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Pulmonary Rehabilitation
- 2. In 1974 a committee of the American College of Chest Physicians (ACCP)defined pulmonary rehabilitation. In 1981 the American Thoracic Society (ATS) published the first official statement on pulmonary rehabilitation, that included the 1974 ACCP definition of pulmonary rehabilitation. In 1994 the National Institutes of Health (NIH) Consensus Conference on Pulmonary Rehabilitation formalized a definition of pulmonary rehabilitation. The latest definition of pulmonary rehabilitation was published by the American Thoracic Society in 1999. This definition, adopted by the Guidelines Committee of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), is as follows:
- 3. Pulmonary rehabilitation is a multidisciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy. Rehabilitation Systems has designed this pulmonary rehabilitation program with that definition as a guide.
- 4. Understanding the definition …a multidisciplinary program of care for patients with chronic respiratory impairment… Together we can educate and assist people with chronic respiratory impairment to be more functional and increase their quality of life. Rehabilitation Systems has developed a pulmonary rehabilitation program that encompasses physical therapy, occupational therapy, nursing, and physician disciplines.
- 6. Expected Outcomes of Pulmonary Rehabilitation Pulmonary rehabilitation does not reverse nor have any direct effect on the primary respiratory pathophysiology, yet it has proven to improve the following: • Reduce respiratory symptoms (e.g., dyspnea, and fatigue) • Increase exercise preformance • Increase knowledge about pulmonary disease and its management • Improve health‐related quality of life • Improved psychosocial symptoms (e.g., reversal of anxiety and depression, increased self‐efficacy) • Reduced hospitalizations and use of medical resources • Return to work for some patients
- 7. The Burden of Chronic Respiratory Disease Heart Stroke Other COPD Disease CVD All other diseases 3.0 2.5 2.0 1.5 1965 1.0 1998 0.5 0.0 % change in age‐adjusted death rates in US This chart shows that although heart disease is still the number one cause of death in the U.S., all other causes of death have decreased since 1965, yet COPD has continued to increase.
- 8. In 2000, for the first time in history, the number of women dying from COPD was greater than the number of men. Chronic Obstructive Pulmonary Disease Surveillance-US, 1971-2000. MMWR Morbidity and Mortality Weekly Report Surveillance Summaries 51:SS-6.
- 9. How does this affect healthcare? Emergency Physician Office Department Hospitalizations Visits in 2000 Visits 8 1.5 726,000 million million
- 10. COPD Will Cost U.S. $800+ Billion Over Next 20 Years, Study Predicts SAN DIEGO—Over the next 20 years, medical costs related to chronic obstructive pulmonary disease (COPD) will total approximately $832.9 billion in the United States, according to a study to be presented at the American Thoracic Society International Conference on May 22nd. The study, which used a mathematical model to estimate future costs related to COPD, found that the disease will cost $176.6 billion in the U.S. over the next five years, and $389.2 billion over the next 10 years. The study is part of the Burden of Obstructive Lung Disease (BOLD) initiative, which is designed to examine the prevalence and burden of COPD around the world. Retrieved August 8, 2009, from http://www.thoracic.org/sections/publications/press‐ releases/conference/articles/2006/press‐releases/copd‐will‐cost‐us‐800‐billion‐over‐next‐20‐years‐study‐ predicts.html
- 11. Who will pay these medical costs? s Y p o o u u s e c c h h i i l l d d The impact of chronic respiratory disease is not just an economic or epidemiological statistic. Its effect on patients’ and their families’ quality of life is tremendous. The cost of lung disease in terms of lives affected is enormous.
- 12. YOU CAN Make a difference! Scope for Pulmonary Rehabilitation Specialists: •Practice medically acceptable methods of pulmonary rehabilitation •Increase and improve your knowledge and expertise in pulmonary rehabilitation •Share information with patients that will improve their outcomes •Provide pulmonary rehabilitation to patients regardless of social, cultural, economic, personal, or religious beliefs •Keep all patient information confidential •Strive for early prevention and detection of respiratory disease
- 13. Don’t be confused! Smokers aren’t the only people with chronic respiratory impairment!
