Pulmonary rehabilitation in post-discharge treatment of patients with COVID-19 pneumonia

Dear Editor,

More and more patients with COVID-19 pneumonia have been discharged, and the rehabilitation of their lung function has become an urgent issue.¹ The patients may suffer from dyspnea or even acute respiratory distress syndrome. Besides, long term bed rest, mechanical ventilation and drug treatment can increase the risk of diaphragm fatigue and respiratory muscle weakness, which will further aggravate pulmonary dysfunction.² The American thoracic society (ATS) and the European respiratory society (ERS) believe that pulmonary rehabilitation (PR) plays an important role in chronic obstructive pulmonary disease (COPD), Community acquired pneumonia (CAP).³ At present, the exploration of PR in patients with covid-19 pneumonia after discharge has been carried out, and good results have been achieved.

In clinical practice, the author believes that:⑴Breathing training. When the patient has shortness of breath and wheezing, encourage the patient to keep the body leaning forward about 30° to reduce the work of breathing and increase the lung capacity; for the patient who cannot stand, it is recommended to rest in a sitting position during non-sleep time, such as raising the head of the bed. 60° high. When the patient has an increased breathing rate or contradictory breathing between the chest and abdomen, encourage the patient to adjust the breathing rhythm through abdominal breathing to reduce the work of breathing and improve the breathing efficiency.⁴ ⑵. For some patients with acquired weakness in ICU, the inspiratory muscles should be trained: the initial load of the respirator is 30% of the maximal inspiratory pressure, 5 inspiratory breaths in each group with an interval of not less than 6 s, do 6 groups at a time, rest for 1 min, once a day.⑶ Patients are encouraged to use postural drainage for expectoration, and postural drainage of the affected lung lobes is recommended to allow patients to maintain the healthy side of the lung on the lower side. If the effect of postural drainage is poor or expectoration is difficult, active circulatory breathing technology can be applied. ⑷ Patients should follow the principle of step-by-step, from low intensity to medium intensity. The exercise frequency is 3–5 times a week, and the exercise time is 20–40 min. It is recommended to use low-intensity treadmill and high-intensity step exercise for patients with better physical conditions. ⑸ Activities of daily living interventions. It includes basic activities daily living (BADL) and instrumental activities daily living (IADL). Training is carried out by simulating the actual scene to find the obstacle points, and it is recommended to carry out targeted intervention under the guidance of rehabilitation physicians. ⑹ Patients with balance dysfunction should be involved in balance training under the guidance of rehabilitation therapists, such as unarmed balance training, balance training instrument, etc.

In conclusion, pulmonary rehabilitation plays an important role in post-discharge treatment of COVID-19 patients, which can significantly improve the prognosis of patients.