Exercise and Pulmonary Rehabilitation in Children with Chronic Lung Diseases

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Exercise and Pulmonary Rehabilitation in Children
with Chronic Lung Diseases

• Suchada Sritippayawan, MD.
• Somjitr Tongkam, BSc
• Chanthana Harnruthakorn, BSc.

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What is Chronic lung disease?

• CLD of prematurity
• Prolonged MV use
• Chronic aspiration
• Chronic infection
• Bronchiectasis
• Chronic ILD
• Asthma
• etc.

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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
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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 - Others 121
cases - Median age 1.3 yrs - Admission rate
2.5/case/yr - Duration of admission 70
days/case/yr
50
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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

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Exercise limitation in CLD
CLD
Ventilatory impairment
Circulatory impairment
Malnutrition
? Oxidative capacity of muscles
? O2 delivery CO2 excretion
Exercise limitation (? Aerobic capacity)
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CLD
Chest wall mechanic problems
Airway problems
Lung mechanic problems

• Hypersecretion
• Bronchospasm
• Collapsed airway

• Restrictive
• Hyperinflation

• Atelectasis
• Recurrent pneumonia

• Ineffective cough
• Retained secretion
• Exercise limitation

Pulmonary rehabilitation Exercise training
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Exercise capacity in CLD
PFT at rest ? Exercise capacity

• Exercise test is helpful in identifying
• pulmonary limitation during exercise
• optimal level of exercise

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Question 1
How to assess exercise capacity in children with
CLD?

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Synonyms of exercise stress test

• Cardiopulmonary exercise test
• Graded exercise test

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Maximum O2 consumption (VO2max)
Exercise test
VO2
VCO2/VO2gt1
Work load
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Indications for exercise testing

• Clinical assessment
• - symptoms or signs induced by exercise
• - medical or surgical interventions
• - baseline data of rehabilitation programs
• Aerobic fitness evaluation

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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

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Contraindications to exercise testing

• Relative contraindications
• - severe left ventricular outflow obs.
• - severe right ventricular outflow obs.
• - congestive heart failure
• - severe mitral stenosis

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Lab equipment

• Ergometers
• Respiratory and metabolic/gas equipment
• Monitoring EKG, HR, SpO2, BP