Title: Exercise and Pulmonary Rehabilitation in Children with Chronic Lung Diseases
1Exercise and Pulmonary Rehabilitation in Children
with Chronic Lung Diseases
- Suchada Sritippayawan, MD.
- Somjitr Tongkam, BSc
- Chanthana Harnruthakorn, BSc.
2What is Chronic lung disease?
- CLD of prematurity
- Prolonged MV use
- Chronic aspiration
- Chronic infection
- Bronchiectasis
- Chronic ILD
- Asthma
- etc.
3CLD 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
4CLD 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
5CLD 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
6Exercise limitation in CLD
CLD
Ventilatory impairment
Circulatory impairment
Malnutrition
? Oxidative capacity of muscles
? O2 delivery CO2 excretion
Exercise limitation (? Aerobic capacity)
7CLD
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
8Exercise capacity in CLD
PFT at rest ? Exercise capacity
- Exercise test is helpful in identifying
- pulmonary limitation during exercise
- optimal level of exercise
9Question 1
How to assess exercise capacity in children with
CLD?
10Synonyms of exercise stress test
- Cardiopulmonary exercise test
- Graded exercise test
11Maximum O2 consumption (VO2max)
Exercise test
VO2
VCO2/VO2gt1
Work load
12Indications for exercise testing
- Clinical assessment
- - symptoms or signs induced by exercise
- - medical or surgical interventions
- - baseline data of rehabilitation programs
- Aerobic fitness evaluation
13Contraindications 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
14Contraindications to exercise testing
- Relative contraindications
- - severe left ventricular outflow obs.
- - severe right ventricular outflow obs.
- - congestive heart failure
- - severe mitral stenosis
-
-
15Lab equipment
- Ergometers
- Respiratory and metabolic/gas equipment
- Monitoring EKG, HR, SpO2, BP