Physiotherapy management of chronic obstructive pulmonary disease ppt by Oluwadamilare Akinwande

Physiotherapy Management of COPD ppt

1. PHYSIOTHERAPY MANAGEMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PRESENTED BY OLUWADAMILARE JOSHUA AKINWANDE (PT) AT PHYSIOTHERAPY DEPARTMENT IN STATE HOSPITAL, ABEOKUTA

2. OUTLINES INTRODUCTION EPIDEMIOLOGY PATHOPHYSIOLOGY RISK FACTORS CLINICAL FEATURES PHYSICAL EXAMINATION,IMAGING, LAB TESTS AND DIAGNOSIS STAGES DIFFERENTIAL DIAGNOSIS MEDICAL MANAGEMENT PHYSIOTHERAPY MANAGEMENT/PULMONARY REHABILITATION SURGICAL MANAGEMENT CONCLUSION REFERENCES

3. INTRODUCTION Chronic obstructive pulmonary disease (COPD) is an umbrella term which is used to describe a group of airways diseases (chronic bronchitis and emphysema) that are not fully reversible ( Khachi , Barnes & Antoniou, 2010) . It is a progressive disease ( Khachi et al., 2010). Chronic bronchitis is defined as the presence of chronic productive cough for at least 3 months in each of two consecutive years in a patient in whom other causes of chronic cough have been excluded (American Thoracic Society [ATS], 1995). Emphysema is a pulmonary disease defined as abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis (ATS, 1995).

4. EPIDEMIOLOGY COPD is a common pulmonary disease worldwide. Globally, COPD is a major cause of chronic morbidity and mortality. Its economic and social burden is substantial ( Schermer et al., 2008).

5. PATHOPHYSIOLOGY An inflammatory process tends to occur in the bronchi in response to inhaled irritants. This usually results in accumulation and hypersecretion of mucous-secreting glands in the bronchial tree. This results in chronic bronchitis, provided it occurs for a minimum of 3 months in each of two successive years ( Khachi et al., 2010). A pathological process that involves progressive and destructive enlargement of the bronchioles, alveolar ducts and the alveoli usually results in emphysema ( Khachi et al., 2010). In summary, the classic airflow obstruction in COPD is caused by disease of the small airways. This is partly due to the effects of inflammation in those airways and in part to the loss of alveolar attachment to the bronchioles that accompanies the destructive changes of emphysema (ATS, 1995).

6. RISK FACTORS The risk factors for COPD are ; Tobacco smoking Indoor air pollution Occupational dusts and chemicals Genetics and Socioeconomic status (ATS, 1995 ; Khachi et al., 2010 ; Schermer et al., 2008).

7. CLINICAL FEATURES COPD is characterized basically by the presence of breathlessness(dyspnea), chronic cough and sputum production ( Khachi et al., 2010 ). It is worth noting that the early stages of COPD are commonly asymptomatic and it is not until affected individuals experience significant limitation that they seek medical advice ( Khachi et al., 2010 ). In the later stages of COPD, the impairment of gas diffusion can result in hypoxemia, hypercapnia and pulmonary hypertension with resultant increased right-ventricular pressure and subsequent cor pulmonale . Other symptoms of COPD include wheeze and chest tightness which can occur at any stage of COPD, though they tend to occur in severe COPD ( Khachi et al., 2010 ).

8. PICTORIAL REPRESENTATION OF COPD CLINICAL FEATURES

9. PHYSICAL EXAMINATION This involves checking for the following; airflow obstruction which is evidenced by wheezes during auscultation on slow or forced breathing likewise prolongation of forced expiratory time. emphysema which is indicated by hyperinflation of the lungs, increase in anteroposterior diameter of the chest, limited diaphragmatic motion and decreased intensity of heart and breath sounds. compensatory breathing mechanisms such as the use of accessory respiratory muscles, assuming an unusual position to relieve breathlessness, exhaling through a pursed lip likewise indrawing of the lower interspaces (ATS, 1995).

10. IMAGING AND LABORATORY TESTS Chest radiography help in the detection of severe emphysema and essentially help to rule out other lung diseases. Spirometry is important to ascertain the presence and the severity of airflow obstruction along the airways. Lung volumes and arterial blood gases measurements (ATS, 1995).

11. DIAGNOSIS The diagnosis of COPD usually take into account the following factors; age affected individual’s medical history and manifestation of the features of COPD exposure to risk factors result of chest examination r esult of spirometry with reverence to the forced expiratory volume in one second(FEV 1 ), forced vital capacity (FVC) and the ratio of FEV 1 to FVC. A post-bronchodilator FEV 1 / FVC ratio <0.7 confirms the presence of COPD ( Khachi et al., 2010 ).

12. STAGES OF COPD According to the National Institute for Health and Clinical Excellence [NICE] and the Global Initiative for Chronic Obstructive Lung Disease [GOLD] , patients with a post-bronchodilator FEV 1 / FVC ratio < 0.7 can be classified as follows; FEV 1 ≥ 80% ; Stage 1(Mild) FEV 1 50-79% ; Stage 2 (Moderate) FEV 1 30-49% ; Stage 3 (Severe) FEV 1 <30% ; Stage 4 (Very Severe) (GOLD, 2020 ; NICE, 2010).

13. DIFFERENTIAL DIAGNOSIS Asthma: Though COPD and asthma may present with some overlapping symptoms, they can be distinguished from one another based on the patient’s history, exposure to risk factors and spirometry results. Reversibility testing using an inhaled bronchodilator can help to distinguish between COPD and asthma ( Khachi et al., 2010 ).

