Introduction

What is Pulmonary Rehabilitation?

Pulmonary rehabilitation, also called pulmonary rehab or PR, is abroad program that helps improve the well-being of people who have chronic (ongoing) breathing problems.

For example, PR may benefit people who have COPD (chronic obstructive pulmonary disease), sarcoidosis, idiopathic pulmonary fibrosis, or cystic fibrosis.

PR also can benefit people who need lung surgery, both before and after the surgery

What Are The Components Of Pr?

PR doesn’t replace medical therapy. Instead, it’s use with medical therapy and may include:

• Exercise training
• Nutrition counseling
• Education on your lung disease or condition and how to manage it
• Energy-conserving techniques
• Breathing strategies
• Psychological counseling and/or group support

PR involves a long-term commitment from the patient and a team of health care providers. The PR team may include doctors, nurses, and specialists. Examples of specialists include respiratory therapists, physical and occupational therapists, dietitians or nutritionists, and psychologists or social workers.

PR often in an outpatient program based in a hospital or clinic. Some patients also can receive PR in their homes.

When you start PR, your rehab team will create a plan that’s tailored to your abilities and needs. You’ll likely attend your PR program weekly. Your team also will expect you to follow your plan, including exercises and lifestyle changes, at home.

PR has many benefits. It can improve your ability to function and your quality of life. The program also may help relieve your breathing problems. Even if you have advanced lung disease, you can still benefit from PR.

Who Needs Pulmonary Rehabilitation

Your doctor may recommend pulmonary rehabilitation (PR) if you have chronic (ongoing) lung disease. He or she also may suggest PR if you have a condition that makes it hard for you to breathe and limits your activities.

For example, you may benefit from PR if you have:

• COPD (chronic obstructive pulmonary disease). COPD includes emphysema and chronic bronchitis. The symptoms of COPD include coughing (either a dry cough or a cough that expels phlegm or mucus from your airways), wheezing, shortness of breath, chest tightness and other symptoms.
• An interstitial lung disease. This type of disease causes scarring of the lung tissue over time. This can lead to coughing, shortness of breath, and other symptoms. Examples of interstitial lung diseases include sarcoidosis and idiopathic pulmonary fibrosis.

Your doctor also may recommend PR before and after lung surgery to help you prepare for and recover from the surgery. For example, people who have surgery for lung cancer or COPD may benefit from PR.

PR also can help people who have muscle-wasting disorders that may affect the muscles used for breathing. One example of this type of disorder is muscular dystrophy.

What to Expect Before PR

When you first start PR, your team of health care providers will want to learn more about health. For example, they’ll want to know how well you’re able to breathe and exercise. You’ll have lung functions tests to check your breathing. These tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.

Your team can check your ability to exercise several ways. They may measure how far you can walk in 6 minutes (called a 6-minute walk test). Or, they may ask you to exercise on a treadmill while your oxygen level, blood pressure, and heart rate are measured.

Your PR team also will review your medical therapy to see whether it needs to be changed during the PR program. For example, you may need to start using, or increase the use of, inhaled bronchodilators. These medications can help you breathe easier during exercise. You also may need oxygen therapy to help you get the most of your exercise plan.

Your PR team may assess your mental health. If you have anxiety or a very depressed, they may refer you to a specialist who can treat these issues.

In addition, the team may measure your weight and height, ask about your food intake andgeneral nutrition, height, ask about your food intake and general nutrition, and recommend a blood test to assess loss of muscle mass.

The data your PR team gathers at the start of your program will help them create a plan that’s tailored to your abilities and needs.

