Introduction
Chronic asthma is identified by airway inflammation and bronchial hyperactivity in response to any allergen, such as dust, pollen, cold air, excessive exertion, or aerosols. The episodic occurrence of asthma results in persistent respiratory symptoms, which may contribute to compromised quality of life owing to worsening the symptoms of exertion or any trigger. Asthma is managed by medication and avoiding the trigger. Still, recently, there has been an introduction of additional non-drug therapy, which is known by the name of “pulmonary rehabilitation.”
What Is Pulmonary Rehabilitation for Asthma?
The concept was introduced in 2013 by the American Thoracic Society. It is a wholesome intervention treatment based on an extensive patient assessment that includes exercise training, education, and behavioral change designed especially for the improvement of the mental as well as the overall health condition of people with long-term respiratory diseases such as asthma. Such rehabilitation techniques promote long-term adherence to health-improving behaviors and habits. The treatment approach is not universal to every patient, but it considers the presence of comorbidities like cardiovascular diseases, muscular and skeletal problems, and metabolic and neurological diseases, which can affect the exercise program.
What Are the Key Components of Pulmonary Rehabilitation of Asthma?
The pulmonary rehabilitation program for asthmatic patients is carried out by using the following components.
1. Education - The educational aspect has always been a key feature in the management of individuals who are affected by respiratory symptoms. Educating about the symptoms, triggers, and allergens of the disease and discussing its management has been a precious component of pulmonary rehabilitation. Education emphasizes the importance of medicine compliance by the patient since statistics reveal that adherence to inhaler treatment in asthmatic patients is very low as compared to other chronic health conditions. The complaint is mainly attributed to patients undermining the symptoms and the consequences of the disease if left untreated. The education part of the pulmonary rehabilitation program implies that the specialist teaches the patients about respiratory symptoms and the practice of self-management of disease. This involves motivating the patients to take treatment and also allowing them to present any doubt, and to practice the correct techniques for using nebulizers and inhalers. Although these modalities are helpful for short-term outcomes only, a constant reminder and support to achieve the health goals can be beneficial. Health professionals can rely on these multidimensional approaches if and when the patients are educated about the same.
2. Exercise Training - The main component on which pulmonary rehabilitation is based is exercise training. Exercise has a positive effect on patients with asthma; however, due to the wide range of symptoms in every other patient, the training needs to be specific for every different individual. The patient needs to take a thorough lung examination that includes a lung function test, spirometry (the test to detect the amount and speed of air that can be exhaled or inhaled by lungs) before and after the bronchodilation(dilation of air cavities), and exercise capacity testing. Exercise capacity is based on cardiopulmonary exercise testing, which includes the six-minute shuttle walk test. The shuttle walk exercise is most commonly used in this training.
3. Endurance Training and Strength Exercise - This component is based on the concept that aerobic muscles can be beneficial for the heart and muscles, and in the same manner, it can help the lungs, too. The airways become constricted and narrow in asthma. Along with the inhalers and medication that help to open up the narrow airways, endurance exercises can be helpful to strengthen the lung muscles and enhance the flexibility of the rib cage. The endurance exercises include swimming, walking, cycling, jogging, and team sports. Short spurts of activity are a good source of endurance exercise for asthmatic patients as they help in building lung stamina.
4. Breathing Exercises - Breathing exercises are often recommended by a doctor or asthma specialist and are taught by them under supervision. A few of the techniques are
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Papworth Method - This technique is taught by physiotherapists with an emphasis on learning to breathe slowly and steadily using the muscles that lie below the rib cage and through the nose.
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Diaphragmatic Breathing - This technique involves breathing from the lowest level of the rib cage and not barely from the chest. This method helps to decrease the oxygen levels needed by the body since it strengthens the muscles.
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Pursed Lip Technique - This technique is used for shortness of breath. It is a good way to slow down breathing.
5. Nutritional and Weight Management - Rehabilitation programs should also include counseling for weight and diet factors. This comes after the studies that obesity has been linked to a higher prevalence of asthma and other respiratory diseases as well. Counter to this, people with lung diseases can end up in obesity due to restricted physical activity and outdoor activities. Obesity is a common comorbidity for asthmatic patients. Exercise and weight loss programs should be included in the pulmonary rehabilitation treatment plan.
6. Physiological Counseling - For anxiety and depression, asthma is considered the risk factor. This may lead to general weakness and a reduction in physical activity. The rehabilitation program should include counseling for the mental well-being of the patient so that the person feels confident in himself despite facing the challenges of the disease during the day-to-day activities. Cognitive behavioral therapy helps explore a person's perception and also helps to cope with negative thoughts and behavior toward a positive mindset.
Conclusion
Pulmonary rehabilitation in asthmatic patients aims to improve the symptoms and minimize the further risk. However, the outcome of pulmonary rehabilitation has shown marvelous results in symptoms of chronic obstructive pulmonary disorder in comparison to asthma. Yet the role of pulmonary rehabilitation in cases of asthma can not be negated, as it helps to reduce the distress symptoms. In conclusion, further studies are needed to address the role of pulmonary rehabilitation in improving the care of asthmatics.
