TABLE 27.4.

Summary of Goals and Methods of Pulmonary Rehabilitation

Goals	Methods
Primary and Secondary Prevention
Smoking cessation	Smoking cessation programs, emotional support, monitor and encourage abstinence
Immunization	Assure proper immunizations (flu and pneumonia), communicate with primary physician
Prevent exacerbations	Disease education Self-assessment skills taught Self-intervention taught Instruct on accessing private physician
Appropriate medication use	Review medication Focus on inhaler technique Review dosing schedules Review interactions and side effects Focus on appropriate use of inhalers and nebulizers
Pulmonary toilet	Review bronchial hygiene Teach cough techniques/huffing Teach appropriate use of chest physiotherapy techniques to the patient and family
Appropriate use of oxygen therapy	Encourage acceptance of the need for O2 Appropriate use of oxygen at rest and with exertion Review self-monitoring with pulse oximetry Review oxygen equipment and appropriate systems for a given patient Emphasize the importance of supplemental oxygen use and the consequences of failure to use oxygen
Nutritional counseling	Aim to achieve ideal body weight For CO2-retaining individuals, avoid high-carbohydrate diet Maintenance of low-sodium diets Encourage balanced nutrition, avoidance of fad diets
Family training	Disease-specific training Pulmonary toilet and chest physiotherapy Medication and oxygen use Family support group Counseling as needed
Dyspnea Relief: Exercise Training
Exercise	Multifaceted program individualized to each patient’s needs
•Strengthening	Emphasis on gradual increase in strength with a focus on proximal muscle groups Avoid injury to weakened musculotendinous structures that may have been weakened by disuse and medications Focus on high-repetition, low-intensity training
•Conditioning	Aim to increase exercise tolerance with aerobic exercises Cross-training program to avoid injury Create an independent training program Increase ambulation endurance with gait training Appropriate oxygen titration during exercise
•Respiratory muscle training for selected conditions	Isocapnic hyperpnea Inspiratory resistance training Inspiratory threshold training
•Upper extremity training	Increase strength, focus on proximal muscles Increase endurance for sustained activity, aim to decrease fatigue with ADL
•ADL training	Energy conservation and adaptive techniques Teach anxiety and stress relief Teach pacing in activities
Dyspnea Relief: Lifestyle Modifications
Breathing retraining	Technique of pursed lip breathing, especially in obstructive conditions Diaphragmatic breathing
Anxiety reduction	Stress relaxation techniques Paced breathing Autohypnosis Visualization Use of anxiolytics as needed Evaluate and treat any underlying depression
Improve confidence	Build compensatory techniques Build confidence in ability to exercise Provide ability to self-assess and learn disease management techniques
Disease Management
Disease acceptance	Family and patient education regarding disease process
Coping skills	Patient and family support group Psychology and social work intervention as needed Treatment of depression as needed
Quality of life improvement	Simplify ADL management, improved coping skills Improve disease management strategies
Advance directives review	Counseling regarding end-of-life planning Establishment of healthcare proxy Clarification of intention for resuscitation Assistance in preparing paperwork
Encouragement	Patient support group Use of social work and psychological support
Continuing exercise and disease management compliance	Multidisciplinary team encouragement Physician (specialty and primary care) consensus Family education and involvement

ADL, Activity of daily living.