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Published byBeverley Miles Modified over 9 years ago
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Exercise and Pulmonary Rehabilitation in Children with Chronic Lung Diseases Suchada Sritippayawan, MD. Somjitr Tongkam, BSc Chanthana Harnruthakorn, BSc.
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What is Chronic lung disease? CLD of prematurity Prolonged MV use Chronic aspiration Chronic infection Bronchiectasis Chronic ILD Asthma etc.
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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%
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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%
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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
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Exercise limitation in CLD CLD Ventilatory impairment Circulatory impairment Malnutrition Oxidative capacity of muscles O 2 delivery & CO 2 excretion Exercise limitation ( Aerobic capacity)
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CLD Airway problemsLung mechanic problems Chest wall mechanic problems Hypersecretion Bronchospasm Collapsed airway Restrictive Hyperinflation Ineffective cough Retained secretion Exercise limitation Atelectasis Recurrent pneumonia Pulmonary rehabilitation & Exercise training
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PFT at rest ≠ Exercise capacity Exercise test is helpful in identifying pulmonary limitation during exercise optimal level of exercise Exercise capacity in CLD
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Question #1 How to assess exercise capacity in children with CLD?
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Synonyms of exercise stress test: -Cardiopulmonary exercise test -Graded exercise test
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Exercise test VO 2 VCO 2 /VO 2 >1 Maximum O 2 consumption (VO 2 max) Work load
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