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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