breathlessness management-1.pptx.........

Breathlessness management........

1. BREATHLESSNES MANAGEMENT varsha

2. DYSPNEA : American Thoracic Society defined dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.”

3. CAUSES OF DYSPNEA : ☞ Physiologic ☞ Restrictive Pulmonary ☞ Obstructive Pulmonary ☞ Cardiac ☞ Circulatory ☞ Chemical ☞ Neurologic ☞ Psychogenic ☞ Mechanical

4. DYSPNEA ASSESSMENT

5. Gold standard for diagnosis and assessment is patient’s self report Asthma ➜ tightness in the chest Interstitial disease ➜ rapid breathing Congestive heart failure ➜ suffocating COPD ➜ unable to take enough air in

6. History Onset Duration & frequency Aggravating and relieving factors Diurnal variation Positional variation Associated factors Severity Occupational and personal history

7. Standard spirometry and lung volume and capacity measurements Lung volume measurement by plethysmography Gas dilution techniques Assessment of lung function following administration of an inhaled bronchodilator

8. Measurement of gas diffusion Pulse oximetry ( arterial oxygen saturation) Arterial blood sampling ( hypercapnia ) Mixed venous measurement Also incorporation of co-morbidities and psychological status in evaluation

9. In 1952, Fletcher published a 5-point rating scale , which was employed by the Pneumoconiosis Research Unit to rate the impact of dyspnea on activities. A revised version of the scale is now widely known as Medical Research Council (MRC) scale.

10. Baseline Dyspnea Index Transition Dyspnea Index University of California at San Diego Shortness of Breath Questionnaire (UCSDQ) Evaluation of dyspnea during supervised tasks ( cycle ergometry , 6-min walk test) Exercise testing: ventilatory reserve during exercise

11. Dyspnea and Quality of Life The Chronic Respiratory Disease Questionnaire (CRQ) The Saint George Respiratory Questionnaire (SGRQ) The Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ)) The Pulmonary Function Status Scale (PFSS) SF-36

12. Medical Management Opiods – first line of therapy for symptomatic control of dyspnea Anxiolytics – prescribed for anxiety related to dyspnea Oxygen Symptomatic management of the underlying cause.

13. Bronchodilators in case of narrowed airways Antibiotics in case of respiratory infections Anti-inflammatory agents for inflammation in the respiratory tracts Steroids Inhaled β 2 adrenergic agonists Inhaled anti- cholinergics Sustained release theophylline Methylxanthines Resection, chemotherapy, radiotherapy, laser, thoracocentesis and fluid drainage in case of cancer related complications

14. Surgical Interventions for conditions like pleural effusion, pericardial tamponade and endobronchial obstruction. Thoracocentesis , tube thoracostomy or pleuroperitoneal shunts for pleural effusion Pericardial fluid drainage for tamponade . Endobronchial brachytherapy , ablation with laser, cautery and insertion of endobronchial stents for endobronchial obstructions.

15. Reducing lung hyperinflation: surgical volume reduction : Massive bullectomy ( >1/3rd of hemithorax ) and lung volume reduction surgery. CPAP

16. Physiotherapy Management Relaxation Positions to be taught in case of an acute exacerbation to relieve dyspnea . Leaning forward position improve overall inspiratory muscle strength (O’Neil 1983), increase diaphragm recruitment, reduce participation of neck and upper costal muscles in respiration decrease abdominal paradoxical breathing,

17. Relaxation techniques Jacobson’s progressive muscle relaxation techniques Reciprocal relaxation Positioning with hip and knee in flexion for facilitation of the diaphragm and decreasing tension in the abdominal muscles

18. relaxation techniques

19. Breathing Retraining Diaphragmatic breathing to improve inspiration (restrictive lung diseases) Pursed lip breathing to improve expiration (obstructive lung diseases) Segmental breathing in case of decreased hemithorax expansion

20. Diaphragmatic Facilitation Relaxation Repattern techniques to prolong expiration Upper chest inhibition to facilitate diaphragm PNF technique of normal timing Scoop technique at the end of expiration and start of inspiration

21. Postures for improved breathing and better expansion of both the lungs Preferably side lying or quarter-turn to ensure that the good lung is downwards. Use PNF technique timing for emphasis and restrict the good lung thereby facilitating expansion of the affected lung

22. Exercise Training Targeted high-intensity exercise training improves aerobic capacity, thereby decresing exertional dyspnea. Generalised graded exercises involving walking and stair climbing can be used.

23. Desensitization Exposure to greater than usual sensations of dyspnea in a safe environment” Aim: to increase a patient's self-efficacy for coping with a symptom and potentially heighten the perceptual threshold Exercise in safe environment - to overcome apprehension, anxiety, and/or fear associated with exertional dyspnea Exercise training – “the most powerful means of desensitization to dyspnea ”

24. Supplemental Oxygen during exercise Reduction in blood lactate Improves ventilatory muscle function Chest wall vibration to the intercostal muscles reduce dyspnea Low levels of CPAP in acute bronchoconstriction during asthma attack, in patients being weaned off the ventilator and while exercise in patients with advanced COPD.

25. Improving inspiratory muscle strength and endurance. Inspiratory muscle training. Activity pacing and energy conservation. Upper limb assisted thoracic mobility exercise. Nutrition

26. Unsupported limb training

27. Resistance training

28. motivation....

29. Y motivation is important?

30. Education About disease, prognosis, complications, management and its limitations Only for asthma, evidence established self-care strategies is thought to increase the patients' confidence avoiding triggers, symptom monitoring, medication adjustment, recognizing problems as they arise

31. Energy conservation

32. Q O L

33. Subjective relief after training…

34. Thank you