1. Physiology II-4 Cardio and pulmonary rehabilitation General Management Helen Andersson Physiotherapist SLAZ Amsterdam

2. ESP slide 2 General Management 1.Oxygen Therapy Hough,p. 119-130 2.Nutrition Hough,p. 131-133 3.Drug Therapy Hough,p. 133-144

3. ESP slide 3 Oxygen Therapy 1.Indications - Hypoxaemia, if SaPO2 < 90% - terminally ill patients - breathlessness on exercise - endurance training 2.Questionable - Prescription as required, as no physical need for oxygen - better: patient education

4. ESP slide 4 Oxygen Therapy 3.Complications - ↑ concentration of O2 may impair respiratory drive (see Video) - O2 toxicity - psychological dependency 4.Benefits - ↓ cor pulmonale * - ↑ quality of life - ↑ sleep - ↓ exacerabations and hospital admission

5. ESP slide 5 Oxygen Therapy * Cor Pulmonale Cor pulmonale, or pulmonary heart disease, occurs in 25% of patients with chronic obstructive pulmonary disease (COPD) In fact, about 85% of patients diagnosed with cor pulmonale have COPD. High blood pressure in the blood vessels of the lungs (= pulmonary hypertension) causes enlargement of the right ventricle.

6. ESP slide 6 Oxygen Therapy Oxygen Delivery Devices 1Low flow performance mask 2High flow performance mask 3Nasal Canula 4Nasal Catheter 5Transtracheal Catherter 6Other 7PICTURES

7. ESP slide 7 Nutrition 1.Importance - malnourishment » ↓ muscle mass, weight » unable/poor improvement of muscle function » ↑ chance of infections and less resistance » hinders mobility » ↓ quality of life 2.Causes - ↓ appetite in smoking, depression, drugs - breathlessness while eating, preparing > ↓ food intake - desaturation during eating > ↓ food intake - ↑ WOB during eating > ↓ food intake - hypoxaemia - other

8. ESP slide 8 3.Physiotherapeutic considerations - ask regularity of food intake at patient/nurse - consider SNAQ score Nutrition Score 0-1 = no underfooding Score 2 = some underfooding Score ≥3 = serious underfooding

9. ESP slide 9 Drug Therapy 1.Drug purpose - to prevent inflammation (Chromones) - treat inflammation (Corticosteroids) - treat bronchospasm (bronchodilators) - treat breathlessness (bronchodilators) - treat infection (Antibiotics) - help clear secretions (humidification, ↑ drinking) - inhibit coughing (nebulized local anaesthetics) - improve ventilation (respiratory stimulants) - relieve oedema (diuretics)

10. ESP slide 10 Drug Therapy 1.PIC page 134

11. ESP slide 11 Drug Therapy 2.Drug delivery devices = delivery of aerosolized drugs in air, directly to respiratory tract - Inhalers - Nebulizers