Many patients with COPD also have an asthmatic component. INTRODUCTION. Indications for Pulmonary Rehabilitation, Patient Selection and Contraindications/Pulmoner Rehabilitasyon Endikasyonlari, Hasta Secimi Ve Kontrendikasyonlar (Education Turkish Journal of Physical Medicine and Rehabilitation 2010, Dec. Turkish Journal of Physical Medicine and Rehabilitation. Not all patients with COPD benefit from this technique; therefore, close clinical monitoring to ascertain efficacy is required. Efficiency and safety of pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease. Respiration. 12(2):113-7. Over 1 year, pulmonary rehabilitation was associated with decreased health service use, reduced direct costs, and improved health status for patients with COPD. An associated condition that might interfere with the rehabilitative process. Theophylline improves respiratory muscle function, stimulates the respiratory center, and promotes bronchodilation, in addition to demonstrating anti-inflammatory effects. The adverse effects of influenza vaccine are seen in fewer than 5% of cases and include low-grade fever and mild systemic symptoms. Nicotine replacement therapy chewing pieces are marketed in 2 strengths (ie, 2 mg, 4 mg). Depression is often comorbid with COPD. Lancet. A health-related QOL instrument can assess the overall benefit of improvements in the patient's symptoms, disability, and handicap. Pulmonary rehabilitation. Arch Intern Med. An oxygen concentrator provides a flow of up to 6 L/min for patients requiring long-term oxygen supplementation. Because of theophylline's potential for toxicity, monitor serum levels of theophylline during therapy. COPD commonly is associated with progressive hypoxemia. Are primarily related to the exercise portion of the program. Dyspnea is the most common symptom of individuals with chronic pulmonary disease and is frequently the major reason for seeking acute care. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. The effect of dyspnea on daily activities can be measured with the Medical Research Council dyspnea questionnaire or with the dyspnea component of the chronic respiratory disease questionnaire. [Medline]. , Steroid myopathy or intensive care unit (ICU) neuropathy, Psychosocial dysfunction resulting from anxiety, depression, guilt, dependency, and sleep disturbance. Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease. Inhaled beta-2 agonists are the initial treatment of choice for acute exacerbations of COPD. Nasal oxygen delivery is also beneficial for most mouth-breathing patients. 1986 Dec. 7(4):585-97. This technique relieves dyspnea by increasing expiratory airway pressure, thereby inhibiting dynamic expiratory airway collapse. Carefully document the effectiveness of such therapy (>20% improvement in FEV1) before giving a patient prolonged daily or alternate-day treatment. [Full Text]. [Full Text]. Patients, even those who have no measurable increase in expiratory flow, benefit from treatment using beta 2 agonists. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. . Nutritional status and mortality in chronic obstructive pulmonary disease. During expiration, the patient may contract the abdominal wall muscles to displace the diaphragm more cephalad. Inpatient rehabilitation generally is recommended for patients affected to the greatest degree, because intensive rehabilitative services and specialized training for the patient and/or family will be available. The patient can be handicapped further by inadequate finances, inadequate family support or education, and various public policies. Am Rev Respir Dis. Anxiety, depression, difficulties in coping with chronic lung disease, and the inability to cope with illness contribute to the handicap of advanced respiratory disease. You will learn to achieve exercise with less shortness of breath. Exercise performance improves in patients with COPD due to respiratory muscle endurance training. 11:391-7. Each liter of oxygen flow adds 3-4% to the fractional inspired oxygen (FIO2). Determinants of successful completion of pulmonary rehabilitation in COPD. The value of this therapy in stable patients with COPD and in acute COPD exacerbation is uncertain. In combination with a beta-2 agonist, there is an additional 20-40% bronchodilation. Optimal nutritional status in pulmonary rehabilitation should help to maximize the patient's state of health, respiratory muscle function, and overall sense of well-being; it also may improve disease outcome. Despite a lack of conclusive evidence to support the role of inhaled corticosteroids in the management of COPD, the use of these agents is widespread. The goal of treatment is to preserve optimal lung function, thereby preventing symptoms and recurrence of exacerbations and, as a result, improving function in daily living, as well as QOL. [Medline]. 2002
122(11):823-32. In a meta-analysis of 16 controlled trials in patients with stable COPD, researchers found that approximately 10% of these patients responded to these drugs. Leaning-forward postures frequently relieve dyspnea in patients with COPD by reducing respiratory effort. Lung transplantation also is used in patients with sarcoidosis, eosinophilic granuloma, extrinsic allergic alveolitis, lymphangioleiomyomatosis, pulmonary hypertension, cystic fibrosis, and severe bronchiectasis. Oseltamivir resistance emerged in the United States during the 2008-2009 influenza season. The rehabilitation intervention is geared toward the unique problems and needs of each patient and is implemented by a multidisciplinary team of health care professionals. 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