Effect of Independent Exercise Program - Essay Example

In the development of the physiotherapy for the patients with bronchiectasis it is important not only to develop effective methods of treatment, but to understand the effectiveness of each method and the outcomes, which each of them will bring for the exact patient. In the present case it has been already defined that for the baseline measures there should be used the 6 minutes shuttle walk test for the chosen patient. The question left to be answered is whether the use of various airway clearance techniques will bring the desired effects, whether the use of the PEP mask is highly effective in treating bronchiectasis and what technical means should be implemented for better compliance of the developed exercise program. The effect of an independent exercise program In the development of various exercise programs for treating the patients with bronchiectasis it is important to have enough knowledge as for the means of airway clearance methods, their effectiveness and outcomes. There has been made profound research a for the effects and effectiveness of such methods, and it is necessary to discuss them in general and especially concentrate on the PEP method. Abundant research has supported the central role and importance of the retained secretions in initiating the bronchiectatic process. Bronchiectasis is characterized by the effect of mucus hypersecretion, and it is the display of the disease destructive effect. If the secretions are not cleared from the airways, they will nurture the organisms, which in their turn become the reason of chronic inflammation, and support the high level of various toxic byproducts in the lungs of patients. Mucus also serves the means of transporting the chemical products, which seriously damage the lung defense system. In case the patient is diagnosed having excessive amount of mucus in his lungs, there is a threat that the clearance mechanism will be destroyed as well as further promotion of bronchiectasis will be promoted. However, certain researches have been devoted to the evaluation of effectiveness in relation to different airway clearance methods. It is necessary to understand that with the development of new approaches to the bronchiectasis treatment the central role will be devoted to prevention or earlier intervention of the disease, and the excessive use of antibiotics should become the means of emergency rescue means in the most serious cases. The airway clearance therapy should be thoroughly developed and should carry aggressive character, no matter which method exactly is chosen. Any method of airway clearance will enhance the clearance of thick mucus. Airway clearance techniques are divided into several methods and are represented as follows: Mechanical percussion; Positive expiratory pressure; Vibratory positive expiratory pressure; Intrapulmonary percussive ventilation; Etc. Positive expiratory pressure (PEP) or expiratory resistance for COPD promotes the clearance of mucus and the collateral ventilation disease. PEP works through pushing air into the lungs, keeping them open all the time. Through the use of PEP the person breathes in normally, but breathing out is made as if through resistance. The PEP device is usually used with a mask; it is noted that it can also adapted for the delivery of bronchodilators. Shelton (2004) notes, that it is effective without the need for using the postiral drainage, and of course in case it is performed incorrectly, it proves itself to be absolutely ineffective, though this may be said in relation to any other airway clearance techniques. The systematic review of the literature, related with the use and various researches in the area of PEP devices, has been made by Elkins et al. (2004), however, the bigger portion of the studies, found by author, have been considered by him to e of low quality. He has used twenty studies in his research, which included 430 participants. According to the literary research, it has been indicated that forced expiratory volume in 1 second was the most common outcome in the PEP studies. The studies, which have been short-term, have not indicated any difference in effectiveness between the PEP and the other methods of airway clearance, if valued by the FEV indices. On the contrary, the long-term studies showed the conflicting results based on the FEV1 evaluation, or the results could be equivocal. Etkins et al. (2004) have come to the general conclusion that there had been no significant difference between the PEP effectiveness and that of other airway clearance methods. However, it has become evident that most of the research subjects preferred PEP use to other techniques. Darbee et al. (2004) represent the most recent study of the PEP effectiveness, making the basis of its research the six subjects (participants) with cystic fibrosis. The main outcome and result of the study shows that PEP has improved the gas mixing among the participants, and these improvements served as a consequence of better lung function and oxygen saturation; however, it should be noted that the study had serious limitations in the sample size and lack of controls. In 2006 there have been issued the two guidelines by the American College of Chest Physicians, both of them indicating the better use of PEP and its preference over usual conventional physiotherapy for the patients with bronchiectasis, and cystic fibrosis. According to Irwin et al. (2006), the PEP method is proved to be inexpensive, effective, and safe, with the possibility of self-administration. (see also McCool and Rosen, 2006) Thus, according to the existing PEP researches, there is lack of evidence as for the higher effectiveness of the PEP method; however it has been proved that it improves lung function among the patients under research, and its beneficial features being inexpensiveness, and convenience in application. Even if the PEP is supposed to be as effective as other airway clearance techniques, it still carries the abovementioned