Tips to Improve Respiratory Health
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The respiratory health the quality of the air that we breathe in has a significant impact on our respiratory system. Air pollutants like smoke from various sources, gases coming from industries and engines, even natural pollutants like pollen are very harmful to our respiratory system. Our lungs are vital organs that are susceptible to airborne infection easily than can be assumed. Respiratory diseases are one of the most common causes of disability and death world wide (WHO, 2017).
Here are some facts to consider:
a. Respiratory diseases offer a huge health burden worldwide, both at the individual level and the healthcare system level. Approx.65 million people are suffering from Chronic Obstructive Pulmonary disease. Among them, about 3 million die every year, which makes it the third leading cause of death globally (WHO, 2017).
b. About 334 million people suffer from Asthma, and it is one of the most common diseases of childhood, affecting about 14% of kids worldwide (WHO, 2017).
c. One of the most common lethal neoplasms is lung cancer killing 1.6 million people every year (WHO, 2017).
Let’s have a look at the statistics of India.
a. With 18% of the world’s population, India has 32% of the global burden of respiratory diseases (Ghosh, 2018).
b. COPD is responsible for 10.9% of total deaths and 6.4% of total DALYs in India in 2016. The figures were 9.6% and 4.5% respectively in 1990(Ghosh, 2018).
c. Pollution is the biggest contributor to respiratory diseases. About 33.6% of COPD cases are attributed to air pollution, 25.8% to indoor air pollution and 21% to smoking (Ghosh, 2018).
Fortunately, we can prevent most respiratory diseases by improving the air quality that we breathe in and boosting immunity to fight the bacteria and viruses causing infections. Prevention, control and cure of respiratory diseases should be of utmost priority to the health sector. We can take various steps to limit the cases of respiratory illnesses. Some of those are listed below.
a. Prevent or minimize the exposure to the common source of unhealthy air pollution, smoke containing allergens, toxic particles, fumes etc.
b. Prevent occupational lung diseases by maintaining the indoor air quality of the workplace according to standards.
c. Participate in robust immunization programs to prevent various types of pneumonia.
d. Train medical personnel and educate the general populace regarding the prevalent respiratory diseases.
e. Keep the immunity strong by following good food, lifestyle and exercise habits.
How can physiotherapy help in improving your respiratory health?
Exercises, when done under the observation of a specialist, can increase oxygen delivery and exchange, ventilation, cardiac output (due to rapid heart rate), blood flow, bronchodilation in normal lungs and mucus secretion etc.,
A well-designed exercise regimen can improve pulmonary functions by:
a. Strengthening your respiratory muscles
b. Improving your pulmonary parameters like vital capacity, maximum voluntary ventilation, peak expiratory flow etc.
c. Improving your cardio-respiratory parameters like VO2Max, respiratory exchange ratio, maxEQO2 etc.
d. Improving your trunk stability and mobility.
What is pulmonary rehabilitation?
Pulmonary Rehab is a tailor-made treatment protocol designed and executed by a team of physiotherapists, occupational therapists, respiratory nurses, and psychologist’s to help patients with breathing difficulties so that they can improve their functional activity and increase their quality of life. Pulmonary rehabilitation consists of a supervised program that includes health education, breathing techniques and exercise training, among other aspects. Each session consists of moderate exercises to challenge the patients without pushing them beyond their comfort. The sessions mostly dedicated to improving the patients’ overall fitness and managing the symptoms related to respiratory illnesses.
People with severe lung conditions like COPD get entrapped in the vicious cycle of inactivity due to the restrictions of their health condition both physically and psychologically. As they quickly get out of breath, they tend to avoid the activities like moving around, exercising etc., and as a result, they lose their overall fitness, which can further exaggerate their symptoms.
Pulmonary rehabilitation improves the lung condition in COPD patients (Schroff, 2017). After taking sessions from the experts, a patient can move easily without exerting his respiratory system and indulge in day-to-day activity more comfortably.
What are the general benefits of Pulmonary rehabilitation?
There are so many benefits of pulmonary rehabilitation like:
a. It increases the independency of the patients in taking care of themselves.
b. It boosts patients’ function, strength, and endurance.
c. It reduces the hospital stay pre and post-surgery.
d. It teaches patients to control their symptoms.
e. It increases the overall quality of life of the patients (Richardson, 2019).
Are you the right candidate?
Anyone with a lung condition who is suffering from breathlessness can be a good candidate for pulmonary rehabilitation as long as they don’t have a physical condition that limits their movement, like a problem with joints and muscles. Pulmonary rehabilitation is ideal for patients suffering from obstructive disorders like chronic bronchitis, emphysema, Asthma, etc. and restrictive disorders like interstitial lung disease etc.
What a routine program under pulmonary rehabilitation entails?
Before designing a pulmonary rehabilitation plan, current condition will be assessed using few tests:
a. Pulmonary function tests – These tests are mainly designed to find out how well your lungs are working by measuring lung capacity, volume, and rate of flow of gases. PFT or pulmonary function test can be done using two methods – spirometry and plethysmography.
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b. Exercise stress test – During the test, the patient is asked to exercise on a treadmill while the health professional monitors the patient’s lung and heart function.
c. Six-minute walk test – This test is used to determine the exercise tolerance of a patient with chronic respiratory disease (Dajczman E,2015) and heart disease
Every session of Pulmonary rehabilitation includes the warm-up, exercise, and cool-down phase. Exercise training during pulmonary rehabilitation includes treadmill walking, lower and upper limb strengthening, stationary cycling etc.
