NAME: Khadija Shahbaz

REGISTRATION NO: DPT70042807

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A 70 year ………………….. saturation.

Describe a comprehensive physiotherapy and rehabilitation

management plan for the patient.

 Treatment in early stage

Increasing/maintaining exercise tolerance
Advice should be given on taking regular exercises, for example a short walk every
day.
There is now unequivocal evidence to suggest that pulmonary rehabilitation
improves both exercise capacity and health-related quality of life. Pulmonary
rehabilitation programme include aerobic exercise training, education about the
background of the disease, smoking cessation, compliance with medication,
nutritional support and energy-conserving strategies for activities of daily living
(ADLs). Pulmonary rehabilitation programmes may also include psychosocial
support with regard to advice on benefits, sexual function and anxiety management.

Threshold IMT provides consistent and specific pressure for inspiratory muscle
strength and endurance training, regardless of how quickly or slowly patients
breathe. This device incorporates a flow-independent one-way valve to ensure
consistent resistance and features an adjustable specific pressure setting (in cm
H2O) to be set by a healthcare professional.

Inspiratory Muscle technique

The potential for fatigue of the ventilatory muscles is now recognised as an
important component of ventilatory limitation in patients with COPD.
Fatigue may be caused by a combination of:
• increased mechanical load on the respiratory Muscles.
• reduced muscle strength;
• reduced energy supply to the respiratory muscles

Techniques, which might specifically target the respiratory muscles, may prove
beneficial in improving exercise tolerance in patients with COPD who may develop
respiratory muscle weakness because of a loss of muscle mass.

Removal of secretions
The active cycle of breathing technique (ACBT)
This is a cycle of breathing control, thoracic expansion exercises and the forced
expiratory technique (FET), and has been shown to be effective in the clearance of
bronchial secretions and to improve lung function.

Thoracic expansion exercises are deep breathing exercises which may be

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combined with a three second hold on inspiration. This increase in lung volume
allows air to flow via collateral channels and may assist in mobilising the secretions
as air is able to get behind the secretions. The increase in lung volume during the
inspiratory phase of the cycle may also be achieved by the patient performing a
‘sniff’ manoeuvre at the end of a deep inspiration. Manual techniques, for example
shaking, vibrations or chest clapping, may further aid in removal of secretions. The
FET manoeuvre is a combination of one or two forced expirations (huffs) against
an open glottis (as opposed to a cough, which is a forced expiration against a closed
glottis).

Postural drainage/positioning
This may also aid sputum removal and may be combined with the ACBT technique.
ACBT alone may be effective for many in the seated position and changes in
position should be used to optimise gaseous exchange. In the lateral position, the
lower lung is always better ventilated, regardless of the side on which the subject is
lying, although there still remains a bias in favour of the right side because of its
larger size when compared with the left lung. Perfusion is also preferential to the
lower lung in the lateral position in the spontaneously breathing person, although if
pathology exists within the lowermost lung gaseous exchange may be compromised
because of the presence of pulmonary hypoxic vasoconstriction, which cannot be
overcome by gravity.

Humidification
If the secretions are very thick and tenacious the patient may be given
humidification via a nebuliser, usually nebulised saline.

Improving the breathing pattern

The patient is taught how to relax the shoulder girdle in a supported posturally
correct position, such as crook half lying. Breathing control is taught following
clearance of secretions. If the patient is breathless, respiratory control is regained
starting with short respiratory phases and allowing the rate to slow as the patient’s
breathing pattern improves.

 Treatment in the later stages

It is imperative that patients with COPD are able to maintain as much independence
and maximum function as is possible through the support from the hospital or
community healthcare team. During acute exacerbations, the ACBT may be
continued to assist clearance of secretions.

Non-invasive positive-pressure ventilation

Tracheal intubation and mechanical ventilation providing intermittent positive-
pressure ventilation (IPPV) is used in intensive care units or high-dependency units
to manage patients with deteriorating respiratory failure. However, tracheal
intubation may result in complications, including tracheal injury and infection.
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Furthermore, it may be difficult to wean these patients off IPPV, resulting in a
prolonged stay in intensive care.

NIV may be used to assist sputum clearance but, if unavailable, intermittent

positive-pressure breathing (IPPB) may also be given to assist sputum mobilisation.
Suction via an airway or nasal suction may have to be used as a last resort to remove
secretions if the patient is unable to cough spontaneously or effectively.

Terminal care
The main theme is to keep the patient as comfortable as possible. Treatment needs
to be short and frequent.