Pulmonary rehabilitation and patient education can help COPD patients regain lost functioning and enjoy a better quality of life.
The trick is making sure patients maintain those gains over time.
Three AARC members who work with these patients know what it takes; and it begins and ends with exercise.
Patient’s new normal
“We continuously stress that progressive exercise is the patient’s new normal. Exercise has to be a part of their lifestyle from now on,” said Shari Dunn, RRT, who serves as a coordinator in the PR program at St. Luke’s Hospital in Chesterfield, MO.
She believes exercise is the key to a better quality of life and the ability to engage in more activities, both inside and outside of the patient’s home. It helps to minimize acute exacerbations too and it makes it easier for the patient to recover from an exacerbation when one does occur.
Rita Edwards, BS, RRT, RPFT, starts emphasizing the need for life-long exercise from day one of her program at the Paoli Hospital Pulmonary Diagnostic & Wellness Center in Paoli, PA.
“When our patients initially enter our PR program, we encourage them to think about how they will continue their exercise program and give them the three typical options: to exercise at home if they have the equipment and will discipline themselves on a regular basis, begin or continue in their community gym, or remain with us in our maintenance program,” Edwards said.
“Patients really need that kind of encouragement,” said Dawn Fielding, BS, RRT, AE-C, HME systems director at Intermountain Homecare & Hospice in South Jordan, UT.
“The danger of falling back into old habits . . . is ever present and they need to be aware and make a conscious effort to maintain their physical fitness,” Fielding said. “Doing this helps preserve their mental well-being, both due to the physical activity itself as well as providing them the ability to stay active in the things they love the most.”
Winning at the game of COPD
Fielding motivates her patients to keep moving by identifying the things they want to do the most and then modifying the physical aspects of those things so that they can do them.
For example, she and her staff have built raised planters for patients who like to garden and stepping stools right at tractor height for others who just want to mow their own grass again.
They help patients set specific goals too, such as identifying the exact number of steps required to do something they want to do and then working with them to be able to take that many steps.
“Winning at the game of COPD includes having the foresight for making adjustments and the fortitude to try new things,” Fielding said.
Addressing medication issues
Dunn notes it’s also important to address medication issues with patients that may be keeping them from being able to exercise to their full capacity.
“We see many patients that aren’t using inhalers properly. With effective dosages and techniques, they can have better workouts, have better outcomes and symptom relief,” Dunn said.
Patients, who leave her program with effective medications and a commitment to exercise, regularly report back about how their lives have changed for the better.
“Many comment on how they can tell a difference in their daily activities,” she said. “They report more ease in climbing stairs, routine household tasks, and more willingness to take small trips or even larger vacations.”
The support group she and her colleagues run for PR grads makes a world of difference too, giving patients a place where they can continue to learn and socialize with others who are facing the same problems they are.
Keeping in touch
Ongoing contact is considered essential in Edwards’ program as well. Her patients are followed for a year after graduation and about half of them end up enrolling in the hospital’s maintenance program.
“The goal of pulmonary rehab is to give the patients the ability to manage their lung disease so it doesn’t manage them,” Edwards said. “Through the initial assessment process, we identify areas in their lives that need focused education and we give them the tools needed, as well as consistent encouragement to make those changes.”
Most keep up with exercise and she says it is rare to see a program graduate back in the hospital with an acute exacerbation.
“We have very good satisfaction surveys reflecting that they have adapted to positive changes in their lives which made a big difference,” says the RT.
Fielding says she regularly hears from her former PR patients about how their lives have changed since taking part in the program. Whether it’s being able to make tortillas for their family again or singing all the way through Sunday church service, they are proud of their accomplishments.
Every once in a while she even gets the chance to witness one of these transformations first hand.
“I can’t express the emotion I felt one day when I was driving down the road and passed one of my former patients riding his bike down the road,” she says. “This was the same patient that came to my clinic after giving up on just about everything.”
Seeing this gentleman peddling away, with his oxygen tank in the basket of his bike and a big smile on his face, made her day.
“It was one of the most beautiful things I’ve ever had the pleasure of witnessing,” says Fielding. “I had to pull over and cry.”