Pulmonary Rehabilitation

Transcription

1 Pulmonary Rehabilitation

2 What do these patients have in common?

3

4 Factors contributing to exercise intolerance

5 Factors contributing to exercise intolerance

6 Factors contributing to exercise intolerance

7 Factors contributing to exercise intolerance

8 Factors contributing to exercise intolerance

9

10 Common indications for referral for pulmonary rehabilitation American Thoracic Society. Am J Respir Crit Care Med. 1999;159:

11 The Dyspnea Spiral Dyspnea during moderate exertion Respiratory impairment Dyspnea during mild exertion Abstinence from exercise Further abstention Dyspnea during ADL * Further deconditioning Physical deconditioning *Stay at home, depression, oxygen therapy, etc. Adapted from Dennis O Donnell, MD.

12 Timing of pulmonary rehabilitation

13 ABCD Assessment Tool 2017 Global Initiative for Chronic Obstructive Lung Disease

14

15 Pulmonary rehabilitation ATS/ERS definition

16 Goals of pulmonary rehabilitation American Thoracic Society. Am J Respir Crit Care Med. 1999;159: British Thoracic Society Standards of Care Subcommittee on Pulmonary Rehabilitation. Thorax. 2001;56: ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel. Chest. 1997;112:

17 What is pulmonary rehabilitation? Dyspnea Functional Capacity QOL

18 What is Pulmonary rehabilitation?

19 Exercise training

20 Exercise training

21 Exercise practice guidelines

22 Maximizing the effects of exercise training

23 Behavior change and collaborative self-management

24 Body composition abnormalities and interventions

25 Body composition impact

26 Body composition interventions

27

28 Pulmonary rehabilitation outcome measurements

29 Pulmonary rehab in NETT Max medical Rx (with rehab) + LVRS NETT centers + >400 rehab satellite centers Improved exercise, symptoms, QOL after rehab Slightly greater exercise at NETT centers vs. satellites; no difference symptoms/qol

30 10 5 % Change Wmax PB PMF 6MW 6PB 6PMF all p <

31 % Change SOBQ SGRQ Total SGRQ Activ SGRQ Impact SGRQ Symp QWB all p <

32 Effect of rehab location % Change * ** * Wmax PB PMF 6MW 6PB 6PMF NETT Center Satellite

33 Effect of rehab location 0 * -2 % Change SOBQ SGRQ Total SGRQ Activ SGRQ Impact SGRQ Symp NETT Center Satellite

34 Effect of prior rehab % Change ** *** *** ** SOBQ SGRQ Total SGRQ Activ SGRQ Impact SGRQ Symp No Prior Rehab Prior Rehab

35 Effect of prior rehab % Change * * *** ** * Wmax PB PMF 6MW 6PB 6PMF No Prior Rehab Prior Rehab

36 Lessons from NETT

37 Lessons from NETT Effectiveness of pulmonary rehab Multiple centers Patients with severe disease Important adjunct to surgery Preparation for surgery Recovery from surgery CMS coverage for LVRS requires pulmonary rehab pre- and post-op

38 Cote et al. ERJ 2005; 26.

39 Puhan et al. Respiratory Research 2005; 6.

40 Puhan et al. Respiratory Research 2005; 6.

41 Puhan et al. Respiratory Research 2005; 6.

42 Puhan et al. Respiratory Research 2005; 6.

43 Outpatient Pulmonary Rehabilitation: Study Objective and Design Griffiths TL et al. Lancet. 2000;355:

44 Outpatient Pulmonary Rehabilitation: Study Results SGRQ = St. George s Respiratory Questionnaire; CRDQ = Chronic Respiratory Disease Questionnaire. Griffiths TL et al. Lancet. 2000;355:

45 The effect of pulmonary rehabilitation on health status 0 6 Weeks 1 Year -2 Change from Baseline in SGRQ Score Symptoms Activity Impact Total Improvement SGRQ = St. George s Respiratory Questionnaire. Griffiths TL et al. Lancet. 2000;355:

46 Pulmonary rehabilitation and days spent in hospital Nonrespiratory Respiratory Total Days Control 10.4 Rehabilitation P =.021. Griffiths TL et al. Lancet. 2000;355:

47 Cochrane meta-analysis McCarthy et al. Cochrane Database Syst Rev. 2015;2.

48 McCarthy et al. Cochrane Database Syst Rev. 2015;2.

49 McCarthy et al. Cochrane Database Syst Rev. 2015;2.

50 McCarthy et al. Cochrane Database Syst Rev. 2015;2.

51 Guell et al. AJRCCM 2017:195;

52 Guell et al. AJRCCM 2017:195;

53 Guell et al. AJRCCM 2017:195;

54 Guell et al. AJRCCM 2017:195;

55 Guell et al. AJRCCM 2017:195;

56 Summary: Impact of pulmonary rehabilitation

57 The Dyspnea Spiral Dyspnea during moderate exertion Respiratory impairment Dyspnea during mild exertion Abstinence from exercise Further abstention Dyspnea during ADL * Further deconditioning Physical deconditioning *Stay at home, depression, oxygen therapy, etc. Adapted from Dennis O Donnell, MD.