THE ROLE OF PULMONARY REHABILITATION IN ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Objective: Chronic obstructive pulmonary disease (COPD) reduces lung function and generates systemic effects that decrease the quality of life. COPD is a major cause of chronic morbidity and mortality worldwide. Pulmonary rehabilitation can reduce symptoms of dyspnea and improve exercise capacity and quality of life in COPD patients.
Methods: We report a case of a 60 y old male with an acute exacerbation (AE) of COPD and pneumonia. The inpatient pulmonary rehabilitation program was 5 consecutive days of 3 repetitions of cough control, 2 sets of 6 repetitions of pursed-lip breathing, 2 sets of 6 repetitions of deep breathing exercises, postural drainage, and manual clapping twice daily. Postural drainage in the lateral basal segment and manual clapping in the right lower lobe was chosen according to the chest x-ray (CXR).
Results: At the initial visit, the following information was noted: inspiration capacity with incentive spirometry, 600 cc/s; chest expansion, 1.5 cm; and single-breath counting (SBC), 11. The activities of daily living (ADL) score according to the Barthel Index was 70, and CXR results showed COPD and pneumonia in the right lower lobe. After 5 d of pulmonary rehabilitation, there was a clear airway and improvement in shortness of breath (SOB), and the following was noted: incentive spirometry, 900 cc/s; chest expansion, 2 cm; SBC, 20; and Barthel Index score, 100.
Conclusion: Early inpatient pulmonary rehabilitation in COPD AEs is clinically effective and safe, controls breathing and coughing, strengthens the respiratory muscles, and improves the clearing of the airway, which improves the patient’s pulmonary function capacity and quality of life.
2. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-64.
3. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006;CD003793.
4. Jacome C, Marques A. Impact of pulmonary rehabilitation in patients with mild COPD. Respir Care 2014;59:1-6.
5. Riario Sforza GG, Incorvaia C, Paterniti F, Pessina L, Caligiuri R, Pravettoni C, et al. Effects of pulmonary rehabilitation on exercise capacity in patients with COPD: A number needed to treat study. Int J Chron Obstruct Pulmon Dis 2009;4:315-9.
6. Mikelsons C, Wedzicha W. Pulmonary rehabilitation and exacerbation. Semin Respir Crit Care Med 2009;30:649-55.
7. Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M. Physical activity and hospitalisation for exacerbation of COPD. Chest 2006;129:536-44.
8. Eaton T, Young P, Ferguson W, Moodie L, Zeng I, O’kane F, et al. Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study. Respirology 2009;14:230-8.
9. Puhan MA, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2009;CD005305.
10. Jette DU, Bourgeois MC, Buchbinder R. Pulmonary rehabilitation following acute exacerbation of the chronic obstructive pulmonary disease. Physical Ther 2010;90:9-12.
This work is licensed under a Creative Commons Attribution 4.0 International License.