Chronic Obstructive Pulmonary Disease (COPD) is a systematic disease with

Transcription

1 Chronic Obstructive Pulmonary Disease (COPD) is a systematic disease with considerable impact on several dimensions of daily life. Those that suffer from COPD can be submitted to rehabilitation programmes. These are run by multidisciplinary specialists who try to enhance and maintain the patient s health. This essay will discuss the different types of programmes available to patients, and how they have come about and been developed to meet the patient s needs (Bates et al, 1985). The symptoms of the COPD include an ongoing cough and the production of excess amounts of mucus or sputum. Other symptoms include shortness of breath, especially when the patients are undergoing physical activity. Patients may also suffer from wheezing and chest tightness. Patients tend to be more susceptible to frequent colds or flu. Severe COPD can lead to swelling of the ankles, feet, or legs; there is also a noticeable blush colour of the patients lips due to low levels of oxygen in their blood. COPD can be accounted for more in low- and middle-income countries. COPD is also more common in men, but due to increasing numbers of women using tobacco and a high risk of exposure to indoor air pollution women are just as susceptible as men (WHO, 2009). The main risk factors of COPD can be caused by smoking and passive smoking however other factors include indoor and outdoor pollution and occupational vapours and fumes for example someone that works in a factory and work with substances that can create harmful fumes (Laccasse et al,.1999). It has been estimated from previous reports that 600,000 cases are related to sufferers over 40 years old Soriano et al., (2000), in addition to 5% in the ages of and 10% aged 75 and over (Davidson &.Morgan, 1998).

2 The aim of the pulmonary rehabilitation programme is established to treat patients who are suffering from chronic obstructive pulmonary disease (COPD). COPD is the progressive and permanent cause of lung damage, usually due to expose to chemicals such as smoking that leads to an obstruction of airflow during exhalation (Troosters, 2000). In severe conditions, it will benefit individuals who are suffering lung disorders, chronic asthma and pulmonary fibrosis. The lung disorder comes about more frequently in smokers than non smokers, those that have high alcohol consumption and also could come about in individuals who suffer from other illness and disabilities that can contribute to the cause and symptoms of COPD (Petty, 1985; BTS, 2001). The assessments must be implemented on an individual basis to establish adequate outcomes of the rehabilitative structure (WHO, 1980). The pulmonary rehabilitation enhances quality of Life (QOL), strength, exercise endurance and reduce symptoms Dyspnoea and other chronic conditions however the question that is in doubt, is the enhancement of the ventilatory muscles during the rehabilitation programme(celli, 1995). The approach to this comprehensive rehabilitation programme can be through education and respiratory care instructions, psychosocial support and supervised exercise training (Ries et al,.1995). Celi (1995) supports the approach by suggesting that education and physiological support is significant methods to use, furthermore De Souza et al., (2003) emphasizes the difficulties commonly faced by patients, such as depression, smoking, fear, and family and social problems. Medications and rehabilitations may relief symptoms and improve the lung efficiency along with enhanced exercise tolerance, research on the other hand shows that health care use by COPD patients appears to be related even more to an impaired quality of

3 life than to the severity of the lung disease itself, therefore, improvement in quality of life should be one of the aims of treatment COPD (Wijkstra et al., 1994). This paper will focus directly at pulmonary rehabilitation and the forms of treatments and assessments though health care professionals. The most effective forms of rehabilitation is through either home setting or community based settings, according to Strijobs et al, (1996) stated that home environment settings at a long and sustained periods will aid a patients strength levels and prevent the occurrence of dyspnoea. The following programme that will be implemented for an individual is physical and social performance delivered by a multidisciplinary team, that in return can be supported by health professional for example physiotherapist, nurse or pharmacists (Berry et al., 1999). The core strategies within the pulmonary rehabilitation course are disease education and exercise, in addition to lower and upper body strength training, furthermore nutritional, smoking, physiological interventions applied (Mahler, 1998). The duration and frequency spent on programmes is between 1-5 weeks, and 30 minutes of hospitalization (Ringbaek et al., 2000). A 6-weeks intervention course for an outpatient environment has been shown to be effective however to a certain extent, both courses have similar effects but different in cost, duration and frequency (Foglio et al., 1999). This type of treatment can offer enhanced exercise components, improve health status and reduce the amount of dyspnoea. The long term health benefits for the economic side can reduce the number of people attending hospitals, the time period of stay, the amount of practitioners attending homes, will in return lower the cost (Griffiths et al., 2001). The methods are cost effective and are financially beneficial for health services, however home interventions may be cost

4 effective depending on the individual, but the long term follow up will provide improvements (Oh, 2003). Improvements are effective following a long follow up period, however when relating health importance to exercise performance is limited in its capacity. To introduce a well developed, well structured 2 year programme, it may show progress to the health status, that however is dependant on the individual state (Ries et al., 1995). When implementing an aerobic programme, staff must take into consideration the limitation of COPD sufferer s cardio levels. Staff must also report medical setting prior to implementing any testing; this therefore requires adequacy and accuracy in methodology (Gallefoss et al., 1999). COPD patients have a psychological fear, which causes muscle fatigue, panic, and to some extent breathlessness prior to exercising (Calverley et al., 2001). In order to avoid this from occurring Lacasse et al,. (1996) suggest that the aim of the rehabilitation program is gained through providing education for the patients in benefit of exercise, psychological, behaviour intervention and outcome assessment (Lacasse et al, 1996). When taking part in exercise programme, considerations must be placed upon the duration, frequency and the intensity of the training, this will determined the increase of the health status. The response of these exercises will enhance fitness levels, increase strength and in return measure changes to reflect upon the improvement. In terms of duration, as mentioned previously, 12 weeks under training supervision at 2-3 times a week with a moderate intensity (Clarks et al,. 1996). The testing that can be applied must be under extra supervision when putting them under maximal testing (VO2max, treadmill) (Man et al,. 2004).

