Dr B. Egger Service de Pneumologie Hôpital de Rolle

Transcription

1 Dr B. Egger Service de Pneumologie Hôpital de Rolle

2 Planning COPD/rehabilitation introduction COPD rehabilitation programs : Benefits Components/Modalities COPD and congestive heart failure COPD and ischemic heart disease COPD and pulmonary hypertension

3 Planning COPD/rehabilitation introduction COPD rehabilitation programs : Benefits Components/Modalities COPD and congestive heart failure COPD and ischemic heart disease COPD and pulmonary hypertension

4 COPD Comorbidities Eur Respir Rev 2014; 23: 131

5 update 2010

6 Pulmonary rehabilitation AJRCCM 2013; 188: e13

7 BODE Index

8 BODE 0-2 BODE 3-4 BODE 5-6 BODE >7 NEJM 2004; 350: 1005

9 Indications AJRCCM 2013; 188: e13

10 Contraindications Unstable or limiting disease! Resiratory, Cardiac or Psychatric diseases Orthopedic or neurologic diseases AJRCCM 2006; 173: 1390 Arch Phys Med Rehab 2005; 86: 1788

11 Planning COPD/rehabilitation introduction COPD rehabilitation programs : Benefits Components/Modalities COPD and congestive heart failure COPD and ischemic heart disease COPD and pulmonary hypertension

12 Benefits update 2011

13 Hospitalizations Respiratory Research 2005; 6:54

14 Distance Respiratory Research 2005; 6:54

15 Quality of life Respiratory Research 2005; 6:54

16 Survival Respiratory Research 2005; 6:54

17 ERJ 2005; 20: 630

18 Severity of the lung disease Berry et al.: 151 patients, 12 weeks: - COPD: mild 99 patients - moderate 36 patients - severe 16 patients AJRCCM 1999; 160: 1248

19 AJRCCM 2005; 172: 19

20 Clin Chest Med 2014; 35: 391

21 Planning COPD/rehabilitation introduction COPD rehabilitation programs : Benefits Components/Modalities COPD and congestive heart failure COPD and ischemic heart disease COPD and pulmonary hypertension

22 Components Comorbidities management Self Management AJRCCM 2013; 188: e13 J Appl Physiol; 115: 16

23 Clin Chest Med 2014; 35: 303 Types

24 Duration Inpatients: during min. 2-3 weeks, idealy 4 weeks Outpatients: 6-26 weeks (min. 20 sessions) combination of supervised and self-managed sessions Chest 2005; 127: 105

25 J CardioPulm Rehab Prev 2016; 36: 75

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28 J CardioPulm Rehab Prev 2016; 36: 75

29 J CardioPulm Rehab Prev 2015; 35: 163

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31 J CardioPulm Rehab Prev 2009; 29: 126

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33 Respiratory muscles training E. Lynne Geddes et al., Resp Med 2008

34 Low intensity rehabilitation Proc Am Thorac Soc 2006; 3: 66

35 Journal Cardio Pulm Rehab 2008; 28: 79

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38 Clin Chest Med 2014; 35: 313

39 Planning COPD/rehabilitation introduction COPD rehabilitation programs : Benefits Components/Modalities COPD and congestive heart failure COPD and ischemic heart disease COPD and pulmonary hypertension

40 Contraindications Unstable or limiting disease! Resiratory, Cardiac or Psychatric diseases Orthopedic or neurologic diseases AJRCCM 2006; 173: 1390 Arch Phys Med Rehab 2005; 86: 1788

41 Leading causes of mortality R. Rodriguez-Roisin et al. Lancet 2009

42 Protective effect R. Rodriguez-Roisin et al. Lancet 2009

43 Planning COPD/rehabilitation introduction COPD rehabilitation programs : Benefits Components/Modalities COPD and congestive heart failure COPD and ischemic heart disease COPD and pulmonary hypertension

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46 Muscle impairment J Appl Physiol; 115: 16

47 J Appl Physiol; 115: 16

48 J CardioPulm Rehab Prev 2007; 27: 368

49 Planning COPD/rehabilitation introduction COPD rehabilitation programs : Benefits Components/Modalities COPD and congestive heart failure COPD and ischemic heart disease COPD and pulmonary hypertension

50 Cardiovasc Drugs Ther 2015; 29: 147

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53 β-blockers FH Rutten et al., Arch Intern Med 2010

54 Planning COPD/rehabilitation introduction COPD rehabilitation programs : Benefits Components/Modalities COPD and congestive heart failure COPD and ischemic heart disease COPD and pulmonary hypertension

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58 Exercise Training Program Common rehabilitation program for 3 weeks (inpatient) - stable patients Additionnal exercise program 7d a week at low workloads (10-60W) Interval bicycle ergometer training (30 lower 60 higher workload) during /d = 60-80% of the heart rate reached during initial peak O2 uptake Intensity increased (individual tolerability and improvement) Limited by: peak HR (< 120 bpm) sato2 > 85% - subjective physical exertion 60 of walking 5 d/week (flat and uphill) accompanied by a physiotherapist Dumbbell training with low weights (0.5-1 kg) 30 of respiratory training (stretching, breathing techniques ) At home : Training manuel + bicycle pd + respiratory exercise + dumbbell walk twice a week + supervised by phone

59 Pr Training Gr after 3 weeks : /- 56 m /- 37 m after 15 weeks : /- 61 m /- 54 m Delta = 111 meters Control Gr D. Mereles et al.; Circulation 2006, 114: 1482

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62 Conclusions COPD and comorbidities Benefits: survival, QoL, dyspnea, exercise capacity PR Components: more than exercise PR Modalities: endurance, resistance, arms training, interval training, inspiratory muscles, low intensity, neurostimulation, other Cardiac heart failure, ischemic heart disease, pulmonary hypertension: special considerations/focus for training, b- blockers => «protective» effect of the COPD

63 Thanks