 30 min/day, thrice/week for 12 weeks by certified yoga instructors. Pulmonary function parameters (PFT) such as forced vital capacity (FVC), forced expiratory volume in first second (FEV 1 ), ratio between FEV 1 and FVC (FEV 1 /FVC), peak expiratory flow rate (PEFR), maximum voluntary ventilation (MVV), and forced expiratory flow 25-75 (FEF 25-75 ), were recorded at baseline and after 12 weeks of pranayama training using the computerized spirometer (Micro laboratory V1.32, England).
Results: In SPG, PEFR, and FEF 25-75 improved significantly (P < 0.05) while other parameters (FVC, FEV 1 , FEV 1 /FVC, and MVV) showed only marginal improvements. In FPG, FEV 1 /FVC, PEFR, and FEF 25-75 parameters improved significantly (P < 0.05), while FVC, FEV 1 , and MVV did not show significant (P > 0.05) change. No significant change was observed in CG.
Conclusion: Twelve weeks of pranayama training in young subjects showed improvement in the commonly measured PFT. This indicates that pranayama training improved pulmonary function and that this was more pronounced in the FPG.
This document provides information on Gurmeet Singh's education and employment history as well as his organizational memberships. It then summarizes his presentation on the role of small airways in COPD. The presentation discusses how small airway inflammation and remodeling can contribute to COPD progression and airflow limitation. It also reviews techniques for assessing small airway dysfunction like spirometry, imaging, and forced oscillation. The importance of targeting small airways with therapies like bronchodilators and anti-inflammatories is also highlighted.
1) Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that causes shortness of breath. It includes emphysema, chronic bronchitis, and chronic asthma. Cigarette smoking is the primary cause.
2) Exercise can help people with COPD by improving cardiovascular health, reducing symptoms like breathlessness, and enhancing quality of life. Aerobic exercise, strength training, flexibility, and neuromuscular exercises are all beneficial.
3) Pulmonary rehabilitation including ongoing exercise is effective for improving quality of life and managing COPD symptoms. An individualized exercise program tailored to a person's capabilities is important.
This document summarizes a literature review on the effects of physical training on asthma in adults. The review analyzed 6 studies that involved a physical training intervention for adults with asthma, measuring effects on physical fitness, pulmonary function, asthma control, and quality of life. The studies generally found that physical training significantly improved measures of physical fitness like VO2max, but results on lung function were inconclusive. Some individual studies reported improvements in asthma control, severity, and quality of life with training, but overall the evidence is insufficient to conclude on effects in those areas. No studies reported any negative effects of exercise on asthma.
This randomized clinical trial investigated whether acetazolamide reduces the duration of mechanical ventilation among patients with chronic obstructive pulmonary disease (COPD) and metabolic alkalosis. The study assigned 382 COPD patients receiving invasive mechanical ventilation to receive either acetazolamide or placebo. The primary outcome was duration of invasive mechanical ventilation. While acetazolamide significantly reduced serum bicarbonate levels and days of metabolic alkalosis, it did not result in a statistically significant reduction in the duration of mechanical ventilation compared to placebo, though the difference was clinically important. Secondary outcomes like weaning time and respiratory parameters also did not differ significantly between groups.
This document provides a summary of selected new evidence relevant to the NICE clinical guideline on the management of chronic obstructive pulmonary disease (COPD) in adults. It discusses 27 pieces of new evidence identified since the literature search was last conducted for the guideline. The evidence is grouped into the following sections: managing stable COPD, management of exacerbations, and areas not currently covered by NICE guidance. For stable COPD, the evidence discusses topics like smoking cessation, inhaled therapy, pulmonary rehabilitation, and vaccination. It finds that smoking cessation benefits may extend to more severe COPD, and counseling plus nicotine replacement or antidepressants can help patients stop smoking. For inhaled therapy, combinations of long-acting beta-
1. Several therapeutic options for bronchiolitis have been studied but none have been shown to alter the course of the disease or its major outcomes.
2. The most promising combination to date appears to be oral dexamethasone and inhaled epinephrine, but many issues around this need further clarification.
3. Future research should focus on detailed characterization of infants most likely to benefit from specific interventions for bronchiolitis.
This document provides an introduction to the dissertation which aims to develop and evaluate a tool called the Assessment of Burden of COPD (ABC) tool. It first defines key concepts related to chronic disease management including health, chronic obstructive pulmonary disease (COPD), and the chronic care model. It emphasizes the importance of a holistic, patient-centered approach for COPD that incorporates patient-reported outcomes and self-management support. The document then states the need for a tool that can measure integrated health status, provide insight into a patient's disease, and facilitate shared decision making. The aim of the research is to develop and evaluate the effectiveness of such a tool focused on measuring and treating the experienced burden of COPD.
Effects of souvenaid on plasma micronutrient levels and fatty acid profiles i...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
Role of cardiopulmonary physiotherapy in covid 19 pptxQuratBenu1
This document discusses the role of cardiopulmonary physiotherapists in treating patients with COVID-19. It notes that COVID-19 causes respiratory illness and complications like pneumonia in many patients. While most cases are mild, moderate to severe cases require hospitalization and oxygen support. The document outlines physiotherapy recommendations for oxygen therapy, including cautious use of high flow nasal oxygen. It stresses close monitoring of patients and timely escalation of care if respiratory function worsens.
This document summarizes evidence on the use of noninvasive ventilation (NIV) in acute respiratory failure. It finds that NIV is an effective first-line treatment for moderate-to-severe exacerbations of chronic obstructive pulmonary disease (COPD) and acute cardiogenic pulmonary edema, reducing the need for invasive mechanical ventilation and improving outcomes. It also discusses how NIV is used in other clinical settings such as postoperative care, pneumonia, asthma, and palliative care. The document concludes that appropriate patient selection and technique are important for the successful use of NIV.
2018 GOLD POCKET GUIDE
Evidence-based strategy document for COPD diagnosis, management, and prevention, with citations from the scientific literature.
