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LEARNING OBJECTIVES
Define the disease processes (including definition, etiology, pathophysiology, clinical presentation, and clinical course) of chronic obstructive pulmonary disease, asthma, cystic fibrosis, and restrictive lung disease.
Describe examination procedures (including patient interview, vital signs, observation, inspection, palpation, auscultation, and laboratory tests) for a patient with pulmonary disease.
Identify the anticipated goals and expected outcomes of pulmonary rehabilitation.
Describe the rehabilitative management of a patient with chronic pulmonary dysfunction.
Value the therapist's role in the management of a patient with chronic pulmonary dysfunction.
Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.
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Pulmonary rehabilitation is a multidisciplinary comprehensive program of care for patients with chronic respiratory disease that is designed to reduce symptoms, optimize physical functioning and social participation, and reduce health care costs.1 A diversity of health professionals is essential to meet the medical, physical, social, and psychological needs of the patient with pulmonary disease. The team may include a nurse, physician, physical therapist, occupational therapist, nutritionist, pharmacist, respiratory care practitioner, exercise physiologist, psychologist, and, most important, the patient and the patient's family and caregivers.
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Years ago, patients with chronic pulmonary disease were given a standard prescription for rest and avoidance of exercise.2 The stress imposed by exercise was considered deleterious to people with pulmonary disorders. A pivotal study by Pierce et al3 provided the impetus to change direction in the treatment of pulmonary dysfunction. Exercise training effects of decreased heart rate (HR), respiratory rate, minute ventilation, oxygen consumption, and carbon dioxide production at submaximal exercise levels were documented in their subjects with chronic obstructive pulmonary disease (COPD). Increased maximal aerobic capacity was also documented.3 Reconditioning of patients with pulmonary disease was found to be possible.
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COPD, asthma, and cystic fibrosis are the most common chronic obstructive lung diseases for which pulmonary rehabilitation is rendered. Patients with a restrictive lung disease, such as idiopathic pulmonary fibrosis, have also demonstrated improvement in functional abilities following pulmonary rehabilitation.4 It is clear that pulmonary rehabilitation is of value for all patients in whom respiratory symptoms have resulted in a decreased functional capacity or a decreased quality of life.1
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In this chapter, the most common chronic pulmonary diseases that present to pulmonary rehabilitation programs will be discussed, as well as the physical therapy examination and treatment of patients with chronic pulmonary disease. A brief review of ventilation and respiration is warranted for a better understanding of the disease pathologies and for understanding the rationale of the physical therapy procedures.
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RESPIRATORY PHYSIOLOGY
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Air is inspired through the nose or mouth, through all of the conducting airways until it reaches the distal respiratory unit, which contains the respiratory bronchiole, alveolar ducts, alveolar sacs, and alveoli (Fig. 12.1). The movement of air through the conducting airways is ...