Pulmonary rehabilitation in an ambulatory group practice setting

Pulmonary Rehabilitation in Patients Undergoing Lung-Volume Reduction Surgery

Chronic obstructive pulmonary disease (COPD) is the most common form of primary pulmonary disability. Few effective treatment options exist for it, but recently, lung-volume reduction surgery (LVRS) has been shown to be effective in selected patients with emphysema. Pulmonary rehabilitation is an integral part of the preparation for and recovery from the procedure and has significant benefit in helping to improve the quality of life and conditioning of patients with COPD who undergo LVRS.

OVERALL ARTICLE OBJECTIVES

(a) To describe the role of pulmonary rehabilitation in LVRS, (b) to understand the components of a comprehensive pulmonary rehabilitation program, and (c) to describe the effects of a pulmonary rehabilitation program.

Effects of psychological well-being, physical status, and social support on oxygen-dependent COPD patients' level of functioning

Thirty oxygen-dependent patients with chronic obstructive pulmonary disease (COPD) participated in a descriptive correlational study in which investigators examined the relationship between oxygen-dependent COPD patients' psychological well-being, physical status, social support, and level of functioning. Lazarus and Folkman's (1984) theory of psychological stress and coping was used to guide the study. Using multiple regression analysis, physical symptoms had the most predictive power in relation to the level of functioning, accounting for 44.3% of the variance. Among the symptoms, dyspnea had the greatest influence on functioning.

Chronic obstructive airway disease. Impact of health education

We conducted a controlled study of the impact of an education program on the health outcomes and perceptions of patients with varying degrees of airway obstruction in two communities. In one community, patients with chronic obstructive airway disease (COAD) were identified, assessed and offered an educational program. In the other community, patients were identified, assessed and advised of the findings only. Patients at both sites were given the same pretest and, one year later, the same posttest. These tests measured physical and social function, and health outcomes (eg, respiratory symptoms, exercise tolerance, mental health), plus patients' health perceptions. Posttest results showed a significant difference between groups on a health perception measure and locus of control, but no difference on health outcomes. We conclude that education programs for COAD are unlikely to improve patients' health status unless they are part of a comprehensive medical program that includes physical reconditioning.

Designing a pulmonary rehabilitation programme

Physiotherapists have an important role to play in the rehabilitation of patients with chronic obstructive pulmonary disease. Individually-tailored programmes including the following components, namely education, exercise, secretion removal, breathing 'training', home programmes, ventilatory muscle training, medications, support systems and counselling can provide subjective and objective benefits for these patients. A primary consideration is to involve patients in the planning, implementation and evaluation of the programme and to encourage them to develop self-help skills. Guidelines for designing a pulmonary rehabilitation programme are outlined,' and pertinent literature reviewed.