2018 GOLD POCKET GUIDE
http://goldcopd.org/gold-reports/
This document provides an updated global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD) from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). It discusses definitions of COPD, the disease burden, pathogenesis and pathophysiology. Guidelines are provided on diagnosis, assessment of symptoms and risk, therapeutic options including pharmacologic and non-pharmacologic treatments, management of stable COPD and exacerbations, and management of COPD comorbidities. The document is intended as a tool for healthcare professionals to implement effective COPD management programs.
Pulmonary rehabilitation is a multidisciplinary treatment for chronic respiratory diseases like COPD. It addresses the respiratory limitations and systemic consequences of the disease through exercise training, education, psychosocial support, and nutrition intervention. Studies show pulmonary rehabilitation improves outcomes like dyspnea, exercise capacity, and quality of life. It is now a standard treatment for COPD alongside bronchodilator therapy.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It includes chronic bronchitis and emphysema. The main risk factor is exposure to tobacco smoke, which accounts for 80-90% of COPD cases. Patients experience symptoms of cough, sputum production, and dyspnea on exertion. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy to relieve symptoms and reduce exacerbations. Nursing care includes education on disease management, breathing exercises, medication administration, and promoting lifestyle changes to improve quality of life.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. It includes chronic bronchitis and emphysema. The main risk factor is exposure to tobacco smoke, which accounts for 80-90% of COPD cases. Patients experience symptoms of cough, sputum production, and dyspnea on exertion. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, pulmonary rehabilitation, and oxygen therapy to relieve symptoms and reduce exacerbations. Nursing care includes education on disease management, breathing exercises, medication administration, and promoting lifestyle changes to improve quality of life.
A Study to Assess the Knowledge Regarding Buteyko Breathing Technique among A...ijtsrd
Asthma is an incurable disease of inflammation of the airways. In affected patients, inflammation causes recurrent episodes of shortness of breath, shortness of breath, chest tightness and coughing, especially at night or very early in the morning. The objectives of the study were to test information on Buteykos respiratory system. The Quantitative test method was adopted in the current study. 60 patients with Bronchial asthma who experienced an inclusive procedure were selected for a simplified procedure. The study was conducted at Medanta Hospital, Lucknow. Data were collected using information questionnaires to assess information on breathing exercises among OPD asthmatic patients. These study results show that out of 60 samples 10 16.6 had sufficient information and 16 26.7 had limited information and 34 56.7 had sufficient information. The study found that the majority of respondents who participated in the study had insufficient knowledge about breathing exercises very few participants are experienced enough. Miss. Gunjan Singh | Mr. Raghavendran M. "A Study to Assess the Knowledge Regarding Buteyko Breathing Technique among Asthma Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47629.pdf Paper URL : https://www.ijtsrd.com/medicine/nursing/47629/a-study-to-assess-the-knowledge-regarding-buteyko-breathing-technique-among-asthma-patients/miss-gunjan-singh
Respirology - 2022 - Barnett - Thoracic Society of Australia and New Zealand ...AssessoriadaGernciaG
This position paper from the Thoracic Society of Australia and New Zealand provides recommendations for acute oxygen use in adults. Key recommendations include:
1) Pulse oximetry should be routinely recorded along with vital signs to assess oxygenation. Arterial blood gases are still the gold standard but have limitations.
2) Oxygen is a drug that requires prescription documenting flow rate, delivery device, oxygen saturation targets, and criteria for deterioration or improvement.
3) The recommended oxygen saturation target range is 88-92% for those with chronic respiratory disease to avoid hypercapnia, and 92-96% for other situations.
4) Nasal cannulae are the preferred delivery method. Humidified
This document provides recommendations for physical therapists managing hospitalized patients with COVID-19 in the Netherlands. It recommends minimizing direct contact with COVID-19 patients and using personal protective equipment if needed. Treatment involves respiratory support and active mobilization, tailored to the patient's severity and needs. Recommendations cover safety protocols, treatments for critically ill ICU patients and severely ill ward patients, discharge planning, and staffing considerations. The guidance aims to support patient recovery and therapist safety during the pandemic.
Biopsychosocial Concepts for Advanced Nursing Practice I.pdfbkbk37
This document presents a concept map for a nursing care plan for a patient named Jane Doe experiencing shortness of breath and difficulty breathing. The concept map includes nursing diagnoses of impaired gas exchange, ineffective airway clearance, and activity intolerance related to her medical history of COPD. It outlines independent and collaborative nursing interventions to address her conditions and improve outcomes, including monitoring her status, teaching breathing techniques, positioning, rest periods, and oxygen therapy. The rationales for the interventions and expected outcomes are also provided.
Long covid, or prolonged symptoms after a COVID-19 infection, is common and can present in a variety of ways. The main approaches to managing long covid in primary care include supportive and holistic care focused on symptom control and detecting treatable complications. Fatigue is the most common symptom, and management focuses on pacing activities and symptom triggers. While the exact causes of long covid are unknown, it is thought to involve chronic inflammation and microvascular damage in multiple organ systems. Many long covid patients can be effectively supported in primary care, though specialist referrals are needed in some cases.
The document discusses chronic obstructive pulmonary disease (COPD). Some key points:
- COPD affects over 210 million people globally and is a leading cause of death. The burden is increasing and may affect over 4.5 million deaths annually by 2030.
- In India, the burden of COPD has more than doubled from 14.84 million cases in 1971 to over 30 million estimated current cases. Patients often present at moderate to severe stages.
- The 2017 GOLD guidelines updated the COPD definition and treatment paradigm to focus on relieving symptoms and reducing exacerbation risk through dual bronchodilation.
Role of physiotherapy on COVID-19 patient in ICU settingsJavidsultandar
Early physiotherapy, i.e., started during mechanical ventilation, is considered feasible and safe to improve patient performance and long-term quality of life ( kayambu et al., 2013), although this has not yet been proven in COVID-19. Among chest physiotherapy strategies during mechanical ventilation, mucus clearance and alveolar RMs are very commonly applied in clinical practice. Sputum production was reported in about 34 % of COVID-19 patients ( Guan et al., 2020), thus suggesting that, by promoting mucus clearance during mechanical ventilation, early physiotherapy interventions (such as subglottic secretion drainage, postural hygiene, and ventilator hyperinflation) may produce beneficial effects in this new critically ill population (Thomas et al., 2020).
