Chronic obstructive lung disease home program during COVID
Patient caregiver Education:
-Basic lung physiology of COPD, asthma, chronic bronchitis. Reduction in airflow, oxygen exchange to
tissues primarily due to impaired exhalation with air remaining in lungs. Symptoms are wheezing,
coughing, mucus production w/more severe presentation of hypoxemia, unintended weight loss,
significant decline in function. Associated with: depression, poor sleep, cognitive decline, physical
deconditioning, immune system dysregulation *very similar to effects of social isolation
Discuss w/MD: role of irritants daily monitoring, asthma action plan avoiding triggers,
sidenote*maximize clean air
-Benefits of Exercise: more energy to do what you love, improved strength, stronger bones, more
resilient to fight off disease, better sleep exercise earlier with natural light.
-RPE scale Modified Borg 1-10 self-assessment highly correlated with vitals when used correctly initially
will need feedback. Use during all exercise and sustained activity. Use 4-6 moderate intensity.
-Energy conservation pacing throughout the day, importance of daily schedule more so during
quarantine
-Breathing exercises: PLB, DB, singing
Daily Schedule
-Benefits for older adults are: decreased insomnia, increased adherence of medications and exercise
program. Remember the best ones are individualized, pt centered and setup in collaboration w/pt and
family.
Exercise Prescription:
-Aerobic exercise: warm up and cool down, 3-4 home sessions, 2 additional supervised sessions/wk.
Intensity is moderate to high x20-30 minutes w/moderate dyspnea RPE 4-6. Progression w/emphasis on
duration and frequency NOT intensity.
-Strength training follow ACSM, determined by RPE 4-6 and O2 sat, specific to pt goals and medical recs.
Exercise at home ideas below perform 30 min in AM w/natural light. Mild impairement/disease: if able
go outside walk 20-30min, stationary bike. Moderate dz: marching in place high stepping continuous 2
min/break/2min for 20 min, gardening 20-30min. Severe dz: cooking a meal standing or 100 leg kicks in
20 min. Include hobbies, incorporate SMART goals and involve family.
Respiratory therex:
PLB : count exhale twice as long as inhale, “smell flowers, blow out candles”
Diaphragmatic breathing: hands on belly, can combine w/PLB. Goal is to relax accessory breathing
muscles of neck and chest while strengthening diaphragm. By slowing down the breath, it activates
parasympathetic response of rest and digest, relaxation
Singing : start w/easier songs (Silent night, Imagine, Can you Feel the Love tonight), More advanced
songs (Jingle Bell Rock, ABC, I’m still standing). Increase challenge by standing, holding a note, or singing
more lines without taking a break.
Sample schedule- Moderate asthma Morning :wake up by, meds, breakfast, exercise walk, fun relax rest,
knit by natural light. Afternoon: lunch, nap, social hour calls, relax. Evening: dinner, breathing exercises
singing 15-20min, sleep goal by 10pm.
Nutritional considerations: Malnutrition and COPD due to increased metabolic rate work of breathing.
Foods rich in flavonoids and antioxidants slow down decline in lung function (veg and fruits)
Reference: APTA webinar 4/4/20 “Minimizing the impact of social distancing in older adults” time 47:00-