1. By: Nermine Mounir Assistant prof. chest Department, Ain Shams University

2.  It is a multidisciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance.

3.  Symptomatic chronic lung disease.  Stable on standard therapy.  Functional limitation from disease.  Relationship with primary care provider.  Motivated to be actively involved in and take responsibility for own health care.  No other interfering or unstable medical conditions.  No arbitrary lung function or age criteria.

4.  Screening interview.  Medical evaluation.  Diagnostic testing → PFTs, Exercise, ABGs/oximetry.  Psychosocial assessment.

5.  It is broad program that helps improve the well-being of people who have chronic breathing problems or who need lung surgery, both before and after the surgery.  Include:  Exercise training  Nutritional counseling  Education about the disease and how to manage  Energy – conserving techniques  Breathing strategies  Psychological counseling

6.  It’s a long term commitment.  It s a team work  Its often an outpatient program  It can improve the function and quality of life even in advanced lung diseases.

7. Benefits:  Improve quality of life  Function better in daily life  Increase ability to exercise  Decrease symptoms  Help to manage anxiety and depression Risks: Usually safe, the risks related to the exercise part of the program as injuries to muscles or bones. If there is another disorder such as heart disease may increase heart attack or arrhythmia.

8. 1- PFTS 2- 6 – minute walk test or exercise on treadmill to check the ability to exercise. 3- Review the medical therapy 4- Assess the mental health(depression or anxiety) 5- Weight and height measurement 6- Assess general nutrition and muscle mass assessment.

9.  To improve the endurance and muscle strength.  The plan must include exercises for both arms and legs.  The plan may involve several short sessions with rest breaks in between.  Blood oxygenation should be checked.  At least 3 times/ week for the most benefits.

10.  Exercise programs for pulmonary patients typically emphasize lower extremity training (walking or cycling).  Other types of exercise → upper extremity training and ventilatory muscle training.

11.  Detection if the patient is overweight or underweight.  Accordingly a healthy eating plan is suggested.  Sufficient caloric intake and protein supplements.

12.  The patient should learn about his disease and its possible management.  Learn to avoid situations that worsen the symptoms e.g. resp. infection, lung irritants such as smoking or air pollution.  Learn about the importance of vaccination and how to prevent infection.  Learn how to take medicines and how to use oxygen therapy, nebulizers and MDI.  Learn Self- management plan to relieve symptoms.  Learn how to use exercises, breathing strategies, and other lifestyle changes.

13.  Respiratory and Chest Physiotherapy Techniques → chest physiotherapy to control secretions, breathing retraining techniques (diaphragmatic and pursed lips breathing techniques).

14.  To prevent symptoms like dyspnea and to find easier ways to do daily tasks.  Tips include ways to avoid reaching, lifting, and bending.  Stress can use up energy and cause dyspnea.

15.  To improve breathing as take longer, deeper, and less frequent breaths e.g. pursed-lip breathing.  Pursed-lip breathing decreases how often the patient take breaths and keeps the small airways open longer.

16.  People who have chronic lung diseases are more prone to depression, anxiety, and other emotional problems(denial, anger and isolation).  Cognitive and neuropsycholgical dysfunction, possibly related to or exacerbated by the effects of hypoxemia on the brain.

17.  Decrease in →  Medical resource utilization  Respiratory symptoms  Psychological symptoms.

18.  Increase in →  Quality of life  Physical activity  Exercise tolerance (endurance or maximal level of activities of daily living)  Knowledge  independence

19.  Return to work possible.  No change in lung function.  Possible prolonged survival.

20. Thank you