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This document provides guidelines for the management of community acquired pneumonia (CAP) in adults. It covers definitions of CAP, investigations that should be performed, and severity assessments. The key investigations recommended include chest x-rays, blood tests, sputum cultures, Legionella and pneumococcal urine antigens. Severity is assessed using the CRB65 score for patients managed in the community and the CURB65 score for hospitalized patients. Based on the scores, treatment recommendations are provided for either hospital or home management.
Biopsychosocial Concepts for Advanced Nursing.docxwrite31
The document discusses a concept map for a nursing care plan for a patient with shortness of breath and difficulty breathing. The concept map includes diagnoses of impaired gas exchange, ineffective airway clearance, and activity intolerance. Nursing interventions include monitoring vital signs, teaching breathing techniques, positioning, and collaborating with other providers. The expected outcomes are improved gas exchange and signs of open airways. Additional context and evidence are provided to justify the care plan and highlight the importance of interprofessional collaboration to achieve quality outcomes for COPD patients.
Autologous mononuclear and mesenchymal stromal cells infusion in COPD patients: impact on pulmonary capacity and quality of life in a Phase I randomized clinical trial
A Descriptive Study to Assess the Knowledge and Practice Regarding Ventilator...ijtsrd
INTRODUCTION Mechanical ventilation has become the most commonly used mode of life support in medicine today. Mechanical ventilation is life saving, but like other interventions, it is not without complications. Physiologic complications associated with mechanical ventilation include ventilator induced lung injury, cardiovascular compromise gastrointestinal disturbances, pneumothorax and the most importantly ventilator associated pneumonia. Patients in the intensive care unit ICU are at risk for dying not only from their critical illness but also from secondary process such as nosocomial infection. Hospital Acquired Pneumonia is the second most common nosocomial infection in critically ill patient’s affecting 27 of all critically ill patients. Ventilator associated pneumonia VAP is a form of nosocomial pneumonia that occurs in patients receiving mechanical ventilation within 48 hours of intubation.AIM The aim of the study is to assess the knowledge and practice regarding ventilator associated pneumonia VAP critical care bundle among nursing students.MATERIAL AND METHODS The conceptual framework of the study was based on Health Belief Model. A quantitative research approach with descriptive design was adopted for the study. Non probability convenience sampling technique was used and 150 samples from selected colleges were selected. The data was collected by using Sociodemographic variables, self structured questionnaire regarding ventilator and checklist was prepared. RESULTS The study finding were as 75 respondents has excellent knowledge, 22 had good knowledge, 3 had average and no one had poor knowledge regarding Ventilator Associative Pneumonia VAP . Practice score of study shows that 73 of study subjects had Good practice, 25 had excellent practice, 2 had average practice and no one had poor practice regarding ventilator associated pneumonia VAP critical care bundle among nursing students. It shows that there is significant association between knowledge score and practice score with gender, there is no significant association between the level of knowledge and practice score regarding VAP with other demographic variablesCONCLUSION The present study was undertaken to evaluate knowledge and practice regarding Ventilator Associated Pneumonia VAP critical care bundle among nursing students. The study revealed that nursing students had excellent knowledge and good practice regarding Ventilator Associated Pneumonia VAP critical care bundle. Anuradha | Dr. Narinder Kaur Walia | Mrs. Manu Nagra | Mrs. Manpreet Kaur "A Descriptive Study to Assess the Knowledge and Practice Regarding Ventilator Associated Pneumonia (VAP) Critical Care Bundle among Students of Selected Nursing Colleges of Distt. Mohali, Punjab" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd48028.pdf Paper URL: https://www.ijtsrd.com/medicine/nursin
This document outlines the anaesthesiology module for medical students at UKM. It includes:
- The module heads and coordinators.
- A directory of teaching staff in the department.
- An overview of the 2-week module structure which includes lectures, skills labs, computer simulations, operating theatre sessions, tutorials, and a basic life support course.
- Details of the module objectives, content, teaching methods, assessment criteria, and a sample timetable.
The module aims to introduce students to airway management, anaesthesia techniques, perioperative care and resuscitation. Assessment is based on logbook, case write-up, end-of-term exam, and objective structured clinical
This document proposes a tele-rehabilitation model for assessing and rehabilitating COVID-19 survivors. It notes that about 20% of COVID-19 patients require hospitalization, and about half of survivors have residual functional deficits requiring rehabilitation. Existing rehabilitation services do not have the capacity to meet this demand. The document proposes an integrated post-discharge care pathway using tele-rehabilitation to remotely assess and provide rehabilitation to COVID-19 survivors following hospital discharge. Tele-rehabilitation could offer a quick and effective way to respond to the specialist rehabilitation needs in a way that is compliant with social distancing requirements during the pandemic.
The document provides guidelines for diagnosing and assessing chronic obstructive pulmonary disease (COPD). Key points include:
- COPD is characterized by persistent airflow limitation associated with respiratory symptoms and exposure to noxious particles.
- A clinical diagnosis requires spirometry showing post-bronchodilator FEV1/FVC < 0.70.
- Assessment of COPD involves evaluating symptoms, degree of airflow limitation via spirometry, risk of exacerbations, and comorbidities.
- Treatment aims to reduce symptoms and exacerbations and improve health status.