What to Expect During PR

PR can have many parts, and not all programs offer every part. PR programs may include:

• Exercise training
• Nutritional counseling
• Education on your lung disease or condition and how to manage it
• Energy-conserving techniques
• Breathing strategies
• Psychological counseling and/ or group support

• Exercise training
  Your PR team will give you a physical activity tailored to your needs. They’ll design the plan to improve your endurance and muscle strength, so you’re better able to carry out daily activities.
  The plan will likely include exercises for both your arms and legs. You might used a treadmill, stationary bike, or weights to do your exercises.
  If you can’t handle long exercise sessions, your plan may involve several short sessions with rest breaks in between. While you exercise, your team may check your blood oxygen levels with a device that’s attached to your finger.
  You’ll probably have to do your exercises at least three times a week to get the most benefits from them.

• Nutritional counseling
  The data your PR team gathers when you start the PR program will show whether you’re overweight or underweight. Both of these conditions can make it hard for you to breathe.
  If you’re overweight, fat around your waist can push against your diaphragm ( a muscle that helps you breathe). This will give your lungs less rom to expand during breathing. Your team may recommend a healthy eating plan to help you lose weight.
  You also can have breathing problems if you’re underweight. Some people who have chronig (ongoing) lung diseases have trouble maintaining weight. If you lose too much weight, you can lose muscle mass. This can weaken the muscles used for breathing.
  If you’re underweight, your team may recommend healthy eating plan to help you gain weight. They also may give you calorie and protein supplements to help you avoid weght loss and loss of muscle mass.

• Education on your lung disease or condition and how to manage it
  Part of PR involve learning about your disease or condition and how to manage it (including how to avoid situations that worsen symptoms). Your symptoms may get worse if you have a respiratory infection or breathe in lung irritants, such as cigarette smoke or air pollution.
  Your PR team will teach you about the importance of vaccinations and other ways to prevent infections. If you smoke, you’ll be offered a program to help you quit.
  Part of PR education is making sure you know when and how to take your medications. Your PR team will teach you how to use inhalers and nebulizers if you need them to take your medicine. They also will show you how to use oxygen. If you’re getting oxygen therapy.
  In addition, your PR team will help you create a self-management plan. This plan will explain what you should do if your symptoms get worse or you have signs of a respiratory infection.
  The self-management plan will describe what you can do on your own to relieve symptoms. It also will explain when you should contact your doctor or seek emergency care.
  Most PR programs last a few months. To fully benefit from your program, you’ll be taught how to use the exercises, breathing strategies, and other lifestyle changes you learn in PR at home. This also will be part of your self-management plan.

• Energy-conserving techniques
  One way to help prevent symptoms like shortness of breath is to find easier ways to do daily tasks. PR programs often give you tips on how you can conserve your energy and breathe easier.
  These tips include ways to avoid reaching, lifting, and bending. Such movements use energy and tighten your abdominal muscle, making it harder for you to breathe.
  Stress also can use up energy and make you short of breath. Many PR programs teach relaxations skills and ways to avoid or relieve stress.

• Breathing strategies
  While in PR, you’ll learn strategies that can improve your breathing. For example, you may learn how to take longer, deeper, less frequent breaths. One example of this type of exercise is pursed-lip breathing.
  Pursed-lip breathing decreases how often you take breaths and keeps your airways open longer. This allows more air to flow in and out of your lungs so you can be more physically active.
  Other breathing strategies involve positioning your body so your lungs can expand the most when you breathe in. You also may learn how to use your abdominal muscles to more effectively breathe out.
  Techniques to expel mucus from your lungs is also taught.

• Psychological counseling and/ or group support
  People who have chronic lung diseases are more prone to depression, anxiety and other emotional problems. Thus many PR programs offer counseling or support groups.

What To Expect After PR

Most PR programs last a few months. At the end of your program, you’ll undergo tests and answer questions. Some of these tests, such as exercise tests, will be the same ones you had at the start of your program.

The data gathered at the end of the program will show whether your symptoms, physical activity level, and quality of life have improved. If they have, your team will encourage you to continue your exercises, breathing strategies, and other prescribed changed on your own.

If you have little to no improvement, talk with your doctor. He or she might want to change your medical therapy. Or, your doctor might recommend another condition that also may have to be treated to improve your breathing.