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INTRODUCTION

Patients with chronic pulmonary disease have increased rates of morbidity and mortality in addition to a lower quality of life. Pulmonary rehabilitation is a multispecialty comprehensive management program for these patients with the goal of improving pulmonary function, decreasing mortality and morbidity, and improving quality of life.

Key components of a pulmonary rehabilitation program include nutritional management, rehabilitation therapies, patient education, medication and oxygen delivery, and use of assisted ventilation. Common diseases that contribute to pulmonary dysfunction are reviewed in this chapter along with rehabilitation strategies. Finally, key outcome variables are reviewed.

REHABILITATION OF ASTHMA PATIENTS

Background

The rehabilitation of asthmatics is a relatively new field. The Centers for Disease Control and Prevention (CDC) has reported the prevalence of asthma at 25.7 million in 20101 and increasing by 2.9% per year. Over 8% of children and adults are asthmatic. There were 1.8 million emergency department visits in 2011 and 10.5 million physician visits for it in 2012.24 However, the reversible episodes of wheezing, coughing, dyspnea, chest tightness, and deconditioning characteristic of asthma are amenable to medical and pulmonary rehabilitation (PR) interventions. Bronchodilators and corticosteroids are the mainstay of therapy58; these agents can reverse the inflammatory component9 and can significantly increase the forced expiratory volume in 1 second (FEV1) by 12% or more.10,11 Rehabilitation complements traditional management options and can significantly decrease exacerbation frequency and the need for frequent physician services and improve exercise tolerance and well-being.12,13

Asthmatics often require particular attention to nutrition to optimize body weight and to avoid the characteristic triggers of cold air and exposure to inhaled allergens (aeroallergens). Before beginning reconditioning exercise, inhaled glucocorticoids, often along with long-acting inhaled beta agonists, can increase exercise tolerance by preventing exercise-induced bronchospasm. Patients may also benefit from leukotriene modifiers, lipoxygenase inhibitors, theophylline, cromoglycates, anti-IgE therapy (omalizumab), and monoclonal antibodies (mepolizumab and reslizumab)14 (Fig. 50–1).

Figure 50–1

Interpretation of pulmonary function tests. (Bottom left panel: Reprinted from Weinberger SE. Principles of Pulmonary Medicine, 4th ed. Philadelphia, PA: Saunders 2004.)

<img id="/data/books/2550/mitra_c50_f01.png" data-original="/data/books/2550/m_mitra_c50_f01.png" src="/data/books/2550/mitra_c50_f01.png" alt="It represents a flow chart illustrating how to interpret the pulmonary function tests. Forced expiratory volume in 1 second (FEV1). Flow chart starts with FEV1/FVC ratio (actual, not % predicted) and then to either ?70% FEV1/FVC: NORMAL or RESTRICTIVE which follows as RESTRICTIVE: TLC <80% predicted or NORMAL: TLC ? 80% predicted or <70% fev1/fvc:="" obstructive="" which="" continues="" as="" either="" irreversible="" fev1="" defect="" and="" then="" to="" copd="" and="" then="" either="" mild:="" fev1="" %="" pred="">80% or Moderate: FEV1 % pred 50–80% or Severe: FEV1 % pred 30–50% or Very severe: FEV1 % pred <30%. or="" reversible="" fev1="" defect="" and="" then="" follows="" to="" asthma.="" also="" the="" image="" shows="" a="" graph="" showing="" various="" variations="" (increase="" or="" decrease)="" of="" the="" functions="" assocaited="" with="" pulmoinary="" functions.="" also="" mentioned="" is="" a="" chart="" with="" units,="" actual="" and="" percentage="" predicted="" values="" for="" the="" various="" functions.="" fev1="" l="" 0.48="" and="" 26%="" values,="" and="" fvc="" l="" 1.70="" and="" 72%,="" fev1/fvc="" %="" 28="" 37%,="" tlc="" l="" 5.03="" 85%,="" rv="" l="" 3.07="" and="" 140%,="" frc="" l="" 3.94="" and="" 149%,="" and="" dlco="" ml/mmhg/min="" 16.9="" and="" 51%."="" class="contentFigures rs_skip">

Fearing exacerbation of their asthma symptoms, asthmatics tend to become less physically active.1517 The diminished activities of daily living (ADLs) decrease social interactions and quality of life and exacerbate deconditioning. Structured exercise programs can improve these and increase aerobic fitness and asthma control, as demonstrated in a 12-week supervised exercise program that included muscle strengthening and aerobic training including jogging, cycling, and elliptical/rowing machines.18 Additional ...

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