IOSR Journal of Mathematics(IOSR-JM) is an open access international journal that provides rapid publication (within a month) of articles in all areas of mathemetics and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in mathematics. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Assessment of the Implementation of Ventilator-associated Pneumonia Preventiv...IOSR Journals
Background: Pneumonia associated with mechanical ventilation (VAP) is one of the important
causes of nosocomial infections in pediatric intensive care units (PICU). VAP is the leading cause of morbidity
and mortality in PICUs. Aim: To assess the compliance to ventilator bundle components: elevation of the head
of bed >30, sedation interruption, spontaneous breathing trial, peptic ulcer prophylaxis and its effect on the
prevention of VAP. Subjects and Methods: A case control study at PICU of Abo EL Reish El Moneira Hospital,
including all mechanically ventilated patients admitted over a period of one year. The study tested the effect of
implementation of this bundle as regard the rate of VAP in both group, compliance to bundle and most affecting
component of it. Results: There was decrease incidence of VAP after implementation of the bundle, from (50%)
to (14%). Development of VAP was mostly affected by being in supine position, long duration of mechanical
ventilation and presence of pump failure. (p<0.05) The compliance to bundle components was statistically
significant, p= 0.001. Conclusion: VAP rate decreased after implementation of this bundle. Elevation of the
head of bed was the most compliant component of bundle in the PICU.
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2. Post- COVID Pulmonary Rehabilitation
Page
2
Table of Contents
1. Abstract
1.1 Background
1.2 Aim
1.3 Problem Description
1.4 Preliminary Thesis
1.5 Materials used
1.6 Study Methodology
1.7 Result
2. Introduction
Current knowledge
2.1 What is Pulmonary Rehabilitation?
2.2 Triad of Practice: Structure, Adherence & Maintenance
3. Considerations and Contraindications
4. General Intervention with Specific Exercise Recommendations for Inpatient
4.1 For Mild Disease
4.2 For Moderate Disease
4.3 For Severe Disease
5. Acute Inpatient Management
6. Outpatient Management Criteria
7. Discussion: Post- Acute Rehabilitation
8. Conclusion
9. References
3. Post- COVID Pulmonary Rehabilitation
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3
1. Abstract
1.1 Background
The global pandemic caused by SARS-CoV-2 started in Wuhan, China, which has since spread around
the world affecting millions of people. After the COVID-19 outbreak, a growing number of patients
worldwide who have survived the disease are still suffering from its sequelae. Despite testing
clinically negative, patients have been suffering from COVID-19 complications such as ARDS,
pneumonia, lung fibrosis, and pulmonary embolism. Hence, legitimizing the need for pulmonary
rehabilitation as a post- COVID management.
This paper provides a collective data from prior studies to bring a pulmonary Rehabilitation
perspective and intervention to the multidisciplinary treatment of COVID-19. The aim of pulmonary
rehabilitation in COVID-19 patients is to enhance and preserve function ad improve quality of life by
minimizing disability and reducing complications and anxiety. Pulmonary rehabilitation should be
considered during acute management of COVID-19 when possible and safe and should include
nutrition, airway, posture, clearing technique, oxygen supplementation, breathing exercises,
stretching, manual therapy and physical activity. Given the likelihood of long- term disability,
outpatient post- hospitalization pulmonary rehabilitation could also be considered altogether via
tele-medicine& tele-rehabilitation. Pulmonary Rehabilitation is a core aspect of medical
rehabilitation and the basic tools and interventions of pulmonary rehabilitation are extremely
important traditional interventions that have a particular important new role within the treatment
of COVID-19.
1.2 Aim
The aim of this paper is to review the published data and provide preliminary analysis, composed of
post Covid-19 pulmonary rehabilitation and its benefits
1.3 Problem Description
Pulmonary rehabilitation provides medical teams with unique tools to combat diseases for which
there is currently no clear cure other than supportive care. These recommendations are based on
research and knowledge of COVID19 patients, pulmonary rehabilitation patients without COVID19,
and previous SARS/MERS epidemics. The flexibility and integration of heterogeneous and
multidisciplinary data and knowledge among majors is very important to face the new and unique
rehabilitation challenges brought by this epidemic.
4. Post- COVID Pulmonary Rehabilitation
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4
1.4 Preliminary Thesis
This review serves as a guide to understand the need for the continuous management of functional
and co-morbid rehabilitation issues related to COVID19. The definition of pulmonary rehabilitation,
as adapted from the American Thoracic Society/European Respiratory Society, is a comprehensive
intervention based on a comprehensive evaluation of the patient, followed by treatment tailored to
the patient, including but not limited to exercise training, education and behavior. Changes aimed at
improving the physical condition of patients with respiratory diseases. And with the same ideology,
pulmonary rehabilitation should be tailored for each patient.
1.5 Materials used
This paper is composed of data derived from peer-reviewed published papers and pre-print
manuscripts on post COVID19 pulmonary rehabilitation and its benefits.
1.6 Study Methodology
we utilized distinctive clinical sites joined the content words for "SARS-CoV-2", and
"Coronavirus", pulmonary recovery and their rehabilitation". References of audit articles were
additionally looked to fuse quickly advancing information regarding the matter. I utilize a quest
for Covid affiliation clinical articles accessible in (ScieneDirect.com) despite the fact that there
isn't a lot of data yet, also (PubMed, NCBI). I pick cautiously the specific data I need to
remember for the exploration. Articles from Cochrane library, Taylor & Francis Journal, BMJ,
Chinese Journal, European Journal of Respiratory Disease were also used.
Keywords: Pulmonary Rehabilitation, Inpatient, Outpatient, Rehabilitation, COVID-19.
1.7 Result
The retrospective review analyzes the 2019 novel corona virus outbreak (COVID-19) to assist
provide direction for additional studies which will facilitate the way we perceive COVID-19
rehabilitation and its requirement, with an emphasis on Rehabilitation medicine.
5. Post- COVID Pulmonary Rehabilitation
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5
2. Introduction
Pulmonary rehabilitation is a complete intervention that begins with a thorough assessment of the
patient, followed by individualized treatment that includes exercise training, education, and lifestyle
changes. Its goal, as described by the American Thoracic Society and the European Respiratory
Society in 2013, is to "improve the physical and psychological condition of patients with chronic
respiratory disorders, as well as to promote long-term adherence to health-improving
activities."(1)Pulmonary Rehabilitation is suitable for individuals who have recently deteriorated.