Warm-up exercises–Warm-up exercises help your body in preventing injuries. Warm-up exercises should last for at least 5 minutes.
1. Shoulder elevation
2. Shoulder circling
3. Head rotations
4. Trunk rotations
5. Side bends
6. Knee lifts
7. On-spot marching
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Aerobic exercises – One should aim for at least 20-30 minutes of aerobic exercises five times a week. Keeping the condition of the patient and age in mind, your physiotherapist will gradually increase the time with an aim to keep him moderately breathless. A few of the exercises that are incorporated are:
1. 5 minutes of marching on the spot
2. 5 minutes of stepping up
3. 20 minutes of continuous walking
4. 10-15 minutes of continuous cycling
Strengthening exercises – With any prevalent respiratory condition, your muscles can become weaker. Your therapist will ensure to incorporate at least three sessions of strengthening exercises per week. The exercises consist of:
1. Biceps curls
2. Wall push-off
3. Shoulder press
4. Knee extension
5. Sit to stand
6. Squats
7. Heel raise
Cool-down exercises – Cool down exercises let your body return to normal. Your cool-down period should last at least five minutes. The exercises are:
1. Walk for two minutes at a slow pace.
2. Stretching like back stretch, chest stretch, side stretch, quadriceps stretch, calf stretch and hamstring stretch.
In addition to these, few other techniques are also used to manage respiratory problems like:
1. Active cycle of breathing technique – The technique effectively clears the excess mucus secretion (McKoy NA, 2016). ACBT, or active cycle of breathing technique, is a breathing technique that helps in improving the effectiveness of the coughing reflex (Thomson A, Skinner A) while also improving ventilation. The technique can be used in combination with positioning to boost its benefits.
ACBT has three components:
a. Breathing control – It includes breathing gently with little efforts. The patient is instructed to keep his hand on his rib cage and feel every movement as he breathes in and out—breath in through nose and breath out through nose or mouth. Try to make breaths slower and relax your body. Once the patient learns breathing control, he is progressed to the next stage.
b. Deep breathing Exercises – Deep breathing exercises help loosen the secretions of the lungs (Oxford University Hospitals, 2018).
The patient is instructed to take few long and slow deep breaths through the nose. Now he needs to stop at the end of each breath for 3-4 seconds. After that, he is instructed to breathe out gently using his mouth like a sigh while keeping his shoulder and chest relaxed. It needs to be repeated few more times before progressing to the next stage.
c. Forced expiratory technique – This technique is very successful in moving the secretions. Forced expiratory technique or huffing is a process where exhaling is done forcefully through an open mouth. The technique allows the secretions to move from small airways to large airways from where it can be spilt out using coughing (Emma Larner & Penny Galey, 2002). There are two types of huffs – medium volume huff and high-volume huff.
2. Postural drainage– Postural drainage uses different gravity assisting positions to remove the excess mucous from the lungs. When combined with ACBT, it can be very effective. Patients are instructed to lie down in a specific position to drain a particular segment of the lung.
3. Humidification – Humidification is used when the secretions are very tenacious. Humidification of the patient is done using a nebuliser.
Following through with the right guidance, you can improve your overall well-being. Respiratory therapists will work very closely with you, helping you perform the exercises especially customized for you. Discuss your treatment options with the experts in Progressive Physiocare and experience the best care from them.
Alternative methods like Yoga and Pranayama also have shown promising results in achieving the desired results.
References:
1. WHO. (2017). The global impact of respiratory disease (Second edition). Forum of International Respiratory Societies. https://www.who.int/gard/publications/The_Global_Impact_of_Respiratory_Disease.pdf
2. Ghosh, A. (2018, September 13). India bears 32 per cent global burden of respiratory diseases: Global Burden of Disease study. The Indian Express. https://indianexpress.com/article/india/india-respiratory-diseases-global-burden-of-disease-study-5353493/
3. Schroff, P. (2017, January). Pulmonary Rehabilitation Improves Outcomes in Chronic Obstructive Pulmonary Disease Independent of Disease Burden. PubMed. https://pubmed.ncbi.nlm.nih.gov/27739881/
4. Richardson, C. R. (2019, June 17). Advances in rehabilitation for chronic diseases: improving health outcomes and function. PubMed. https://pubmed.ncbi.nlm.nih.gov/31208954/
5. Dajczman E, Wardini R, Kasymjanova G, Préfontaine D, Baltzan MA, Wolkove N. Six-minute walk distance is a predictor of survival in patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation. Can Respir J. 2015;22(4):225–229. doi:10.1155/2015/280187
6. Pollentier B, Irons SL, Benedetto CM, et al. Examination of the six-minute walk test to determine functional capacity in people with chronic heart failure: a systematic review. Cardiopulm Phys Ther J. 2010;21(1):13–21. PMID: 20467515
7. McKoy NA, Saldanha IJ, Odelola OA, Robinson KA.Active cycle of breathing technique for cystic fibrosis. Cochrane Database Syst Rev. 2016 Jul 05; DOI:10.1002/14651858.CD007862.pub4
8. Thomson A, Skinner A, Piercy J. Tidy’s Physiotherapy. 12th edition.Butterworth Heinemann publication.
9. Oxford University Hospitals. The Active Cycle of Breathing Techniques.p3 https://www.ouh.nhs.uk/patient-guide/leaflets/files/11659Pbreathing.pdf. (Accessed 2nd July, 2018).
10. Emma Larner & Penny Galey.THE ACTIVE CYCLE OF BREATHING TECHNIQUE (ACBT). Sept 2002 – review date Sept 2004.
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