Pulmonary rehabilitation helps people suffering from chronic respiratory diseases. Who is recommended pulmonary rehabilitation, what is it, how to get a referral for pulmonary rehabilitation at the National He alth Fund?
Pulmonary rehabilitation is nothing new. It has been practiced in the world for decades and comes from the tradition of the so-called breathing gymnastics, which was used as early as the end of the 19th century, and which in the 1930s was enriched with breathing exercises and other chest physiotherapy procedures (including the so-called respiratory tree toilet). Also in Poland, its seeds were used even before World War II. Patients suffering from "consumption", as tuberculosis was then called, were directed to suburban he alth resorts, where attempts were made to treat this disease with fresh air, saturated with pine oils. Currently, however, pulmonary rehabilitation in Poland looks completely different and is used in different cases.
According to the definition of the National Institute of He alth in the USA, pulmonary rehabilitation is a series of treatments used in patients with chronic respiratory diseases, individually tailored to the needs of a given patient, the purpose of which is to improve their he alth. By reducing the nuisance resulting from the disease, pulmonary rehabilitation is also supposed to improve the physical fitness and mental state, in a word - the quality of life of a chronically ill person.
Contents :
- Pulmonary rehabilitation: for whom?
- Pulmonary rehabilitation: what does it give?
- Pulmonary rehabilitation: what is it?
- Pulmonary rehabilitation: reimbursement from the National He alth Fund
- Pulmonary rehabilitation: contraindications
Pulmonary rehabilitation: for whom?
Patients suffering from chronic respiratory system diseases are directed to pulmonary rehabilitation programs, it is also recommended in the case of any disease that somehow impairs the functioning of the respiratory system. The main indications for pulmonary rehabilitation are:
- chronic obstructive pulmonary disease (COPD),
- cystic fibrosis,
- bronchial asthma,
- interstitial lung tissue diseases (including sarcoidosis,silicosis, fibrosis),
- bronchiectasis,
- diseases and disorders of the chest wall, as well as neuromuscular disorders in this area,
- lung cancer.
However, such rehabilitation is also implemented in other cases that may affect the work of the respiratory system:
- after surgery on the chest (including lung cancer excision, lung transplantation or reduction of their volume),
- and also after surgeries of the upper abdominal cavity, as a result of which the functioning of the respiratory system is impeded.
When a patient requiring pulmonary rehabilitation also suffers from cardiovascular diseases, rehabilitation is also combined with cardiac rehabilitation.
Pulmonary rehabilitation: what does it give?
Pulmonary rehabilitation relieves the symptoms of the disease and, as much as possible, restores the proper functioning of the respiratory system, e.g. reduces the feeling of breathlessness. It also increases physical performance, strength and endurance of muscles, which in turn translates into better mobility.
The patient undergoing pulmonary rehabilitation becomes much better. Many patients emphasize that they regain the ability to function normally and begin to cope with activities that have been difficult until now, such as climbing stairs. This, in turn, translates into an improvement in the comfort of everyday life, and as a consequence, it often also improves the patient's well-being and self-esteem, as well as increases their sense of security and frees them from negative thoughts.
The visible effects of pulmonary rehabilitation, primarily the improvement of the quality of life, also encourage many patients to follow the doctor's recommendations, especially appropriate physical activity. And thanks to the fact that the symptoms of the disease are less onerous and often progress more slowly, it is possible to reduce the frequency of medical visits and hospital stays.
Pulmonary rehabilitation: what is it?
The pulmonary rehabilitation program is selected individually, depending on the patient's condition, as well as his individual needs and the treatment that has been used so far.
Before pulmonary rehabilitation is started, the doctor must comprehensively assess the condition and functions of the respiratory system. To do this, you need to perform a series of tests, including:
- morphology and basic biochemical tests,
- spirometry with reversibility test,
- chest X-ray image,
- assessment of arterial oxygen saturation,
- EKG,
- exercise test.
The patient's body structure and composition (including height, BMI, muscle condition) are also assessed, physical activity is assessed, the risk of diseases and the degree of addiction to smoking are assessed. The doctor also assesses the patient's educational needs and determines his individual preferences and goals related to rehabilitation.
Proper pulmonary rehabilitation has several components:
- physical training,
- education of the patient (and his family or caregivers),
- so-called psychological, social and behavioral intervention (if necessary)
The most important element of pulmonary rehabilitation isphysical training . It is recommended that during its duration the patient maintains the effort at the level of 60-75%. the maximum effort it can achieve. Research has shown that such training significantly improves exercise tolerance. Most pulmonary rehabilitation programs include endurance training that takes place two to five times a week and lasts 20-30 minutes. During this time, the patient performs exercises that increase the endurance of the arms and hands (most life activities require their use), as well as training the lower limbs, during which patients exercise on a treadmill and a cycloergonometer. There are also strength exercises (which usually consist of lifting weights), as well as exercises to strengthen the strength of the respiratory muscles, during which special loads are applied.
Another element of rehabilitation iseducation- its purpose is to explain to the patient how the disease came about, the importance of individual elements of therapy, and how the drugs they receive and what they can cause side effects. During it, patients also learn to breathe properly - they train breathing through pursed lips and the so-called diaphragmatic breathing). They also learn respiratory tree toilet techniques, such as effective coughing exercises, the secretion evacuation technique, and postural drainage.
In many patients - especially those who suffer from depression due to a chronic disease and cannot cope with difficult situations,psychosocial and behavioral interventionis also undertaken. at individual meetings with a psychologist or psychiatrist, as well as at meetings in support groups.
The patient undergoing pulmonary rehabilitation is looked after by a team of specialists, including a doctor, physiotherapist, dietitian, nurse, occupational therapist, clinical psychologist, and a social worker.
Pulmonary rehabilitation: reimbursement from the National He alth Fund
Pulmonary rehabilitation programs are usually organized by pulmonary departments or outpatient clinics, and they are conducted both in hospital, outpatient and home settings. The greatest benefits come from rehabilitation that is started in the hospital, then continued on an outpatient basis and gradually moved home, with the increasing involvement of the patient and their caregivers.
Inpatient pulmonary rehabilitation at the National He alth Fund is intended for those patients whose he alth condition or coexisting diseases require constant care. A referral for such rehabilitation can be issued by doctors from the departments:
- pulmonary,
- tuberculosis and lung disease,
- thoracic surgery,
- cardiology,
- internal diseases,
- ENT,
- oncology,
- allergic.
A referral may also be issued by a doctor from a tuberculosis and pulmonary disease clinic, allergy, rehabilitation or thoracic surgery.
The duration of such rehabilitation is up to three weeks, unless there is a justified need to extend it - the decision is then issued by the attending physician, and the written consent must be given by the director of the provincial branch of the National He alth Fund.
Pulmonary rehabilitation: contraindications
Although pulmonary rehabilitation gives very good results, not every patient can benefit from it. There are a number of contraindications that prevent it. These include:
- ischemic heart disease,
- neoplastic disease in the metastatic stage,
- severe pulmonary hypertension,
- acute form of the pulmonary heart,
- kidney failure,
- severe liver dysfunction,
- severe mental disorders, due to which contact with the patient is limited and he / she is unable to follow orders,
- drug and psychotropic substance abuse,
- smoking.