The purpose is to optimize their respiratory function, thereby optimizing their QoL and help them
participate in their daily lives. Compared with conventional care, pulmonary rehabilitation has been
shown to significantly improve the QoL and exercise capacity of patients with COPD. (2)
In the view of the COVID pandemic, there has been a shortage in staff, medical equipment e.g., PPE
and the basic medical amenities everyone should receive and the high risk of in-hospital
transmission, rehabilitation has been carried out through telemedicine with minimal exposure. Self-
supervised rehabilitation is initiated through telemedicine. Previous data indicated that o
telemedicine programs and home pulmonary rehabilitation have shown that the results are the same
when compared to center-based programs. If direct supervision is required, full PPE, including
gloves, masks, and gowns, should be used for all-person interaction. In addition, if there is a risk of
infection with aerosol droplets, it is also recommended to wear a facemask and/or goggles. The
current non-invasive ventilation technology has a high risk of SARS CoV2.10,11virus atomization.
The rate of in-hospital transmission among medical staff is extremely high (approximately 35% of
contact medical staff will develop the disease) and the disease has a more serious clinical course
among medical staff.
Current knowledge
COVID-19 is caused by a virus, the extreme acute respiratory syndrome coronavirus 2.
(SARS-CoV-2). The global pandemic began in Wuhan, China, in December 2019 and has since became
global pandemic, with COVID-19 infection cases continuing to increase. As till of July 30, 2021, In
Georgia there are 416,388 COVID-19 patients, 5793 deaths, 381,246 recovered, and 197,703,056
COVID-19 infection cases worldwide. [34]
Discussion:
2.1 What is Pulmonary Rehabilitation?
Pulmonary Rehabilitation plans vary, depending on patient presentation and available resources, but
usually include: -
• Multidisciplinary advisory
• Exercise
• Diet counseling
• Disease education
1
Spruit et al., “An Official American Thoracic Society/European Respiratory Society Statement.”
2
Lee et al., “The Impact of Pulmonary Rehabilitation on Chronic Pain in People with COPD.”
6. Post- COVID Pulmonary Rehabilitation
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6
• Psychological intervention
• Behavioral intervention
e.g., A group of COPD patients, take classes together in a gym or community room, where they
participate in supervised exercises with a physical therapist, and then conduct educational
sessions with nurses or educators on topics such as bronchodilator techniques, nutrition, and
COPD management. (3)
2.2 Triad of Practice: Structure, Adherence & Maintenance
(i) Structure
The duration of the pulmonary rehabilitation plan can vary, from 68 weeks to 1 year. BTS guidelines
recommend 6-12 weeks, with 2 supervised exercises per week (the third unsupervised) and at least
12 supervised exercises. It can be hospital-based, community-based, or both. Previous data has
shown that compared to community-based pulmonary rehabilitation, inpatient-based pulmonary
rehabilitation has better outcomes, as measured by chronic respiratory questionnaires measuring
dyspnea, fatigue, emotional function, and proficiency. The guide also recommends providing people
with some kind of exercise plan after completing the pulmonary rehabilitation.
(ii) Adherence
NICE guidelines recommend an emphasis on adherence to Pulmonary Rehabilitation to
individuals post COVID so that a desired quality of life and improved respiratory function can be
achieved. Some specific ways to improve the state of adherence under optimizing access to
pulmonary rehabilitation are as follows: -
• Suitable time for classes
• Clear access to facilities
• Timely referrals to pulmonary rehabilitation centers
(iii) Maintenance
Since, the guidelines recommend exercise post COVID pulmonary rehabilitation to sustain the
desired respiratory function, exercise tolerance and improved quality of life, its recommended
that an8-week outpatient pulmonary rehabilitation to be maintained at a 2 year follow up plan
for patients with moderate to severe obstructive pulmonary diseases. Also, better scores for a
6min walk distance and BMI, airflow obstruction, BORG score for dyspnea and exercise tolerance.
Adherence to the maintenance programme should be based on the exercise and cycle ergometers
at home and primary health care centers with a supervised session every other week. (4)
3. *Considerations and Contraindications
3
McCarthy et al., “Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease.”
4
“Pulmonary Rehabilitation.”
7. Post- COVID Pulmonary Rehabilitation
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7
NICE guidelines for people who should not undergo Pulmonary Rehabilitation are:-
(i) Patients who are unable to walk
(ii) Patients who suffer from unstable angina
(iii) Patients with recent history of MI
BTS guideline recommends those with MRC: - A dyspnea score of 3-5, for patients who are
functionally limited due to breathlessness should not be referred for pulmonary
rehabilitation.
Specific Consideration should be given to patients: -
(i) Unstable Cardiac disorders
(ii) Physical Disability
(iii) Difficulty in following instructions due to cognitive or psychiatric
impairments
(iv) Presence of a support person to enable and encourage adherence
(5)
4. General Intervention with Specific Exercise Recommendations for Inpatient
management: -
Rehabilitation plays an important role in measuring beneficial outcomes in COVID patients. Since,
there was not enough time to establish a COVID specific rehabilitation service, existing models
of guideline-based exercise have been prescribed and supervised by physiotherapists, often
including the Frequency, Intensity, Time and Type (FITT) methodology. Practically, both
functional and maximal exercise has shown significant improvement post- pulmonary
rehabilitation.
Types of rehabilitation:
(i) Pulmonary Rehabilitation focuses on positioning, and necessary exercises with the
use of bronchodilators.
(ii) Functional training: used for patients with end stage diseases or extreme weakness
post COVID. Major Focus: -
5
Bolton et al., “British Thoracic Society Guideline on Pulmonary Rehabilitation in Adults.”
8. Post- COVID Pulmonary Rehabilitation
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8
(6)
Specific Exercise Recommendations-
4.1 For Mild Lung Disease:
4.2 For Moderate Lung Disease:
Symptom: Patient experience shortness of breath, performing daily activities. * Pulmonary
Rehabilitation has good prognosis for those patients that have had acute pneumonia
post- surgery.
6
Lee et al., “The Impact of Pulmonary Rehabilitation on Chronic Pain in People with COPD.”