5 When progression is applied, there is two methods of prescribing the exercise, firstly increasing the intensity and duration to the primary target, and secondly applying continuous exercises to meet relevant targets (Finnerty et al,.2001).the training must be adapted for the patient and precautions must be considered in case of any incidents occurring, however interval training can be applied when the session is extended to reach targets (Vogiatis et al., 2002). The intensity of the patients can be examined through using a Borg Scale rating to indicate the work rate (Coppoolse et al., 2008). It is recommended that resistant training can assist COPD sufferers in the short and long term programme however the degree of resistance applied must be once again determined Simpson et al., (1992), furthermore this will improve the strength of the individual. Strength training is important (Clark et al,. 1996). Although the intensity must be gradual to assist the patient s technique, tempo and breathing style which is significant prior to engaging within the strength training. Despite the problematic circumstances of muscle training within a pulmonary rehabilitation programme Niederman et al. (1991), the suggestions is that low intensity to enhance the prime components (breathing, tempo, technique) (Garrod et al., 2000). Assessment must be implemented within the pulmonary rehabilitation programme, however the most valid and reliable way of assessing the impact of pulmonary rehabilitation on functional status (COPD) is currently unknown (Laviolette et al,. 2008). There are number of assessments that can be carried for example assessing patient s goals, medical history, exercise capacity, quality of life and shortness of breath (Australian Lung Foundation, 2006). The importance of assessments is determining the severity of the impairment; hence the reason of determining the baseline of exercise

6 capacity is essential in formulating a training prescription and monitoring the hypoxemia during the exercise (Lacasse et al, 1996). In relation to impairments, the interpretation of assessing constant work rate on a treadmill and on a cycle ergometer is open to investigation. It can, however, measure the changes of the rehabilitation programme and reports suggest a 15% increase is shown during maximal test (Lacasse et al, 1996). Other protocols that are used and validated field tests of exercise capacity for patients with chronic obstructive pulmonary disease (COPD) are Six-Minute Walk Test and the shuttle walk test (Singh et al., 1998). The short and long term benefits is shown in the study of Ketelaars et al., (1997) investigates the long-term benefits of pulmonary rehabilitation in terms of healthrelated quality of life (HRQL), maximal exercise performance, peripheral and respiratory muscle strength by carrying out a 12 minute walk test for a 9 month duration, it was found that after care programme will be needed post discharge for severe impaired COPD sufferers (Ketelaars et al.,1997). Troosters et al, (2000) research shows a significant improvement within an outpatient 6 month, high intensive, maximal exercise, and high qualities of life in sever COPD sufferers. This is further emphasised by Verrill et al,. (2005) research determined whether physical performance, quality of life, and dyspnea with activities of daily living improved following both short-term and long-term pulmonary rehabilitation (PR) across multiple hospital outpatient programs; consequently it was found that improvement was made within weeks of pulmonary rehabilitation, further investigation showed that exercise prescription and quality of life improved over long term 18 month program, in addition to short term improvements (Wijkstra et al.,1995).

7 Alternative assessments for other groups for example handicaps use the St Georges Respiratory Questionnaire, Chronic Respiratory Questionnaire and the self report questionnaire are all valid assessments for measuring health status, however Stubbing et al., (1998) states that there are potential positives and negatives. Extensive questionnaires for research purposes provide valuable information, but are time-consuming to fill in and require trained personnel to assist the patient and to calculate the sometimes complicated scoring. Stallber et al, (2009) study argues that it is shorter and easy-to-use questionnaires which needed in primary care, as patient visits generally are brief, and nurses and doctors often lack research experience. It has been shown in a study by Emery et al. (1991) which found that using pulmonary rehabilitation offered significant improvements in reducing symptoms such as anxiety, depression, and improved general well being and neuropsychological functioning in male and female patients ranging from the ages of 53 to 82. In contrast Toshima et al,. (1990) research indicated that there were more intensive programs available however questioned whether the age range has an effect on the treatment. It has been recommended by many researchers that patients over the age of 75 require a much more comprehensive rehabilitation programme. The recommended programmes for patients over the ages of 75 require an alternative programme which is adaptable for that age range (Couser et al, 1995). Emery et al. (1998) supports this concept in his studies by recommending that the most successful programs offer exercise, education and stress management. Psychosocial benefits as a result of long term pulmonary rehabilitation programme can be positive and enduring, dependent upon the patients personality traits which determine the adherence factors (Buchi et al., 1997).

8 In conclusion, we found that the most effective way in treating the symptoms and limitations of COPD is using pulmonary rehabilitation; this along with its benefits has been documented in several studies over the years. On the other hand, the pulmonary rehabilitation programme is effective only if the multidisciplinary team, patient and family work together in order for the program to be successful (Couser et al. (1995). In addition, to maximise the effects patients can be offered the option to have bilateral lung volume reduction surgery along side their pulmonary rehabilitation, this can enhance the improvement of static lung function, gas exchange, QOL, and breathing pattern during maximal exercise. Overall, it can be said pulmonary rehabilitation offers a better quality of life. This is done through elevated levels of physical functionality. By entering the programme it can slowly help diminish the effects of these classified respiratory diseases. Though adequate assessments and education, lung function and productivity has a strong relationship in major aspects of life therefore this safe effective, and inexpensive pulmonary rehabilitation program make it an effective treatment which should be widely recommended and implemented.