BELLARMINE UNIVERSITY, LOUISVILLE, KY

Restrictive Lung Disease

and Breathing Retraining

Counce, Hirsch, Plummer, Reid

BELLARMINE UNIVERSITY, LOUISVILLE, KY

PICO

• P Patients with restrictive lung disease

• I Standard treatment + breathing retraining

• C Standard treatment

• O Reducing dyspnea

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Restrictive Lung Disease/Dysfunction

• Reduced• Pulmonary ventilation (air in/out)• Lung expansion

• Hallmark symptoms:– Dyspnea:

– Subjective perception of breathlessness (Hillegass, 2011)

– Most limiting symptom of RLD (O'Donnell, 1998)

– Irritating, dry, non-productive cough – Wasted, emaciated appearance

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Restrictive Lung Disease/Dysfunction

• Diagnostic criteria– PFT – Chest X-ray– ABG– Breath sounds– Cardiovascular

http://medlibes.com/entry/spirometry

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Standard Pulmonary Rehabilitation

• Exercise program – Peripheral muscle training– Stair climbing– Treadmill walking– Bicycle training– Resistance training

http://www.uofmmedicalcenter.org/healthlibrary/Article/82065

Salhi, 2010

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Breathing Retraining

• Diaphragmatic breathing– Improve dyspnea– Decrease WOB, accessory muscle

activity, RR

• Pursed lip breathing– Improve dyspnea– Decrease RR

http://jpmc.org/pages/pulmonary-rehab

Hillegass, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Breathing Retraining in COPD

• Pursed lip breathing – Effective self-management strategy to

improve dyspnea

• Diaphragmatic breathing– Not effective for individuals with hyper-

inflated lungs

Facchiano, 2011

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Reference

Outcome Measures

Conclusions

Brack 2002

Borg scale RR TV Inspiratory time Expiratory time Minute

ventilation

Slight ↑ or ↓ in tidal volume from the average resting value causes marked ↑ dyspnea in patients with RLD

Patients with RLD breathe in a specific monotonous manner as a deliberate strategy to avoid dyspnea

O ’Donnell1998

Patient-reported qualitative descriptors of dyspnea

Perceived increased inspiratory muscle effort

Any therapeutic intervention that ↓ ventilatory demand, ↑ ventilatory capacity, ↓ mechanical load, or ↑ the functional strength of ventilatory muscles should alleviate dyspnea

Only ILD patients allude to increased inspiratory difficulty at the break-point of exercise

Breathing Retraining in RLD

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Reference

Outcome Measures

Conclusions

Nishiyama

2008

6MWT SGRQ BDI QOL

Further research needed to define factors contributing to dyspnea

Dyspnea important in predicting QOL Pulmonary rehab ↑ functional exercise capacity

and health related QOL

Salhi2010

6MWT Muscle force

(QF) QOL Spirometry VO2 max PImax PEmax

Patients with RLD displaying ↓ submax and max exercise tolerance, muscle weakness and QOL are good candidates for comprehensive multidisciplinary pulmonary rehab

Relevant benefits were observed as early as 12 weeks with an even greater number of responders by 24 weeks

Breathing Retraining in RLD

BELLARMINE UNIVERSITY, LOUISVILLE, KY

Conclusion

• Effective in COPD• Inconclusive in restrictive lung

disease• Benefits gained with standard

pulmonary rehab• Further research needed• The American Lung Association

BELLARMINE UNIVERSITY, LOUISVILLE, KY

References• Brack T, Jubran, Tobin MJ. Dyspnea and decreased variability of breathing in

patients with restrictive lung disease. Am J Respir Crit Care Med. 2002;165:1260-1264.

• Facchiano L, Snyder C, Núñez D. A literature review on breathing retraining as a self-management strategy operationalized through Rosswurm and Larrabee's evidence-based practice model. Journal Of The American Academy Of Nurse Practitioners [serial online]. August 2011;23(8):421-426. Available from: CINAHL with Full Text, Ipswich, MA. Accessed November 19, 2013.

• Hillegass E. Essentials of Cardiopulmonary Physical Therapy. 3rd edition. St. Louis, MO: Elsevier Saunders; 2011.

• Nishiyama O, Kondoh Y, Kimura T, et al. Effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Respirology. 2008;13(3):394–399.

• O'Donnell D, Chau L, Webb K. Qualitative aspects of exertional dyspnea in patients with interstitial lung disease. Journal Of Applied Physiology. 1998;84(6):2000-2009.

• Salhi B, Troosters T, Behaegel M, Joos G, Derom E. Effects of pulmonary rehabilitation in patients with restrictive lung diseases. CHEST. 2010;137(2):273-279.

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