Alternating performance
task
•Slow pace
•Minimize body
movements
•Plan the task with
enough break and rest
Methods to relieve symptoms
•maintaineance of non- interruptive
breathing pattern
•Avoid talking in between tasks
•For COPD patients:- pace during lifting
tasks & lean forward (Increases IAP which
allows the accessory muscles to iniitiate
inspiration)
•For RLD patients:- rapid shallow breaths
are easier (prevents elastic resistance)
•Reduce anxiety related to dyspnea
secondary to biofeedback of non-
respiratory muscles
Enviornmental Adaptation for ease
•Table to slide heavy objects
•Chairs near stairs and in washroom
•Use of adaptive equipment and assistive
technology
•Use of good ventilation
Specific Exercise Recommendations (variable management for)
Mild Lung Disease Moderate Lung Disease Severe Lung Disease
Criteria: -
• Symptoms with effort e.g. cough, sputum
• Spirometry: FEV1 < 70-80%, VC prediction
• ABG: normal or hypoxemia
• Individual Exercise prescribed, patient does not require rehab, focused testing &
training
Criteria: -
• VC &FEV1 55-70% (3-4 MET)
• ET: Progressive, start at 1.5 MET, and increment of 0.5 MET at each stage. Monitor: ECG, BP,
HR or perform 12min walk test
• Exercise potential: - HR monitoring with Borg Scale: 2-3 dyspnea
- Frequency: 5-7times/ week
- For symptomatic patient: Use O2
9. Post- COVID Pulmonary Rehabilitation
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9
4.3 For Severe Lung Disease
Criteria: -
• VC & FEV1 <50%
• SoB on daily activities
• ECG: R ventricular dysfunction
• Exercise potential: - Steady endurance of 2-3 MET
- prescribe interval training, in short bouts (frequent rests)
- Frequency: 5 times/week
- Monitor SpO2 with every drop in 3% and start O2 therapy if
SpO2<88%
- Use BORG scale for chest pain and shortness of breath
10. Post- COVID Pulmonary Rehabilitation
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10
5. Acute Inpatient Management
General Considerations: -
• Early pulmonary rehabilitation and ICU activities may require careful consideration.
• SARSCoV2 will be atomized during surgery and in the ICU setting.
• Should not recommend additional rehabilitation staff for early activities, full-time ICU staff
may consider this.
• During the weaning test, inspiratory muscle training can be performed by a qualified
respiratory therapist as after
prolonged mechanical ventilation,
respiratory muscle weakness caused
by diaphragmatic proteolysis may
occur.
• Safety regulations should be
observed when initiating pulmonary
rehabilitation.
• Intensity of the initial exercise
should be carefully controlled and
change in level of consciousness.
(7)(8)(9)
Physical exercise is a central
component of pulmonary
rehabilitation and can start from
bedridden activities for patients
with extremely weak bodies to
patients who can move. The goal of rehabilitation intervention should be SpO2>90%, while
supplemental oxygen is titrated to maintain target saturation. (10) If SpO2 is less than the
target value or the dyspnea score on the Borg scales>3, activity should be suspended and
breathing technique should be considered, such as resuming labial breathing for exercise
intervention after SpO2 reaches target. (11)
Lip-tightening breathing is carried out through the nasal cavity during training and then exhales
against pursed lips to reduce airway collapse, reduce respiratory rate and dynamic hyperinflation,
with the goal of increasing overall stamina. Supplemental oxygen during physical training has also
7
Lin and Li, “[Interpretation of ‘Guidelines for the Diagnosis and Treatment of Novel Coronavirus (2019-nCoV)
Infection by the National Health Commission (Trial Version 5)’].”
8
Jones et al., “Pulmonary Rehabilitation in Patients with an Acute Exacerbation of Chronic Obstructive Pulmonary
Disease.”
9
Yang et al., “[Pulmonary rehabilitation guidelines in the principle of 4S for patients infected with 2019 novel
coronavirus (2019-nCoV)].”
10
Liu et al., “Effects of Comprehensive Pulmonary Rehabilitation Therapy on Pulmonary Functions and Blood Gas
Indexes of Patients with Severe Pneumonia.”
11
Rodriguez-Morales et al., “Clinical, Laboratory and Imaging Features of COVID-19.”
Exclusion criteria: - Body temperature> 38.0 ℃
- Time from initial
diagnosis or onset of
symptoms ≤ 3 days
- Difficulty of breathingfor
the first time ≤ 3 days
- Disease progression
>50% within 24 to 48 hours
- SpO2 ≤ 90%
- BP 180/90 mmHg
- RR>40 breaths/minute
- HR 120 bpm 9.
- New onset arrhythmia
and MI
11. Post- COVID Pulmonary Rehabilitation
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11
been used successfully to help reduce the load on the respiratory muscles. (12)If SpO must be
interrupted for pulmonary rehabilitation or respiratory exercise, level 2 patients cannot recover and
cannot maintain Borg scale dyspnea score <4 points under conditions of rest and supplemental
oxygen. Rehabilitation exercises should also be interrupted for chest pain, palpation, and dizziness.
The Borg scale is a proven and easy-to-use tool that allows patients to self-monitor their breathing
effort. There is a close correlation between the size of the breathing effort and the intensity of the
dyspnea. The active circulation of breathing technique uses a combination of circulatory airway
clearance technique to ventilate the obstructed lung segment. (13)(14)
Airway clearances a common technique via active cycle of breathing, uses a combination of
techniques to mobilize the secretions. In the peripheral airway, it is followed by normal breathing to
collect the secretions of the middle airway, and deep breathing and coughing to discharge the
secretions. (15) The application of airway clearance technology can significantly reduce the need for
ventilator support, mechanical ventilation and hospital stays. Airway clearance technology aims to
help clear the airway by moving cephalic mucus from the periphery to the upper respiratory tract,
promoting lung capacitance, and clearing mucus through coughing or sputum production. Physical
exercise is the cornerstone of pulmonary rehabilitation and has been shown to help clear mucus. (16)
Lung volume recruitment techniques include air stacking and glottis holding. Air accumulation
involves conveying air through Ambu bags. (17) Glossopharyngeal breathing is a positive pressure
breathing technique that can be used to support defective respiratory muscles and increase tidal
volume. It involves continuously inhaling large amounts of air and pushing it into the lungs. (18) The
3-secondbreath-hold is a way to ventilate the blocked lung segment. The3-second pause allows
Pendelluft to flow, and air moves from the unobstructed area to the blocked area in the lungs. (19)
Forced exhalation can be used, such as sneezing to push secretions. The cough is performed under
the open glottis, where the dynamic compression of the isobaric points of the airway increases the
linear velocity of the expiratory air flow and pushes the secretions. The initiation of forced exhalation
with low lung volumes will displace the isobaric points toward the periphery and the small airways.
