PULMONARY REHABILITATION AND
OXYGEN THERAPY
ANNE E. HOLLAND, PhD
PULMONARY FIBROSIS MANAGEMENT STRATEGIES I
NOVEMBER 13, 2015

LIVING WELL WITH PULMONARY FIBROSIS

SUPPORTIVE THERAPIES FOR PF
• Aim to improve wellness
• Reduce symptoms
• Increase strength and fitness
• Enhance ability to undertake important activities
• Improve knowledge and confidence
• Provide support
• Major aim is not to reduce disease progression
• Rather, to improve quality of life and wellbeing
• Pulmonary rehabilitation and oxygen therapy have key roles

PULMONARY REHABILITATION
A program of exercise and education, designed to improve the physical and psychological condition of people with chronic respiratory disease

WHAT TO EXPECT AT PULMONARY REHABILITATION
• A one-on-one assessment
• An exercise program tailored for you plus monitoring whilst you exercise
• Information, support and self management training
• A home exercise program
(to keep you fit and strong once the program ends)
• A group that contains other patients with a range of diagnoses and disease severity

WHAT TO EXPECT AT PULMONARY REHABILITATION-
SPECIFICALLY:
• 8-12 week program, usually 2-3 times a week
• Walking training and stationary cycle training, light weights for your arms and legs
• Sometimes other physical training, like stretching and balance
• Information on a range of topics including (but not limited to)
• How the lungs work
• How to exercise safely
• Nutrition
• Oxygen therapy
• Managing medications and side effects

HOW MIGHT I FEEL AT THE END?
• At the end of rehab, most people experience:
• Improved exercise capacity (eg 6-min walk test)
• Reduced breathlessness
• Improved energy levels
• Improved quality of life
• Some people experience:
• Reduced anxiety and depression
• Increased levels of physical activity in daily life
Dowman et al, Cochrane Database of Systematic Reviews 2015

MAINTAINING THE GAINS AFTER PULMONARY
REHABILITATION
• What goes up must come down???
• Benefits tend to diminish after six months
• Pulmonary rehabilitation is an opportunity to establish an ongoing exercise program to stay fit and strong
• Talk with your trainer about what might work for you
Holland et al Thorax 2008

KEY MESSAGES ABOUT PULMONARY
REHABILITATION
• Never too early to start
• May be easier and more beneficial if you start early
• We all need a regular exercise program
• May be possible to go back to rehab, especially if your circumstances change
Holland et al Respiratory Medicine 2009

WHY USE OXYGEN THERAPY
• Pulmonary fibrosis makes it more difficult to get oxygen into the blood (and from there to the rest of the body)
• Decreased oxygen saturation
(ie low blood oxygen level)
• Is common during exercise
• May occur during sleep
• Sometimes present when sitting still

DOES OXYGEN THERAPY WORK?
• Most information from people with severe COPD
• Improved survival with oxygen therapy ≥ 16 hrs/day
• In PF, oxygen therapy consistently improves exercise capacity in short-term studies
• Variable effect on symptoms
• No good studies on survival

PATIENT EXPERIENCES WITH OXYGEN THERAPY
• Improved confidence
• Be more active
• Feel more in control
• Constant worry about running out of oxygen
with the oxygen on at least I can get around, not as fast as normally, but I can get around. . ..and I don’t seem to cough as much’ [Terry]
• ‘…I couldn’t sit here this long talking to you without oxygen’ [Frank]’
Duck J Adv Nursing 2015

THE ROLE OF OXYGEN THERAPY
• A tool that assists you to do more of the activities you want, and to do those activities more comfortably
• May assist with a range of symptoms
• Better breathing
• Higher energy levels
• Quicker recovery after activity
• Better sleep
• Less anxiety
• A trade-off with the inconvenience and physical challenges of equipment

OXYGEN DEVICESTHERE ARE MANY…
• Fixed concentrators – great for overnight and around the house
• Cylinders – great for going out but may run out and can be heavy
• Portable concentrators much easier to use but variable flow rates and variable battery life

THE CHALLENGE: MEETING OXYGEN FLOW NEEDS IN PF
• There is a limit to the oxygen flow that any device can deliver – and it varies
• As breathing gets faster, the amount of oxygen inhaled in each breath goes down
• This may not matter if the flow rate is big enough
Chatburn Resp Care 2010

MEETING YOUR OXYGEN FLOW NEEDS
• Situations where the oxygen flow rate is sometimes not enough for some people with PF:
• Fast, shallow breathing
• Exercise
• Sleep
• At rest
• Pulsed oxygen supply
(on demand)
• Some portable concentrators
Chatburn Resp Care 2010

OXYGEN THERAPY THAT IS RIGHT FOR YOU
• Many options and increasing all the time
• Work with your health professional to find the right one:
• Different types of cylinders
• Pulse dose or not
• Different types of oxygen supply (e.g. liquid)
• Different portable concentrators
• Different types of nasal cannulae and tubing

SUMMARY
• Pulmonary rehabilitation and oxygen therapy can contribute to living well with PF
• Never too early to start pulmonary rehabilitation
• Establishing a long term exercise program that you enjoy is key to longer lasting benefits
• Oxygen therapy helps to do more physical activity and may have a range of symptom benefits
• Work with your health care professional to find the device that is right for you