As temperatures drop, pulmonary rehab specialists work overtime to maintain lung function.
Pulmonary rehabilitation specialists are at the forefront of improving patients’ physical conditions by offering extensive programs on exercise, support and education to help them breathe easier and function on a higher level.
Anyone with a chronic respiratory illness should know the crucial role pulmonary rehabilitation can play in their overall well-being. What they should also be aware of, however, is that this role assumes even greater importance during the cold, harsh winter season.
Winter has Consequences
The cold and dry weather is a nightmare for anyone with respiratory issues such as asthma, COPD, pulmonary fibrosis and other conditions — not forgetting the amount of viruses floating around — causing them to avoid the amount of activity they normally maintain during warmer months, leaving patients with exacerbated symptoms and pulmonary rehab specialists with a higher caseload.
“Pulmonary rehab may be even more crucial in the winter months because the opportunity for patients with a chronic lung disease to be active outside the home is much more limited,” said Gregory C. Kane, MD, FACP, chair and The Jane and Leonard Korman Professor of Pulmonary Medicine, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia. “During the good weather our patients may be able to attend events like a baseball game or go on vacation where they can be outside. That gives them an opportunity to maintain a certain level of activity that can help them maintain their conditioning.”
If you have a chronic respiratory illness, it’s important to be aware of the implications of living in a colder area or in locales with harsh winter seasons. Noah Greenspan, DPT, CCS, EMT-B, cardiovascular and pulmonary clinical specialist and program director at Pulmonary Wellness & Rehabilitation Center in New York City, explains that there are two main concerns for patients during this season.
“A lot of people have difficulty with the cold from a physiological perspective, meaning they walk outside and their airways naturally tighten up,” Greenspan said. “The other concern is because people are often much less active, spending more time indoors — possibly eating more — then spring comes and they are much more short of breath due to this inactivity and deconditioning during the winter.”
“One of the problems that we have with chronic lung disease is that patients get worsening shortness of breath when they’re active, which leads to a vicious cycle where they become less active and worsen their overall performance,” Kane added. “You can imagine in the winter months — when you’re not able to do things outside — going to a pulmonary rehab program, where there is a scheduled visit and scheduled opportunity to exercise, is a huge advantage for a patient.”
Not only does the grating weather make it harder for respiratory-compromised patients to breathe and function well, but during winter they also need to worry about the spreading of viruses that, if contracted, can inhibit their ability to stay active and maintain their conditioning.
“The big nemesis for our respiratory patients during the winter is the cold and flu season,” said Kane. “The first step is to make sure every patient gets a flu shot. Beyond the flu, though, there are a number of respiratory viruses that can cause exacerbation. They end up needing to go to the doctor more often or even get hospitalized, and they become more deconditioned. Being able to keep up with pulmonary rehab is crucial for patients during the winter months and may be even more critical because it’s the portion of the year when they’re most at risk for a flare-up.”
“People with respiratory issues are especially vulnerable to common colds, the flu, pneumonia and other respiratory ailments, further impairing their ability to be active and their level of conditioning,” Greenspan concurred. “As they recover from their acute illness and try to return to daily activities, their symptoms are often heightened due to the extreme inactivity, requiring them almost to be ‘rebuilt’ to their normal activity level.”
Nutrition Plays a Part
According to Greenspan, nutrition is a key component to a patient’s rehab program when they are facing two circumstances: being overweight and being underweight. “When someone is overweight, there is increased demand on the respiratory system, potentially increasing shortness of breath and decreasing ability to do certain activities,” he warned. “This affects your breathing because it makes you work harder to take each breath, potentially decreasing your volume of air with each inhale.” And with colder temperatures come poorer eating habits.
On the other hand, those with a chronic respiratory condition who are underweight are usually working too hard just to breathe, which in turn burns more calories and prevents the patient from obtaining adequate nutrition, Greenspan continued.
“People will often get full much more quickly as well, which can lead to increased pressure on the diaphragm, making breathing difficult,” he said. “So we suggest that these people eat six small meals a day rather than three larger ones. We also highly recommend eating things like healthy fats to keep weight on.”
Kane pointed out that once an initial comprehensive assessment is completed, clinicians can fine-tune their recommendation for physical therapy and occupational therapy. “We may have issues related to strength, balance and daily tasks, and that’s where both PT and OT can come in to give our patients some tricks of the trade to improve their ability to navigate,” he said.
Greenspan encourages OTs to help patients work on increased strength, endurance, flexibility and balance, rather than focusing on having them conserve energy. “Classically, we teach people about energy conservation, which often involves reducing the workload,” he said. “But we know now that that is not the most beneficial approach for patients.” He suggests that OTs should be focusing on the aforementioned skills and also helping the patient “work smarter so that they can work harder.”
Filling in the Gaps
When it comes to improving patient experience and outcomes, Kane and Greenspan have suggestions to address unmet needs. “One of the gaps that we have all been more cognizant of lately is assessing the patient’s fall risk,” said Kane. “Our practice is a patient-centered specialty practice, so we focus on a more comprehensive view of the patient in terms of communication with primary care, and assessing real risk factors that could lead to patient harm. It’s an opportunity for us to review those things and work with the PTs to strengthen their endurance and balance, which is a great asset to our patients, especially in the winter when there is snow and icy conditions.”
Greenspan suggested earlier and more regular patient referrals. “A lot of times we get the idea that a patient is too healthy for rehab or too sick for rehab; patients need to be taught about their disease and how to manage its associated manifestations. Education is huge in the management of any chronic disease, especially one that affects every area of your life.”
Kane said there is clear evidence that these patients can avoid hospital stays, improve well-being and enjoy terrific outcomes. “The goal is how they feel, how they’re functioning and what they’re able to do,” he said. “And by focusing on comprehensive care that goes beyond just the routine medications that they need, we can really have a major impact on their health and well-being.”