Forced exhalation with a high lung volume will move the isobaric point into the large central airway.
Posture plays an important role in respiratory function, which may encourage patients to perform
upright head and neck postures during respiratory therapy whenever possible. (20)If available, an
oscillation frequency of less than 17 Hz can be used to apply external vibration to improve
mucociliary clearance.
12
Wax and Christian, “Practical Recommendations for Critical Care and Anesthesiology Teams Caring for Novel
Coronavirus (2019-NCoV) Patients.”
13
Bissett, Gosselink, and van Haren, “Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical
Ventilation.”
14
Chinese Association of Rehabilitation Medicine, Respiratory Rehabilitation Committee of Chinese Association of
Rehabilitation Medicine, and Cardiopulmonary Rehabilitation Group of Chinese Society of Physical Medicine and
Rehabilitation, “[Recommendations for respiratory rehabilitation of coronavirus disease 2019 in adult].”
15
Lim, Ng, and Tay, “Impact of a Viral Respiratory Epidemic on the Practice of Medicine and Rehabilitation.”
16
Mayer et al., “Effects of Acute Use of Pursed-Lips Breathing during Exercise in Patients with COPD.”
17
Kang and Bach, “Maximum Insufflation Capacity.”
18
Maltais, “Glossopharyngeal Breathing.”
19
Crawford et al., “Effect of Airway Closure on Ventilation Distribution.”
20
McIlwaine et al., “PersonalisingAirway Clearance in Chronic Lung Disease.”
12. Post- COVID Pulmonary Rehabilitation
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12
Positioning is efficient, simple and easy to implement. Given the pathophysiology of COVID19 and
other techniques such as postural drainage, localization may be preferable. A V / Q mismatch is
observed. Sitting and standing are the preferred postures for patients who are not critically ill to
maximize lung function, including FVC, increase lung compliance and elastic retraction, move
mediastinal structures and provide mechanical benefits during forced exhalation. Targeted
positioning can be used to improve ventilation, perfusion, oxygenation, and mobilization of
secretions in specific areas of lung consolidation through gravity. Perfusion of the dependent
pulmonary segments is greater in all positions. Priority Ventilation Changes Based on Location. When
performing breathing exercises, two minutes in each position may be sufficient to ventilate / perfuse
the target lung segment.(21)(22)
Anecdotal evidence from the hospital suggests that the prone position is beneficial during the acute
care of patients with COVID19. If possible, we recommend time in all positions, including lying on
your side, upright, supine. The target position can be determined by the consolidation position seen
on the image or found during inspection.
In the upright position, ventilation occurs preferentially in the middle and lower lobe, with the most
perfusion in the lower lobe. The patient can lie supine in a resting position. Assist DLCO occasionally.
The DLCO of healthy subjects increased in the supine position. The supine position also preferentially
ventilates the upper lobes During the administration of inhaled drugs, the lateral position may be a
good position, with a better13% deposition on the drooping upper lobe.
Prone position for 2 minutes can help back lung ventilation by reducing the compression of the heart
on the lungs in the semi-prone position. Due to the ventral displacement of the heart and the increase
in expiratory trans- pulmonary pressure and expiratory reserve, lung expansion from the dorsal to
ventral side is more uniform and oxygenation is improved. PaO2/ FiO2 are used in mechanically
ventilated patients and reduces cardiovascular complications.
The patient can be encouraged to perform routine stretches3 times a day. Stretching has been shown
to increase compliance by upto 50 ml. Stretching exercises should include neck, upper chest,
pectoralis major, lateral chest extension and flexion and extension to mobilize the small joints. It has
been shown that the dorsal chest wall has poor compatibility with ARDS patients.
Osteopathic therapy may help if appropriate, and should address autonomy, lymphatic drainage, and
chest mobility. Patients can also participate in modified segmented breathing. The patient puts
pressure on his chest cavity to resist respiratory deviation in a certain area of the chest cavity and
promote the expansion of adjacent areas of the chest cavity that may reduce ventilation and mobility.
(23)
Education and adequate nutrition are particularly important in COVID19, because studies in Western
countries have shown that obesity is an important risk factor for disease severity, and at least 1/3 of
ICU patients have BMI overweight. In obesity, lung function is also affected.
The same strategy applies to patients recovering from ICU care. In these patients, taking into account
the adaptation that occurs in the ICU, attention to breathing exercises and bed activities may be the
initial intervention. Flexibility exercises on the bed include ankle pump, sliding leg flexion/extension,
head arm extension, sitting by the bed and standing by the bed. In addition, patients with prolonged
21
Manning et al., “Effects of Side Lying on Lung Function in Older Individuals.”
22
Gattinoni et al., “COVID-19 Does Not Lead to a ‘Typical’ Acute Respiratory Distress Syndrome.”
23
Harmony, “Segmental Breathing.”
13. Post- COVID Pulmonary Rehabilitation
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13
mechanical ventilation may suspect respiratory muscle weakness caused by diaphragmatic
proteolysis. These patients can start by
stimulating the spirometer for
inhalation and exhalation muscle
training, and then gradually use the
muscle training equipment. (24)(25)
6. Outpatient Management
Criteria
Mild disease is associated without
imaging manifestations of pneumonia.