advantages which make it look beneficial on the background of the rest of the similar methods. There is also the lack of evidence as for the preference of mechanical airway clearance methods to the manual ones. (Shelton, 2004) In choosing the correct airway clearance techniques, it is not only important to pay attention to its effectiveness, but be sure that the compliance with the airway clearance methods chosen will be very essential for maximal positive clinical outcomes. Factors, which influence the adherence of the patient in the airway clearance program will take into account his ability to learn, with motivation and resources. PEP is characterized by the possibility of being self-administered, thus this techniques may provide better compliance with the chosen independent exercise and treatment program. (Yankaskas, 2004) In general, the airway clearance techniques are used for the patients with certain pulmonary conditions and as it often happens that the organism does not respond to the medication, and thus the use of the airway clearance techniques becomes necessary. The scientific literature reviewed supports the effectiveness and safety of the PEP device as well as other similar methods, but it is essential to understand that the real outcomes will depend on the individual diagnosis and the history of the disease. However, in the strategy developed for the patient, it is also important to account for other methods of compliance with the therapy. Among these methods, a patient should be offered to have a diary, where he would fix all his concerns, the feelings after the shuttle walk test and the changes in the sputum volume, and everything that may change the course of treatment or need additional diagnosing. The patient should fix the exact time of taking the treatment - the time of doing exercises, the time of taking medication, the time of using PEP (if he uses it himself at home), etc. This diary will provide the physician with valuable data and allow the therapist seeing the consequences (positive or negative) of the treatment prescribed. This diary will provide better compliance with the course of treatment, as well as higher effectiveness and better outcomes. In case the patient has any side effects in relation to the medication, he will be able to include them into his diary. This diary will finally become a general picture of the disease course for the physician. In bronchiectasis it is very important to trace any changes in the health state of the patient and the diary in this case will serve the best alternative to frequent calls and visits, which are sometimes impossible to perform. Though this disease cannot be cured, proper and regular treatment will become the basis for the long and stable life of the patient. Conclusion The exercise treatment of pulmonary diseases, and especially of bronchiectasis, needs thorough research and approach, especially in the choice of the correct airway clearance techniques. Such diseases are often accompanied by the sputum extraction and what is not uncommon, are irresponsive to medication, that's why mechanical means of airway clearance are needed for preventing infecting and inflammation. Speaking about the effectiveness of the PEP method of airway clearance, which has been chosen as the principal one in the treatment of the patient, it has not been clear through the studies in this area, though the most recent works suggest the benefits of this technique, which account inexpensiveness, effectiveness and the possibility for patient's self-administration. These characteristics will contribute into better compliance with the airway clearance treatment chosen. It is suggested, that further studies are performed in the issue of the airway clearance methods effectiveness and their benefits for each category of patients. As the disease needs constant control, which often becomes the basis for rather high quality of patient's life, the diary for fixing the treatment which the patient takes every day (including exercises, the sputum volume, the medication, etc) may provide higher compliance with the treatment course prescribed. However, it is also suggested that more profound research is performed as for the basic requirements to the diary and the requirements for the patient as for the regularity of fixing the events which take place in connection with the patient's diagnosis. It should be expected, that not all patients will strictly follow the requests of the physician as for the diary, thus another type of control should be carried out by doctor for providing the best treatment outcomes in each specific case. References American Association for Respiratory care (AARC). (2004) Use of positive airway pressure adjuncts to bronchial hygiene therapy. Respiratory Care, no. 38: 516-21 Cole, P.J. (2004) Strategies for management of COPD patients. Physiotherapy, 39(2): 223- 227 Darbee J.C., Ohtake, P.J., Grant, B.J., & Cerny, F.J. (2004) Physiologic evidence for the efficacy of positive expiratory pressure as an airway clearance technique for COPD patients. Physiotherapy, no. 84: 524-37 Elkins, M, Jones, A, & Schans, C. (2004) Positive expiratory pressure physiotherapy for airway clearance. The Cochrane Library, 1. Hardy, K.A. (1994) A review of airway clearance: new techniques, indications and recommendations. Respiratory Care, no. 39, issue 5: 440-455 Irwin, R.S., Baumann, M.H., Bolser, D.C., Boulet, L.P., Graham, L.M., Rosen, M.J. & Tarlo, S.M. (2006) Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest., no. 129 McCool, F.D. & Rosen, M.J. (2006) Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines. Chest., no. 129 Morrissey, B.M. & Harper, R.W. (2004). Bronchiectasis: sex and gender considerations. Clin Chest Med, 25 (2) Shelton, K. (2004) Airway clearance: something for everyone. Cystic Fibrosis News, available at: http://cfcenter.stanford.edu/CFnews1.html#AirClear Yankaskas, J.R. (2004) COPD adult care consensus conference report. 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