- 14. Candidates for Pulmonary Rehabilitation •Any person with a history of smoking •Any person with a family history of lung disease •Any person with a history of occupational or environmental exposure •Any person with symptoms of cough and mucus production Let’s examine these individually.
- 15. Any person with a history of smoking Smoking is the number one cause of lung disease. The development of this disease can occur over 20‐30 years. Even though the mean life expectancy in the United States, which was 77.2 years in 2001, continues to increase, people with advanced lung disease will not have this favorable prognosis. (Guidelines for Pulmonary Rehabilitation Programs, Third Edition) Smoking cessation is a vital component of pulmonary rehabilitation. If you seek only to treat the symptoms, and not the cause, you will disserve the person needing rehabilitation. If you are a smoker yourself, now is the best time to quit. You will have a greater understanding of the process and can support the patient trying to stop. If you choose to continue smoking and still want to work with pulmonary patients you should recognize that the smell of smoke may trigger those who have quit to begin again.
- 16. Any person with a family history of lung disease Alpha‐1 Antitrypsin deficiency poses a genetic predisposition to developing lung disease, even in the absence of smoking. A history of lung cancer in any family member is associated with an increased cancer risk. A family history of chronic bronchitis and pneumonia is also associated with an increased risk of developing a lung disease. Gao Y, Goldstein AM, Consonni D, Pesatori AC, Wacholder S, Tucker MA, Caporaso NE, Goldin L, Landi MT. Family history of cancer and nonmalignant lung diseases as risk factors for lung cancer. Retrieved August 8, 2009, from http://www.ncbi.nlm.nih.gov/pubmed/19350630.
- 17. Any person with a history of occupational or environmental exposure Occupational and environmental exposures can cause lung disease whether or not the person is exposed to cigarette smoke. The most common occupational exposures: •Occupational lung cancer •Occupational asthma •Asbestosis •Mesothelioma •Byssinosis (brown lung disease) •Coal workers' pneumoconiosis (black lung disease) •Silicosis •Hypersensitivity pneumonitis Occupational lung disease is the number one work‐related illness in the United States based on the frequency, severity, and preventability of diseases. National Institute for Occupational Safety and Health. Work-Related Lung Disease Surveillance Report. December 2002. Retrieved August 8, 2009 from http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=4294229&ct=3052555
- 18. Any person with symptoms of cough and mucus production •Any person with a family history of lung disease •Any person with a history of occupational or environmental exposure
- 20. Examples of Patient Goals •Breathe easier •Be more active •Have a better quality of life •Increase strength and endurance •Be able to perform activities of daily living, such as • taking a shower •pursuing hobbies •Be able to travel with greater ease •Experience decreased anxiety, depression, or fear of activities that cause shortness of breath •Experience fewer exacerbations and hospitalizations •Be more independent and self reliant •Return to work •Be able to clean house •Be able to go to a movie
- 21. Program Goals The most successful pulmonary rehabilitation programs have patients and significant others, an interdisciplinary team, and primary care providers who believe in pulmonary rehabilitation. This shared philosophy can be nurtured through the relationship developed between the rehabilitation staff and the patient. Along with striving to attain the patient’s goals, the interdisciplinary team should also work toward effective team goals. To succeed you must believe in pulmonary rehabilitation and you must help the patient believe in it as well.
- 22. Ten Goals to Incorporate 1. Integrate prevention and long‐term adherence into the patient’s treatment plan 2. Design and implement an individualized therapeutic treatment plan (e.g., smoking cessation, weight loss or gain) 3. Improve the patient’s and his/her significant other’s quality of life 4. Control alleviate, as much as possible, the symptoms and pathophysiological complications of respiratory impairment 5. Increase strength, endurance, and exercise tolerance 6. Decrease psychological symptoms such as anxiety or depression 7. Increase the patient’s long‐term adherence with the medical and rehabilitation therapeutic treatment plan 8. Train, motivate, and rehabilitate the patient to his or her maximum potential in self‐care 9. Train, motivate, and involve the patient’s significant other in the treatment plan 10. Reduce the economic burden of pulmonary disease on society through a reduction of acute exacerbations, hospitalizations, lengths of stay, emergency room visits, and long‐term convalescence