Rehabilitation of mild illnesses can be
managed in outpatient clinics using
telemedicine. (26)
In mild illness, pulmonary rehabilitation
can be considered, including education,
techniques to clear the airways, physical
exercises, breathing exercises, activity
guidance and anxiety management. In
particular, body fluids should be properly managed and handled during home pulmonary
rehabilitation. Patients should be instructed to cover their mouth and nose with a tissue when
coughing or sneezing, and to remove the tissue immediately. Expectorant hygiene should be
strengthened in airtight containers to avoid atomization of sputum. (27)After contact with respiratory
secretions and contaminated objects/materials, hand washing should be emphasized. Patients
should be educated about the clinical process of COVID19, and individualized education should be
conducted according to the patient’s comorbidities. Patients, including asymptomatic relatives, may
be advised to wear masks; SarsCoV2 has a high transmission rate and the asymptomatic prodromal
period is 214 days, with an average of 37 days. Mathematical models show that the use of masks with
50% compliance during a virus outbreak can slow the spread, increasing the prevalence rate by 50 °
and the cumulative incidence rate by 20 °. At this stage, breathing exercises can be used. Diaphragm
breathing involves instructing the patient to primarily contact the diaphragm while minimizing the
activity of the auxiliary muscles. Nasal inhalation should be stimulated to promote recruitment of the
diaphragm and improve humidification. (28)The abdominal muscles should be actively contracted at
the end of exhalation to increase abdominal pressure Yoga, especially Viniyoga, during inhalation or
24
Katz et al., “The Effect of Body Position on Pulmonary Function.”
25
Bailey, Farrow, and Lau, “V/Q SPECT-Normal Values for Lobar Function and Comparison With CT Volumes.”
26
Rodriguez-Morales et al., “Clinical, Laboratory and Imaging Features of COVID-19.”
27
Guo et al., “The Origin, Transmission and Clinical Therapies on Coronavirus Disease 2019 (COVID-19) Outbreak -
an Update on the Status.”
28
Elad, Wolf, and Keck, “Air-Conditioning in the Human Nasal Cavity.”
14. Post- COVID Pulmonary Rehabilitation
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14
exhalation phase Coordinate breathing with arm lift or body posture. Pranayama, Tai Chi, (29) and
singing also use timed breathing techniques.
7. Post- Acute Rehabilitation
The suitability of acute inpatient rehabilitation should be individualized according to the patient and
institution, and should be carried out in accordance with the ongoing Rehabilitation guidelines. (30)
Patient selection criteria should be developed in the coming months for the pandemic. For patients
with residual functional defects due to prolonged hospitalization, occupational and physical therapy
may also be considered. The use of chest radiographs and PFT may be considered for routine
monitoring in an outpatient setting, especially within 6 months of infection and in critically ill
patients. Pulmonary fibrosis can occur in COVID19.
In the 2003 SARS-CoV-2, 45% of patients (diagnosed by X-ray and CT scan) had pulmonary fibrosis
1 month after infection, 36% at 36 months after infection, 46 and 28% 1 year after the infection. The
improvement of lung function in patients with SARS-CoV-2 stabilized at 6 months, especially with
persistent disability in DLCO 2 years after infection. (31)(32) Pulmonary rehabilitation after the acute
phase can help improve exercise capacity. In patients with interstitial lung disease, stress
desaturation is a key feature and is often more severe than other lung diseases. Interstitial lung
disease is associated with discomfort / fatigue during submaximal exercise with reduced ventilation
and tissue oxygenation, as well as metabolic acidosis, dyspnea, and premature onset of the lower
extremities. There is also pulmonary hypertension and reduced exercise capacity. Supplemental
oxygen may be necessary to promote tissue oxygenation and improve exercise capacity. Target SpO2
ranges from85- 90% (33)
8. Conclusion
Rehabilitation professionals (physical therapists, respiratory therapists, speech, language and
swallowing therapists, occupational and physical therapists) participate in the clinical care of
COVID19 patients admitted to the ICU to reduce pulmonary complications and improve functional
recovery. Rehabilitation teams involved in COVID19 care must consult existing medical guidelines
and related literature to obtain the best evidence, but at the same time, equipment strategies and
protocols must take into account their own resources and patient information. Consider the
community pulmonary rehabilitation of COVID19, and family members in the process that produces
positive results.
More research is needed to generate evidence-based methods for effective public relations; focusing
on the optimal dose, duration, intensity, and frequency, designed specifically for COVID19 patients.
In short, there is increasing evidence that pulmonary rehabilitation is helpful for survivors of
COVID19. A pulmonary rehabilitation plan that has already started in the hospital can reduce hospital
29
Ngai, Jones, and Tam, “Tai Chi for Chronic Obstructive Pulmonary Disease (COPD).”
30
Hui et al., “Impact of Severe Acute Respiratory Syndrome (SARS) on Pulmonary Function, Functional Capacity and
Quality of Life in a Cohort of Survivors.”
31
Xie et al., “Follow-up Study on Pulmonary Function and Lung Radiographic Changes in Rehabilitating Severe
Acute Respiratory Syndrome Patients after Discharge.”
32
Venkataraman and Frieman, “The Role of Epidermal Growth Factor Receptor (EGFR) Signaling in SARS
Coronavirus-Induced Pulmonary Fibrosis.”
33
Dowman, Hill, and Holland, “Pulmonary Rehabilitation for Interstitial Lung Disease.”
15. Post- COVID Pulmonary Rehabilitation
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15
stays and improve overall respiratory function. Experts from different countries such as China, Italy,
UK have proposed guiding principles, which can be adjusted according to local needs, in this regard,
global rehabilitation associations such as the ISPM can play an active role. More prospective clinical
trials are needed to determine which pulmonary rehabilitation strategies are safe and successful for
COVID19 survivors, with the objective of enhancing their quality of life after they leave emergency
rooms. Early Intervention and pulmonary rehabilitation provide us with additional tools to fight
COVID19, which may include nutrition, airway, posture, cleansing techniques, oxygen
supplementation, breathing exercises, stretching exercises, manual therapy, and physical activities.
*In the months or years following this pandemic, the burden of disease may be significant, and
both pulmonary medicine and rehabilitation will play a key role in the recovery of patients with
disabilities associated with COVID19.
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