1. Pulmonary Rehabilitation Initial Experiences in Bangladesh
Dr. SM Rowshan Alam
MBBS. MPH. Asthma & COPD diploma level module( UK )
Primary Care Respiratory Physician
Bangladesh

2. Why pulmonary rehab is important?
Reduce symptoms
Decrease disability
Increase physical and social activities
Improve overall quality of life.

3. Components of Pulmonary Rehab
Exercise training
Education
Nutritional therapy
Psychosocial / Behavioural intervention
Outcome assessment
Promotion of long-term adherence

4. Duration of Pulmonary Rehab
The longer the better but usually 6-12 weeks.
Twice weekly minimum.

5. Assessment of Patient
Initial assessment & outcome of PR measuring by St. George’s Respiratory Questionnaire by 3 component score---
Symptoms Score
Activity Score
Impact Score

9. Assessment of Patient Dyspnea assess by Borg Scale .
Assessment of patient should be done followed by problem list
Goals should be made for proper pulmonary rehab.

10. Components of exercise training
Arm exercises
Lower extremity exercises
Ventilatory muscle training.
( Respiratory muscle strengthening).
Breathing exercises.
( Pursed lip breathing, Diaphragmatic Breathing)

11. UNSUPPORTED ARM LIFTING LIFTING WEIGHT
ARM EXERCISE TRAINING
ARM CYCLE ERGOMETER
UNSUPPORTED ARM LIFTING
LIFTING WEIGHT

12. LOWER EXTREMITY EXERCISE
WALKING
TREADMILL
STATIONARY BICYCLE
STAIR CLIMBING

13. Educational topics Breathing Strategies
Benefits of Exercise and Maintaining Physical Activities
Normal Lung Function and Pathophysiology of Lung Disease
Proper Use of Medications, including inhalation technique, Domiciliary Oxygen therapy.
Energy Conservation and Work Simplification Techniques.

14. Educational topics(contu.)
Eating Right
Irritant Avoidance, including Smoking Cessation
Indications for Calling the Health Care Provider
Coping with Chronic Lung Disease and End-of-Life Planning
Anxiety and Panic Control, including Relaxation Techniques and Stress Management.

15. Nutritional supplementation
Energy dense foods
Well distributed during the day
Drink plenty of fluids at least 6 to 8 glasses
Avoid overeating & food that cause gas or bloating.

16. Tips : Short of breath while eating or after meal
Clear airways at least one hour before eating.
Eat more slowly.
Take small bites and chew food slowly.
Choose foods that are easy to chew.
Eating five or six small meals a day instead of three large meals.
Try drinking liquids at the end of meal.
Eat while sitting up to ease the pressure on lungs.
Use purse-lip breathing.

17. Outcome Assessment
Patients opportunity to give feedback about quality control. 
Patient feedback also allows to evaluate the components of pulmonary rehab.
Exercise capacity measurement by patients performance sheet.

18. Outcome Assessment (n=116) 2 times/week, average 8 weeks
Before PR
After PR
Mean Symptom Score 74%
Mean Symptom Score 67%
Mean Activity Score 66%
Mean Activity Score 55%
Mean Impact Score 63%
Mean Impact Score 54%

48. Experiences Patients want to get benefit by PR without medication.
Patients want to get quick results.
Anxiety, depression reduced when they talk with peer-group.
Some percentage discontinue PR due to distance & communication.
Majority appreciated PR.

49. Thank You