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Exercise and Pulmonary Rehabilitation in Children with Chronic Lung Diseases

Exercise and Pulmonary Rehabilitation in Children with Chronic Lung Diseases. Suchada Sritippayawan, MD. Somjitr Tongkam, BSc Chanthana Harnruthakorn, BSc. What is Chronic lung disease?. CLD of prematurity Prolonged MV use Chronic aspiration Chronic infection Bronchiectasis

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Exercise and Pulmonary Rehabilitation in Children with Chronic Lung Diseases

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  1. Exercise and Pulmonary Rehabilitation in Children with Chronic Lung Diseases Suchada Sritippayawan, MD. Somjitr Tongkam, BSc Chanthana Harnruthakorn, BSc.

  2. What is Chronic lung disease? • CLD of prematurity • Prolonged MV use • Chronic aspiration • Chronic infection • Bronchiectasis • Chronic ILD • Asthma • etc.

  3. 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%

  4. 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%

  5. 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

  6. Exercise limitation in CLD CLD Ventilatory impairment Circulatory impairment Malnutrition  Oxidative capacity of muscles  O2 delivery & CO2 excretion Exercise limitation ( Aerobic capacity)

  7. 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

  8. Exercise capacity in CLD PFT at rest ≠ Exercise capacity • Exercise test is helpful in identifying • pulmonary limitation during exercise • optimal level of exercise

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

  10. Synonyms of exercise stress test: • Cardiopulmonary exercise test • Graded exercise test

  11. Maximum O2 consumption (VO2max) Exercise test VO2 VCO2/VO2>1 Work load

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

  13. 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

  14. Contraindications to exercise testing Relative contraindications - severe left ventricular outflow obs. - severe right ventricular outflow obs. - congestive heart failure - severe mitral stenosis

  15. Lab equipment • Ergometers • Respiratory and metabolic/gas equipment • Monitoring : EKG, HR, SpO2, BP

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