Exercise and Pulmonary Rehabilitation in Children with Chronic Lung Diseases Suchada Sritippayawan, MD. Somjitr Tongkam, BSc Chanthana Harnruthakorn, BSc.

What is Chronic lung disease? CLD of prematurity Prolonged MV use Chronic aspiration Chronic infection Bronchiectasis Chronic ILD Asthma etc.

CLD: Burden of the disease Jan – Dec 2006 Out-patient service - 464/1,095 visits (42%) - 116 cases - Chronic aspiration 42 cases - BPD 39 cases - Others 35 cases - 20% on home oxygen therapy - 2% on home ventilator 70%

CLD: Burden of the disease Jan – Dec 2006 In-patient service - 246/3,800 admissions (6.5%) - 246 cases - Chronic aspiration 91 cases - BPD 34 cases - Others 121 cases - Median age 1.3 yrs - Admission rate 2.5/case/yr - Duration of admission 70 days/case/yr 50%

CLD: Pulmonary function Depend on underlying disease BPD – obstructive, air trapping, BHR Bronchiectasis - Mixed obstructive/restrictive, BHR - Not related to CT findings ILD - Restrictive - Diffusion defect

Exercise limitation in CLD Ventilatory impairment Circulatory impairment Malnutrition  Oxidative capacity of muscles  O2 delivery & CO2 excretion Exercise limitation ( Aerobic capacity)

Pulmonary rehabilitation & Exercise training CLD Chest wall mechanic problems Airway problems Lung mechanic problems Hypersecretion Bronchospasm Collapsed airway Restrictive Hyperinflation Atelectasis Recurrent pneumonia Ineffective cough Retained secretion Exercise limitation Pulmonary rehabilitation & Exercise training

Exercise capacity in CLD PFT at rest ≠ Exercise capacity Exercise test is helpful in identifying pulmonary limitation during exercise optimal level of exercise

How to assess exercise capacity in children with CLD? Question #1 How to assess exercise capacity in children with CLD?

Synonyms of exercise stress test: Cardiopulmonary exercise test Graded exercise test

Exercise test Maximum O2 consumption (VO2max) VO2 VCO2/VO2>1 Work load