4. Understanding the definition
…a multidisciplinary program of care for patients
with chronic respiratory impairment…
Together we can educate and
assist people with chronic
respiratory impairment to be
more functional and increase
their quality of life.
Rehabilitation Systems has
developed a pulmonary
rehabilitation program that
encompasses physical therapy,
occupational therapy, nursing,
and physician disciplines.
6. Expected Outcomes of
Pulmonary Rehabilitation
Pulmonary rehabilitation does not reverse nor have any direct effect on the primary respiratory
pathophysiology, yet it has proven to improve the following:
• Reduce respiratory symptoms (e.g., dyspnea, and fatigue)
• Increase exercise preformance
• Increase knowledge about pulmonary disease and its management
• Improve health‐related quality of life
• Improved psychosocial symptoms (e.g., reversal of anxiety and depression, increased self‐efficacy)
• Reduced hospitalizations and use of medical resources
• Return to work for some patients
7. The Burden of Chronic Respiratory Disease
Heart Stroke Other COPD
Disease CVD All other diseases
3.0
2.5
2.0
1.5 1965
1.0 1998
0.5
0.0
% change in age‐adjusted death rates in US
This chart shows that although heart disease is still the number one cause of
death in the U.S., all other causes of death have decreased since 1965, yet
COPD has continued to increase.
9. How does this affect healthcare?
Emergency
Physician Office
Department Hospitalizations
Visits in 2000
Visits
8 1.5
726,000
million million
10. COPD Will Cost U.S. $800+ Billion Over
Next 20 Years, Study Predicts
SAN DIEGO—Over the next 20 years, medical costs related to chronic obstructive
pulmonary disease (COPD) will total approximately $832.9 billion in the United
States, according to a study to be presented at the American Thoracic Society
International Conference on May 22nd.
The study, which used a mathematical model to estimate future costs related to
COPD, found that the disease will cost $176.6 billion in the U.S. over the next five
years, and $389.2 billion over the next 10 years. The study is part of the Burden of
Obstructive Lung Disease (BOLD) initiative, which is designed to examine the
prevalence and burden of COPD around the world.
Retrieved August 8, 2009, from http://www.thoracic.org/sections/publications/press‐
releases/conference/articles/2006/press‐releases/copd‐will‐cost‐us‐800‐billion‐over‐next‐20‐years‐study‐
predicts.html
11. Who will pay these medical costs?
s
Y p
o
o u
u s
e
c c
h h
i i
l l
d d
The impact of chronic respiratory disease is not just an economic or
epidemiological statistic. Its effect on patients’ and their families’ quality of
life is tremendous. The cost of lung disease in terms of lives affected is
enormous.
12. YOU CAN
Make a difference!
Scope for Pulmonary Rehabilitation
Specialists:
•Practice medically acceptable methods of
pulmonary rehabilitation
•Increase and improve your knowledge and
expertise in pulmonary rehabilitation
•Share information with patients that will
improve their outcomes
•Provide pulmonary rehabilitation to patients
regardless of social, cultural, economic,
personal, or religious beliefs
•Keep all patient information confidential
•Strive for early prevention and detection of
respiratory disease
14. Candidates for
Pulmonary Rehabilitation
•Any person with a history of smoking
•Any person with a family history of lung disease
•Any person with a history of occupational or environmental exposure
•Any person with symptoms of cough and mucus production
Let’s examine these individually.
15. Any person with a history of smoking
Smoking is the number one cause of lung disease. The development
of this disease can occur over 20‐30 years. Even though the mean life
expectancy in the United States, which was 77.2 years in 2001,
continues to increase, people with advanced lung disease will not
have this favorable prognosis.
(Guidelines for Pulmonary Rehabilitation Programs, Third Edition)
Smoking cessation is a vital component of pulmonary rehabilitation. If you seek only
to treat the symptoms, and not the cause, you will disserve the person needing
rehabilitation.
If you are a smoker yourself, now is the best time to quit. You will have a greater
understanding of the process and can support the patient trying to stop.
If you choose to continue smoking and still want to work with pulmonary patients
you should recognize that the smell of smoke may trigger those who have quit to
begin again.
16. Any person with a family history
of lung disease
Alpha‐1 Antitrypsin deficiency poses a genetic predisposition to
developing lung disease, even in the absence of smoking.
A history of lung cancer in any family member is associated with
an increased cancer risk.
A family history of chronic bronchitis and pneumonia is also
associated with an increased risk of developing a lung disease.
Gao Y, Goldstein AM, Consonni D, Pesatori AC, Wacholder S, Tucker MA, Caporaso NE,
Goldin L, Landi MT. Family history of cancer and nonmalignant lung diseases as risk
factors for lung cancer. Retrieved August 8, 2009, from
http://www.ncbi.nlm.nih.gov/pubmed/19350630.
17. Any person with a history of occupational
or environmental exposure
Occupational and environmental exposures can cause lung disease
whether or not the person is exposed to cigarette smoke.
The most common occupational exposures:
•Occupational lung cancer
•Occupational asthma
•Asbestosis
•Mesothelioma
•Byssinosis (brown lung disease)
•Coal workers' pneumoconiosis (black lung disease)
•Silicosis
•Hypersensitivity pneumonitis
Occupational lung disease is the number one work‐related illness in the
United States based on the frequency, severity, and preventability of
diseases.
National Institute for Occupational Safety and Health. Work-Related Lung Disease Surveillance Report.
December 2002. Retrieved August 8, 2009 from
http://www.lungusa.org/site/apps/nlnet/content3.aspx?c=dvLUK9O0E&b=4294229&ct=3052555
18. Any person with symptoms of cough and
mucus production
•Any person with a family history of lung disease
•Any person with a history of occupational or environmental exposure
22. Ten Goals to Incorporate
1. Integrate prevention and long‐term adherence into the patient’s treatment plan
2. Design and implement an individualized therapeutic treatment plan (e.g.,
smoking cessation, weight loss or gain)
3. Improve the patient’s and his/her significant other’s quality of life
4. Control alleviate, as much as possible, the symptoms and pathophysiological
complications of respiratory impairment
5. Increase strength, endurance, and exercise tolerance
6. Decrease psychological symptoms such as anxiety or depression
7. Increase the patient’s long‐term adherence with the medical and rehabilitation
therapeutic treatment plan
8. Train, motivate, and rehabilitate the patient to his or her maximum potential in
self‐care
9. Train, motivate, and involve the patient’s significant other in the treatment plan
10. Reduce the economic burden of pulmonary disease on society through a reduction
of acute exacerbations, hospitalizations, lengths of stay, emergency room visits,
and long‐term convalescence
