Pulmonary Rehabilitation

PR is a multidisciplinary program that provides persons with the ability to adapt to chronic lung disease.¹ Rehabilitation for patients with chronic lung conditions is well established and widely accepted as a means of alleviating symptoms and optimizing function.² In COPD, PR has been shown to improve dyspnea, exercise capacity, and health-related quality of life, while reducing health care utilization.² When considering PR interventions, the respiratory disorders can be generally characterized as ventilatory disorders (CO₂ retention) or obstructive disorders (oxygen impairment).³

The characteristics of obstructive and restrictive disorders are shown in Table 14-1.

VENTILATORY DISORDERS (RESTRICTIVE OR MECHANICAL DISORDERS)

Caused by

neuromuscular disorders or skeletal disorders
respiratory muscle function decreasing with a decrease in VC, RV, FRC, and TLC (e.g., myopathy, motor neuron disease, myelopathy, MS, and chest wall deformity)⁴

Keys to clinical monitoring include spirometry for VC and max insufflation capacity, peak cough flows, and noninvasive CO₂ monitoring. Expiratory flow should exceed 160 L/min (≈3 L/s) for secretions to be adequately cleared from the airways.³ If these flows cannot be achieved naturally, insufflation followed by a caregiver-provided abdominal thrust (“quad cough”) or use of an insufflator–exsufflator device (CoughAssist,
Respironics) may be beneficial. Invasive suctioning is a less ideal alternative and must be used with caution.⁴ With paralyzed abdominal muscles due to a UMN lesion, cough can be produced by FES.⁴ Positive expiratory pressure mask therapy and autogenic drainage are additional methods to mobilize secretions.⁴ Glossopharyngeal breathing can be used to maximize insufflation and can serve as a backup in the event of ventilator failure.³

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