COPD Clinical Management

Why Pulmonary Rehabilitation?

The American Association of Cardiovascular and Pulmonary Rehabilitation states “In general, Pulmonary rehabilitation provides the greatest improvements in symptoms, exercise capacity, and health related quality of life of any therapy available for patients with COPD”.

 

Pulmonary rehabilitation is identified in almost every major guideline for the treatment of COPD. Pulmonary rehabilitation should be offered for COPD patients who have limitations of daily living, dyspnea or other respiratory symptoms and reduced exercise capacity. As the severity of symptoms worsen, the need for Pulmonary rehabilitation increases.

 

Introducing these important components reduces dyspnea, optimizes functional status and reduces health care costs through improving patient self-management (patient identifies “red flags”) and stabilizing or decreases the progression of the disease. Pulmonary Rehabilitation is also beneficial for individuals with other chronic lung diseases, notably interstitial lung disease, pulmonary arterial hypertension and those who are pre- or post-lung transplantation.

 

Exclusion Criteria

 

Pulmonary Rehabilitation is NOT appropriate if the patient has significant co-morbidities that render them unable or unsafe to exercise strenuously.

  • Uncontrolled asthma
  • Cancer of poor prognosis
  • Active pulmonary TB
  • Unstable angina
  • Untreated or uncontrolled diabetes or epilepsy
  • Uncontrolled hypertension (BP>170/100)
  • Known uncontrolled cardiac arrhythmias
  • Recent cardiac event (eg. MI,6/52)
  • Poor motivation or severe cognitive impairment
  • Any serious condition which would prevent exercise or be exacerbated by exercise

 

Inclusion Criteria

 

Patient must meet ALL inclusion criteria prior to referral

 

  • Breathlessness that limits functional ability, secondary to a respiratory cause
  • Symptomatic, stable chronic lung disease with breathlessness of pulmonary origin
  • Cardiovascularly stable
  • Good motivation and consented to referral
  • Medically stable and optimized medication
  • Know this is a group activity which requires attendance three times weekly for 6 weeks
  • Able to follow simple commands in a group environment
  • Stable co-morbidities

 

 

 

GP Expectations

 

DOCTOR:  As the referring physician, you will typically retain responsibility for your patient. We will be contacting your patient within 72 hours of receiving a referral for Pulmonary Rehabilitation. Your patient will receive instruction in self-care and therapy in the Pulmonary Rehabilitation Program. You will be provided with a follow up letter indicating progress of your client pre and post Pulmonary Rehab program. Should you have any questions about your patients care while in the Pulmonary Rehabilitation Program, or wish to have more frequent reporting, please contact us by phone or fax with your request at any time.

 

Each patient will:

  • Attend 6 education sessions, lasting 1-2 hours once weekly
  • Attend 18 total Exercise sessions (3 days per week, for 6 weeks)
  • Follow the department’s protocol re: smoking cessation
  • Perform a pre and post program six-minute walk
  • Complete quality of life assessments such as the SGRQ pre and post program

 

The staff will: 

  • Evaluate each patient on an individual basis
  • Aid the patient in setting realistic goals
  • Titrate oxygen needs to maintain a saturation greater than 90% during exercise
  • Notify you if there are any trends that demonstrate the need to increase or decrease the present oxygen prescription
  • Devise an exercise prescription for supervised and/or home exercise program to increase strength, flexibility and endurance
  • Instruct the patient in the educational curriculum appropriate for specific lung diseases
  • Ensure diabetic patients monitor their own exercise blood sugars for pre and post exercise

Related Links

  1. https://www.lung.ca/health-professionals  (© 2017 Canadian Lung Association. All Rights Reserved).
  2. http://annals.org/aim/article/737452/diagnosis-management-stable-chronic-obstructive-pulmonary-disease-clinical-practice-guideline (American College of Chest Physician’s guidelines for COPD)
  3. http://www.thoracic.org/statements/copd.php (American Thoracic Society Official Guidelines for COPD)
  4. http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd (Gold initiative for COPD)
  5. http://www.livingwellwithcopd.com/exclusive-educational-tools.html (“Living Well With COPD” Healthcare Professional educational tools.