2. Interstitial Lung Disease
• Broad category of lung diseases
• Illness effecting the lung parenchyma
ILD of known cause or
association
ILD of unknown
cause
EXPOSURES SYSTEMIC DISEASE IIP
RB-ILD CTD IPF
DIP Sarcoidosis NSIP
HP LAM COP
Medications LIP
Radiation
Occupation
3. • The delicate balance between the capillaries
and the alveolar space is disrupted and the
lung is permanently damaged with increase
interstitial tissue replacing the normal
capillaries , alveoli and healthy interstitium.
• Impairment in lung physiology
• Work of breathing is increased
• Increased exercise intolerance
4. ILD: Clinical Problem
• Dyspnoea on exertion
• Reduced functional capacity
• Reduced quality of life
• Fatigue
• Weakness
• Immuno-supressed
6. The goals of pulmonary rehabilitation are to
improve quality of life by:
• Decreasing respiratory symptoms and
complications
• Encouraging self management and control
over daily functioning
• Improving physical conditioning and exercise
performance
• Improving emotional well being
• Reducing hospitalizations
7. Patient Education
• Normal pulmonary anatomy and physiology
• Pathophysiology of chronic respiratory
disease
• Interpretation of medical testing
• Breathing strategies
• Role of medications, including oxygen
therapy
• Effective use of respiratory devices
• Benefits of exercise and physical activities
• Energy conservation during activities of daily
living
• Healthy food intake
• Irritant avoidance
8. Exercise
Strengthen essential muscle groups [steroid
related muscle weakness],Improve overall
O2 use, Enhance bodies cardiovascular
response to physical activity
• Lower Extremity Exercises
• Walking exercise
• Upper extremity Exercises
• Ventilatory Muscle training
9. Warm Up
• reduces the stress on the heart and muscles, helps
improve flexibility and reduce muscle soreness.
Conditioning
phase
• intensity of the activity is measured by checking
the heart rate
Cool-down
phase
• the last phase of exercise session. It allows your body to
gradually recover from the conditioning phase. The heart
rate and blood pressure returns to near resting values
10. Six Minute Walk Test
• Measures the distance an individual is able to
walk over a total of six minutes on a hard, flat
surface
• ATS recommends an indoor, 30 meter corridor
or walkway with cones placed at the
beginning and end of the 30 meter boundary
to indicate turns
• Used in conjunction with VO2 testing (often
using a portable metabolic system which
measures oxygen uptake during exercise).
12. Special Considerations For Exercise In
ILD
• Profound desaturation
• Pulmonary hypertension
• Rate of disease progression
13. Diet
• People with interstitial lung disease often lose weight
due to the discomfort of eating and the extra energy
used to breathe.
• To prevent this, a diet rich in nutrients and containing
appropriate calories is essential.
• By selecting food carefully, eating at appropriate times
and keeping the size of their portions manageable
they can get sufficient nourishment.
• It is much easier to breathe when the stomach is not
completely full so they may find it more comfortable
to eat several small meals throughout the day rather
than two or three larger ones.
• Lighter meals like salads and fruit should be included
14. Oxygen Therapy
• It is recommended that patients with persistent
resting hypoxaemia PaO2 at or below 60mm Hg
with clinical evidence of pH and who are
breathless should be considered for oxygen
therapy at home
• Patients who are not chronically hypoxic but who
are breathless and exhibit desaturation on
exercise (<90%) should be considered for
ambulatory oxygen if improvement in exercise
capacity and/or less breathlessness can be
demonstrated
15. • Intermittent supplemental oxygen for periods
of 10–20 min at a time and delivered by
oxygen cylinder (short burst oxygen therapy)
may relieve breathlessness associated with
hypoxaemia in patients with ILD who do not
require continuous oxygen support or and
ambulatory oxygen.
16. Psychological Counseling
• Psychological indicators are
good predictors of
improvement
• Motivating the patient is one
of the major goals of a
pulmonary rehabilitation
program
• Emotional
disturbances:Depression,
irritable, anxiety
• Counseling and relaxation
therapy
17. Benefits of Pulmonary Rehabilitation
Program
• Improvement in dyspnoea scale and fatigue
• Effective in improving exercise endurance and
the quality of life and in reducing hospital
admissions
