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

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

3. 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%

4. 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%

5. 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

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

7. 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

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

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

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

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