14. MEDICAL MANAGEMENT This encompasses the use of inhaled bronchodilators and corticosteroids to manage COPD symptomatically. It also incorporates vaccination (such as pneumococcal and influenza) to alleviate severe illness and reduce mortality in COPD patients ( Schermer et al., 2008).

15. PHYSIOTHERAPY MANAGEMENT This is involved during the acute exacerbation of COPD. The aims of physiotherapy for acute exacerbation are; to reduce work of breathing t o control shortness of breath t o assist in the reduction of viscosity and removal of secretions to facilitate accessory muscles of respiration (Holland, 2014 ; Mikelsons , 2008 ; Solomen , 2019).

16. These aims can be achieved via; positioning o xygen therapy p ursed lip breathing e lectrical stimulation hydration, humidification and nebulization modified postural drainage, huffing and active cycle of breathing techniques s upported arm exercise, forward leaning and anterior pelvic tilt ( Holland, 2014 ; Mikelsons, 2008 ; Solomen, 2019).

17. Physiotherapy management is involved at the time of discharge of a COPD patient to minimize the future risk of disease progression. This aim can be achieved via; exercise prescription for home exercise programme s moking cessation programme ( Solomen , 2019).

18. Physiotherapy management is also involved in the stable phase of a COPD patient. The aims are; to inhibit accessory respiratory muscles t o strengthen the inspiratory muscles t o increase chest expansion and thorax mobility t o improve the patient breathing pattern t o prevent exacerbation and t o reduce energy demand ( Solomen , 2019).

19. These aims can be achieved through; p ositioning u nsupported arm exercise i nspiratory muscle training d iaphragmatic breathing i ncentive spirometry pursed lip breathing Innocenti technique endurance training s trength training and f lexibility training and p ostural correction exercise ( Solomen , 2019).

20. PHYSIOTHERAPY AS A COMPONENT OF PULMONARY REHABILITATION Pulmonary rehabilitation is defined as a “comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to , exercise training, education and behaviour change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors,” (Zeng, Jiang, Chen, Chen & Cai , 2018). It is a multidisciplinary approach that aims to optimize COPD patients’ functional capacity and empower management and coping strategies ( Mikelsons , 2008).

21. Ample bodies of evidence currently support the use of pulmonary rehabilitation in the treatment of patients with COPD, with many randomised controlled trials describing its potential benefits which include: improved exercise capacity, increased quality of life, enhanced patients’ sense of control over their condition , improved emotional function, improved dyspnea and fatigue, increased functional outcomes, reduced length of hospital stay and number of hospitalizations, reduction in primary care consultations and survival benefit ( Mikelsons , 2008 ; Zeng et al., 2018). Pulmonary rehabilitation is indicated in all stages of COPD.

22. Physiotherapists play an integral role in the assessment, exercise and education components of pulmonary rehabilitation ( Mikelsons , 2008). The assessment of all body systems by a physiotherapist will help to identify key priorities for treatment. These may include airway clearance in the presence of sputum and determine the type and level of physical activity appropriate, given the clinical picture of the patient ( Mikelsons , 2008). Exercise training (which can be prescribed by physiotherapists) is regarded as the cornerstone of pulmonary rehabilitation (Zeng, et al., 2018).

23. SURGICAL MANAGEMENT This may be necessary in severe conditions where symptoms are not controlled by the aforesaid managements/interventions. It can also be necessitated when it may improve a COPD patient’s quality of life. This may be achieved via; b ullectomy l ung volume reduction surgery or l ung transplantation (Rees, 2020).

24. CONCLUSION COPD is a progressive and an incurable respiratory disease which can be managed symptomatically via pharmacological and non-pharmacological approaches. The role of physiotherapy management cuts across all aspects of the care of COPD patients in both primary and acute care settings. Pulmonary rehabilitation is helpful in the enhancement of the physical and psychological conditions of COPD patients.

25. REFERENCES American Thoracic Society. (1995). COPD: Definitions, epidemiology, pathophysiology, diagnosis and staging. American Journal of Respiratory and Critical Care Medicine , 152 . Global Initiative for Chronic Obstructive Lung Disease. (2020). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease . Retrieved from https://goldcopd.org/ Holland, A. E. (2014). Physiotherapy management of acute exacerbations of chronic obstructive pulmonary disease. Journal of Physiotherapy, 60 , 181–188. Khachi , H., Barnes, N., & Antoniou, S. (2010). COPD clinical features and diagnosis. Clinical Pharmacist , 2 . Mikelsons , C. (2008). The role of physiotherapy in the management of COPD. Respiratory Medicine , 4 , 2–7.

26. National Institute for Health and Clinical Excellence. (2010). Management of chronic obstructive pulmonary disease in adults in primary and secondary care. Retrieved from https:// www.nice.org.uk Rees, M. (2020). COPD stages and their symptoms . Retrieved from https://www.medicalnewstoday.com/articles/copd-stages Schermer , T., van Weel , C., Barten , F., Buffels , J., Chavannes, N., Kardas , P., … Yaman , H. (2008). Prevention and management of chronic obstructive pulmonary disease (COPD) in primary care: Position paper of the European Forum for Primary Care. Quality in Primary Care , 16 , 363–77. Solomen , S. (2019). Guidelines for the physiotherapy management of chronic obstructive pulmonary disease. Physiother ‑ J Indian Assoc Physiother , 13 , 66 ‑ 72 . Zeng, Y., Jiang, F., Chen, Y., Chen, P., & Cai , S. (2018). Exercise assessments and trainings of pulmonary rehabilitation in COPD: A literature review. International Journal of COPD , 13 , 2013–2023.