1Pulmonary Rehabilitation &COPDASTHMANetraya Nimpitakpong MD., C.Ped.Physical Medicine & Rehabilitation Department,Faculty of Medicine, Thammasat University
2COPD & Asthma Breathing Why need rehabilitation?...
3What is Pulmonary Rehabilitation? Chest physical therapyHome base exerciseRecreation activityeven Playing…
4What is Pulmonary Rehabilitation? Chest physical therapyHome base exerciseRecreation activityeven Playing…But need to be aim to “GOAL”
5GOALS of Pulmonary Rehabilitation for COPD & Asthma patient Prevent airway obstructionImprove airway clearance + ventilationReduce energy costs during respiration
6overall functional capacity Teach the patient how to deal with short-of-breath attacksImprove endurancePrevent accumulation of secretion & Increase the effectiveness of the cough mechanismImprove a patient’soverall functional capacity
7COPD & Asthma Breathing What is the difference?...
8COPD & Asthma attack Normal Breathing Deep & slow rate Quiet breathing & relaxUse normal respiratory musclesShort shallow & rapid rateWheezing & restless!Use respiratory muscles + Accessory muscles
9How they feel when being breathlessness!! Increase respiratory ratelower alveoli ventilation & increase work load
10How they feel when being breathlessness!! Breath in-breath out through mouse (instead of nose)Cold air cold airway increase bronchospasmBreath out …faster than normal collapse small airway & increase air trapping
11COPD & Asthma attack Normal Breathing Normal airway diameter Optimal secretionEffective coughCollapse airway diameterExcessive and sticky secretionNot enough breathing in Poor cough
18ACUTE EXACERBATION!!!When short of breath start….patient can feel scary. It helps the patient know what to do their can stay calm even they're short of breath. Pursed-lip breathing and diaphragmatic breathing will both help. These breathing methods prevent or reduce the trapped air in lungs, and allow patient to breathe in more fresh air. Thus teach them as the following;
19ACUTE EXACERBATION!!!Stop and rest in comfortable position, lower his/her head and shoulders Breathe in through the nose, and blow out through the mouth, breathe in and blow out just as fast as is necessaryBegin to blow out more slowly and for a longer time. Don't force it. Use pursed lip breathing, then slow rate of breathing downBegin breathing through the noseBegin doing diaphragmatic breathing and stay in this position for 5 minutes longer
20Comfortable positions when patient has short of breath Sitting:Sit with back against the back of the chair. Head and shoulders should be rolled forward and relaxed downwards. Rest the hands and forearms on thighs, palms turned upwards. Don’t teach them to lean on their hands (นั่งเท้าคาง) in this position. Their feet should be on the floor, knees rolled slightly outwards.
21Sitting:Lean back into the chair in a slouched position, Head rolled forward, shoulders relaxed downward. Rest the hands gently on stomach. Keep the feet on floor, knees rolled outwardPlace a pillow on a table and sit down, arms folded and resting on the pillow. Keep the feet on the floor or a stool, and rest head on your arms.
22Standing:The same manner as the sitting can be used while standing, arms resting on kitchen counter or back of chair, not leaning, knees bent slightly, one foot in front of the other.Lean with back to the wall, a pole, etc. Place feet slightly apart and at a comfortable distance from the wall, head and shoulders relaxed.Sitting:Lean back into the chair in a slouched position, Head rolled forward, shoulders relaxed downward. Rest the hands gently on stomach. Keep the feet on floor, knees rolled outwardPlace a pillow on a table and sit down, arms folded and resting on the pillow. Keep the feet on the floor or a stool, and rest head on your arms.
23Let the air escape naturally- don't force the air out of lungs Pursed lips breathingLet the air escape naturally- don't force the air out of lungs“Keep doing pursed lip breathing until no longer short of breath”
24ACUTE EXACERBATION!!! Pursed lips breathing Breathe in slowly through the nose for 1 countPurse lips as if you were going to whistle (แบบผิวปาก, เป่าเทียนเบาๆ)Breathe out gently through pursed lips for 2 slow counts, breathe out twice as slowly as the breathed in (ให้ง่ายหายใจเข้านับ หนึ่ง...สอง... หายใจออก นับ หนึ่ง..สอง...สาม...สี่)
26Diaphragmatic breathing Let the patient sit and relax shoulders in a comfortable chair slightly lean backward for easy to breathing training.1st step: Put one of patient’s hand on his/her upper chest, and the other on belly just above waist for monitor the movement of chest and belly while breathing.Diaphragmatic breathing
27Diaphragmatic breathing 2nd step:Let them breathein slowly through nose –instruct the patient that they should be able to feel the hand on their belly moving out but the hand on chest shouldn't move.
28Diaphragmatic breathing 3rd step:Breathe out slowlythrough pursed lips– instruct the patient that they should be able to feel the hand on the belly moving in as they breathe out.
29Long term maintenance Want to be stronger! Learn to improve pulmonary fitnessand also effective coughing
31Maintenance: Cough Training Sit down, head slightly lean forward, place both feet firmly on the ground.Demonstrate a sharp, deep, double cough to the patientplace the patient’s hands on his/her abdomen, let them try to making ”k” sound this manner make the vocal cord tightening, closure glottis, abdominal contraction then patient can detect the feeling when vocal cord closing.
32Maintenance: Cough Training Breathe in deeply using diaphragmatic breathing & try to hold the breath for three seconds.While keeping mouth slightly open, cough out twice.The first cough should bring up the phlegm, and the second cough should move it towards the throat.Take a break and repeat these steps once or twice if necessary
33Chest mobilizationLimb & body movement synchronized with breath in and breath outImprove chest expansion better ventilation & gas exchange
39Retraining of breathing How do I stop my breathlessness?Retraining of breathingLearn to relax by use the proper position &pursed lip breathing when breathlessnessLearn to use Diaphragmatic breathing & segmental breathing techniqueLearn to do the effective coughing