Make Every Breath Count – Pulmonary Rehabilitation
Pulmonary Rehabilitation, is a comprehensive outpatient program for people with chronic breathing problems. The pulmonary rehab team includes a Physician Medical Director, Respiratory Therapists, Nurses, Dietitians, Exercise Physiologists, and social workers.
Pulmonary Rehab benefits people who have COPD, Chronic Obstructive Pulmonary Disease (emphysema, chronic bronchitis and asthma) or Interstitial Lung disease (Idiopathic Pulmonary Fibrosis and Sarcoidosis). Pulmonary rehab also can benefit patients both pre and post-surgery for lung cancer or lung transplant.
The primary goals of a pulmonary rehabilitation program are to:
- Minimize symptoms
- Increase participation in physical and social activities
- Promote independence
- Improve quality of life
- Reduce hospitalizations, thereby reducing overall healthcare costs
Knowledge is power, pulmonary rehab includes:
- Disease management skills including classes on medications, supplemental oxygen, bronchial hygiene and recognition of signs and symptoms of infection or exacerbation (worsening of symptoms).
- Breathing retraining to reduce shortness of breath and improve oxygenation.
- Nutritional counseling on weight loss or weight gain, special diets for cardiac or diabetes and overall healthy eating habits.
- Energy-conservation for activities of daily living (ADL’s) or how to perform life’s activities more efficiently and comfortable.
- Stress management and coping skills to reduce anxiety and depression, common among people living with chronic disease.
- Smoking cessation or how to remain a non-smoker.
Most patients that have a history of smoking have quit smoking before entering the pulmonary rehab and live in a smoke-free environment. Quitting smoking reduces the rate of respiratory symptoms like cough, mucus production and respiratory infections (pneumonia and bronchitis). Continuing to smoke accelerates the damage to the lungs. Smoking cessation is the most important step to improving lung function.
Exercise training to increase strength and endurance is the mainstay of the pulmonary rehab program. When you start pulmonary rehab, an initial evaluation will be done to determine your individual needs and goals. This also includes a six minute walk test to establish a baseline of function and determine if the patients oxygen saturation is 90% and above at rest and with exercise. The use of supplemental oxygen improves exercise tolerance and endurance and oxygen saturations are checked at regular intervals during all exercise classes to maintain safe levels.
The “vicious cycle of pulmonary disease” starts with immobility that leads to physical de-conditioning, worsening of symptoms, social isolation and further impaired exercise tolerance. Physical reconditioning in pulmonary rehab leads to improvement in symptoms, decreased feeling of fear, depression and anxiety and improved exercise tolerance.
People with chronic lung disease become breathless and fatigued from activity that requires the arms to work at shoulder level or above. The exercise sessions includes upper-body strengthening with hand weights, Thera-Bands and exercise balls and upper body ergometers.
Leg strengthening exercises include walking on a treadmill, patients walk at their own pace increasing workloads as tolerated. Some patients are more comfortable walking laps in the gym. Stationary bikes and seated ellipticals improve leg strength without weight bearing. Pursed lip breathing is encouraged during exercise sessions to decrease breath holding, improve gas exchange, (“in with the good, out with the bad”) and reduce air trapping.
During the sessions, patients not only learn from the staff but also from each other. Close relationships are formed and encouragement and support comes from being in a program with people that are dealing with the same issues.
Attending support groups provide continuing lung health education, updates on equipment, community resources and events. For example, the 12th Annual Thomas L. Petty Moving Mountains Conference Oct.3rd, 2015: Details at: http://www.lunghealthco.org/conference/
The benefits of pulmonary rehabilitation have been studied extensively. They include:
- Improved survival
- Improved exercise tolerance
- Lessened perception of breathlessness
- Improved quality of life
- Reduced hospitalization time and hospitalizations per year
- Decreased anxiety and depression
Talk to your primary care physician or pulmonary doctor and ask for a referral to a pulmonary rehab program near you.
BREATHING MATTERS is presented by the Colorado Lung Health Connection: www.lunghealthco.org