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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

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