Download Exercise and Pulmonary Rehabilitation in Children with

Exercise and Pulmonary
Rehabilitation in Children
with Chronic Lung Diseases
Suchada Sritippayawan, MD.
Somjitr Tongkam, BSc
Chanthana Harnruthakorn, BSc.
What is Chronic lung disease?
• CLD of prematurity
• Prolonged MV use
• Chronic aspiration
• Chronic infection
• Bronchiectasis
• Chronic ILD
• Asthma
• etc.
CLD: Burden of the disease
Jan – Dec 2006
Out-patient service
- 464/1,095 visits (42%)
- 116 cases
- Chronic aspiration 42 cases
- BPD 39 cases
- Others 35 cases
- 20% on home oxygen therapy
- 2% on home ventilator
70%
CLD: Burden of the disease
Jan – Dec 2006
In-patient service
- 246/3,800 admissions (6.5%)
- 246 cases
- Chronic aspiration 91 cases
- BPD 34 cases
50%
- Others 121 cases
- Median age 1.3 yrs
- Admission rate 2.5/case/yr
- Duration of admission 70 days/case/yr
CLD: Pulmonary function
• Depend on underlying disease
• BPD – obstructive, air trapping, BHR
• Bronchiectasis
- Mixed obstructive/restrictive, BHR
- Not related to CT findings
• ILD
- Restrictive
- Diffusion defect
Exercise limitation in CLD
CLD
Ventilatory
impairment
Circulatory
impairment
 O2 delivery & CO2
excretion
Malnutrition
 Oxidative capacity
of muscles
Exercise limitation ( Aerobic capacity)
CLD
Airway problems
• Hypersecretion
• Bronchospasm
• Collapsed airway
• Ineffective cough
• Retained secretion
• Exercise limitation
Lung mechanic Chest wall mechanic
problems
problems
• Restrictive
• Hyperinflation
• Atelectasis
• Recurrent pneumonia
Pulmonary rehabilitation
& Exercise training
Exercise capacity in CLD
PFT at rest ≠ Exercise capacity
Exercise test is helpful in identifying
• pulmonary limitation during exercise
• optimal level of exercise
Question #1
How to assess exercise capacity in
children with CLD?
Synonyms of exercise stress test:
- Cardiopulmonary
exercise test
- Graded exercise
test
Exercise test
Maximum O2 consumption
(VO2max)
VO2
VCO2/VO2>1
Work load
Indications for exercise testing
• Clinical assessment
- symptoms or signs induced by exercise
- medical or surgical interventions
- baseline data of rehabilitation programs
• Aerobic fitness evaluation
Contraindications to exercise testing
Absolute contraindications
- active inflammatory heart disease
- active hepatitis
- acute myocardial infarction
- active pneumonia
- severe systemic hypertension
- acute orthopedic injury to an exercise
muscle group
Contraindications to exercise testing
Relative contraindications
- severe left ventricular outflow obs.
- severe right ventricular outflow obs.
- congestive heart failure
- severe mitral stenosis
Lab equipment
• Ergometers
• Respiratory and metabolic/gas equipment
• Monitoring : EKG, HR, SpO2, BP