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 CLD Ventilatory impairment Circulatory impairment Malnutrition  Oxidative capacity of muscles  O 2 delivery & CO 2 excretion Exercise limitation (  Aerobic capacity)

7. 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

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

9. 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 VO 2 VCO 2 /VO 2 >1 Maximum O 2 consumption (VO 2 max) Work load

12. Indications for exercise testing Clinical assessment - symptoms or signs induced by exercise - medical or surgical interventions - baseline data of rehabilitation programs Aerobic fitness evaluation

13. Contraindications to exercise testing Absolute contraindications - active inflammatory heart disease - active hepatitis - acute myocardial infarction - active pneumonia - severe systemic hypertension - acute orthopedic injury to an exercise muscle group

14. Contraindications to exercise testing Relative contraindications - severe left ventricular outflow obs. - severe right ventricular outflow obs. - congestive heart failure - severe mitral stenosis

15. Lab equipment Ergometers Respiratory and metabolic/gas equipment Monitoring : EKG, HR, SpO 2, BP