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Treatment for COPD

by Prodyut Das
(New Delhi, India)

COPD

The pulmonary rehabilitation for treatment of COPD has multidisciplinary team and can consist of a physiatrist and pulmonologist; respiratory, physical, and occupational therapists; an exercise physiologist; a psychiatrist or psychologist; a social worker; a vocational counselor; and a dietitian. However, in the present fiscal environment, an effective small program may have only one specifically trained therapist or nurse under physician supervision.

• Favorable, patient on stable self-medication program and non smoking


• Bronchodilators include beta 2-agonists, anticholinergics, and theophyllines


• Other medications, such as corticosteroids, expectorants, mucolytics, and antibiotics, are used along with humidification, ample fluid intake, oxygen therapy and facilitated airway secretion elimination as warranted

• Improve endurance and efficiency


• Optimize oxygen needs and control of secretions


• Increase independence in ambulation and self-care activities


• Reduce anxiety and improve self-esteem through enhanced body awareness

• Supplemental oxygen needed during exercise


• Discontinue and notify physician if patients becomes severely dyspneic or develops chest pain with exercise

• Conduct ear oximetry at rest and during exercise to determine portable oxygen flow rate needed to maintain oxygen saturation higher than 90%


• Instruct patient in diaphragmatic and pursed-lip breathing


• Instruct patient and family in postural drainage techniques


• Instruct patient and family in portable oxygen use


• Instruct in use of metered-dose inhaler before exercise


• Instruct in use of nocturnal bilevel positive airway pressure

• Assess baseline endurance, using 12-minute walk test


• Begin incremental exercise program to improve endurance through ambulation and stair climbing. Begin with 5-minute sessions, followed by rest periods between sessions. When patient tolerates 20 minutes of total exercise per day, begin consolidating the sessions.


• Initial treatments on daily basis during weeks 1 and 2, taper to three times per week over weeks 3 and 4, and then taper to home program with self-monitoring in weeks 5 and 6.


• Review proper body mechanics and coordinate with breathing patterns, using diaphragmatic and pursed-lip breathing when appropriate

• Assess upper-extremity mobility, strength, and endurance


• Evaluate basic and advanced self-care activities, and provide adaptive aids to improve independence with dressing, hygiene, bathing, cooking, and other chores


• Train the patient in energy conservation and work simplification techniques


• Evaluate home environment and make recommendations for workspace modifications and equipment to improve safety, efficiency, and independence


• Provide relaxation exercise training with visual imagery techniques

• Lung volume reduction surgery


• Lung transplant