Exercise and Pulmonary Rehabilitation in
Children with Chronic Lung Diseases Suchada Sritippayawan, MD.
Somjitr Tongkam, BScChanthana Harnruthakorn, BSc.
What is Chronic lung disease?
• CLD of prematurity
• Prolonged MV use
• Chronic aspiration
• Chronic infection
• Bronchiectasis
• Chronic ILD
• Asthma
• etc.
CLD: Burden of the disease
Jan – Dec 2006Out-patient service
- 464/1,095 visits (42%)
- 116 cases
- Chronic aspiration 42 cases
- BPD 39 cases
- Others 35 cases
- 20% on home oxygen therapy
- 2% on home ventilator
70%
CLD: Burden of the disease
Jan – Dec 2006In-patient service
- 246/3,800 admissions (6.5%)
- 246 cases
- Chronic aspiration 91 cases
- BPD 34 cases
- Others 121 cases
- Median age 1.3 yrs
- Admission rate 2.5/case/yr
- Duration of admission 70 days/case/yr
50%
CLD: Pulmonary function
• Depend on underlying disease
• BPD – obstructive, air trapping, BHR
• Bronchiectasis - Mixed obstructive/restrictive, BHR- Not related to CT findings
• ILD- Restrictive- Diffusion defect
Exercise limitation in CLD
CLD
Ventilatory impairmen
t
Circulatory impairmen
t
Malnutrition
Oxidative capacity of
muscles O2 delivery & CO2
excretion
Exercise limitation ( Aerobic capacity)
CLD
Airway problems
Lung mechanic problems
Chest wall mechanic problems
• Hypersecretion
• Bronchospasm
• Collapsed airway
• Restrictive
• Hyperinflation
• Ineffective cough
• Retained secretion
• Exercise limitation
• Atelectasis
• Recurrent pneumonia
Pulmonary rehabilitation &
Exercise training
PFT at rest ≠ Exercise capacity
Exercise test is helpful in identifying
• pulmonary limitation during exercise
• optimal level of exercise
Exercise capacity in CLD
Question #1
How to assess exercise capacity in children with CLD?
Synonyms of exercise stress test:
- Cardiopulmonary exercise test
- Graded exercise test
Exercise test
VO2
VCO2/VO2>1
Maximum O2 consumption (VO2max)
Work load
Indications for exercise testing
• Clinical assessment
- symptoms or signs induced by exercise
- medical or surgical interventions
- baseline data of rehabilitation programs
• Aerobic fitness evaluation
Contraindications to exercise testing
Absolute contraindications
- active inflammatory heart disease
- active hepatitis
- acute myocardial infarction
- active pneumonia
- severe systemic hypertension
- acute orthopedic injury to an exercise
muscle group
Contraindications to exercise testing
Relative contraindications
- severe left ventricular outflow obs.
- severe right ventricular outflow obs.
- congestive heart failure
- severe mitral stenosis
Lab equipment
• Ergometers
• Respiratory and metabolic/gas
equipment
• Monitoring : EKG, HR, SpO2, BP
