Conditions

Bronchiectasis

Bronchiectasis is the term used for the permanent abnormal dilatation of one or more bronchi.  The main causes of permanent abnormal dilatation are damage to the airways due to severe lower respiratory tract infections such as pneumonia, whooping cough, measles (usually in childhood), gastric aspiration, primary ciliary dyskinesia.  Bronchiectasis may also a secondary manifestation of COPD, sarciodosis and bronchiolitis obliterans. However, often the underlying cause of bronchiectasis is not identified.

Bronchiectasis is characterised by repeated episodes of acute bronchial infection with increased cough and mucus production.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity and health-related quality of life of people with bronchiectasis.¹ However, all trials of PR for bronchiectasis have included airway clearance techniques, which may not be a standard component of all PR programs. Prior to commencing pulmonary rehabilitation, introduction to or a review of an individual’s airway clearance routine should be undertaken and optimised.

Interstitial Lung Diseases

Interstitial lung diseases (ILDs) are a group of over 200 conditions which are characterised by varying degrees of interstitial inflammation and fibrosis. People with ILD experience distressing breathlessness on exertion and fatigue, reduced health-related quality of life, and anxiety and depression.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity and health-related quality of life and reducing breathlessness of people with ILD.¹ However, since many patients with ILD experience significant exercise-induced desaturation, programs that provide PR for people with ILD should ensure that supplemental oxygen is available during training if necessary. interval training may be appropriate.

Pulmonary Hypertension

Pulmonary hypertension (PH) is defined as an increase in the resting mean pulmonary arterial pressure to at least 25 mm Hg on right heart catheterization. People with PH usually experience breathlessness on exertion and may have other symptoms such as fatigue, dizziness, chest discomfort, chest pain, palpitations, cough, pre-syncope, syncope, lower limb oedema and abdominal distension.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity and health-related quality of life of people with PH.¹ However, people with PH should be stable on pharmacotherapy prior to undertaking an exercise training program and PR programs should be delivered in centres experienced in managing people with PH.

Oxygen desaturation <85% increases pulmonary pressures and therefore supplemental oxygen should be available during training. Interval training maybe appropriate . Alternating upper limb and lower limb exercise maybe appropriate to maintain preload.

Lung Cancer

Lung cancer is a malignant tumour in the tissue of one or both lungs. A tumour may be found in the bronchi or in the spongy lung tissue. A tumour that starts in the lung is known as a primary lung cancer. Tumours in the lung may also be due to cancer which has spread through the blood from another part of the body such as the breast, bowel, or prostate – these cancers are called lung “secondary” or “metastases”. The following information refers to primary lung cancer.

Lung cancer is the 5th most diagnosed cancer in Australia. Non-small cell lung cancer is the most common type of lung cancer (85% of new diagnoses). Risk factors for the development of lung cancer include tobacco smoking, occupational or environmental carcinogen exposure and genetics (Granger JoP). One in five people with lung cancer have never smoked (LFA Blueprint 2022). Lung cancer is commonly treated with surgery (early-stage disease), chemotherapy, radiotherapy, immunotherapy or targeted therapies.

Pulmonary rehabilitation has been shown to be effective in improving exercise capacity, muscle strength, health-related quality of life, mood, lung function, sleep and fatigue for people with lung cancer (references -Cavalheri and Granger 2020 Respirology; Singh 2020; Zhou 2021). This includes for patients scheduled to undergo lung surgery (prehabilitation), during or after treatment, and for patients with palliative disease. However, most research regarding the benefits of rehabilitation for people with lung cancer were conducted in the surgical population with non-small cell lung cancer. There are several precautions for exercise for patients with lung cancer including for patients immediately after surgery or those with bone metastasis that warrant careful assessment by a health professional before commencing pulmonary rehabilitation and close monitoring throughout the program.