Pneumological rehabilitation

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The pulmonology rehabilitation as a non-drug therapy of chronic pulmonary diseases aims through a reduction of disease symptoms and to enable an increase in physical performance the person concerned, the greatest possible degree of independence.

Basics

The function of the bronchi and the lung parenchyma can not be improved through exercise , but the function of the striated muscles and the cardiovascular system can . It should be noted that the gas exchange in the lungs is not only guaranteed by the respiratory muscles and the corresponding blood transport, but that a ventilation disorder of the lungs can be worsened by the so-called dynamic hyperinflation ( dynamic overinflation , " air trapping ") during exertion. The cause of this dynamic hyperinflation is to be seen in the fact that COPD patients , for example , cannot simply increase the tidal volume when there is an increased need for oxygen and instead have to react with a (further) increase in the respiratory rate . This also reduces the exhalation time and ultimately overinflates the lungs.

This overinflation of the lungs also leads to a dysfunction of the inspiratory muscles, as the muscle fiber length is shifted towards an unfavorable starting level.

All this means that pneumological rehabilitation must be planned individually for each patient in order to take muscular, cardiovascular and pneumological conditions into account. It also follows that the individual performance of the patient must first be clarified by means of an ergometric assessment in connection with a measurement of the oxygen saturation (especially during exercise).

Indications

Pneumological rehabilitation is indicated for all patients who still have symptoms despite the optimal use of medication. In addition, extensive operations in the chest area are now only performed after prior pneumological rehabilitation.

According to the criteria of evidence-based medicine , certain indications ( evidence class A)

According to experts (evidence class C), pulmonary rehabilitation is also indicated for all other lung diseases with reduced physical performance.

Further indications for pneumological rehabilitation are:

Contraindications

Contraindications are

  • unwillingness or ability to cooperate as well
  • unstable internal diseases with the risk of acute decompensation.

Clarification

Today it is no longer sufficient to use lung function alone as a decision criterion for planning therapeutic measures. It is just as important to collect the following parameters:

Individual measures

  1. Training: Appropriate training of the patient makes it easier to understand the necessity of the following measures and is therefore an effective measure (evidence class A). However, training alone is ineffective.
  2. Diet advice: Underweight goes hand in hand with reduced muscle strength and quality of life, while being overweight increases the burden of daily activities that are already restricted by the shortness of breath. The aim is to build lean muscle mass while reducing fat tissue by a maximum of one kilogram per month.
  3. Respiratory muscle training: The inspiratory muscles required for inhalation are strengthened in a controlled manner. In contrast to the proven benefit of these measures, training the expiratory muscles does not bring any additional benefit.
  4. Endurance training: The prerequisite here is the determination of the optimal heart rate (training frequency), for example using the Karvonen formula
  5. Strength training: Strong thigh muscles, especially with increasing age, equate to an improved quality of life .
  6. Nicotine abstinence: If there is a lack of willingness to abstain from nicotine , a short intervention to quit smoking should be offered, as smoking leads to a significantly faster progression of chronic lung diseases such as COPD and the cessation programs offered take effect (evidence class A).
  7. Respiratory physiotherapy: A key focus here is on expectorant and expectorant measures, as free airways logically reduce the work of breathing (dynamic hyperinflation or "air trapping")

Results

A significant increase in survival time has not yet been clearly demonstrated, although the survival advantage of patients with pneumological rehabilitation for the first two years is stated to be up to 30 percent. In addition, however, the improvement in quality of life and the extent to which people are in need of care play a decisive role.

literature

  • Hartmut Zwick: State of the art: Pneumological rehabilitation . In: Österreichische Ärztezeitung , November 10, 2005
  • S2 guideline : Bronchial asthma of the German Society for Pediatric Rehabilitation and Prevention, AWMF register number 070/002 ( full text ), status 10/2007

Individual evidence

  1. Pneumological rehabilitation in Austria. Retrieved March 28, 2019