Exploring the Potential Benefits of Pulmonary Rehabilitation

A key legislative effort for the respiratory care profession is Senate Bill 1440, which would require Medicare coverage of both cardiac and pulmonary rehabilitation. Pulmonary rehabilitation has not been a covered benefit in Arkansas for many years. Some private insurers have allowed minimal coverage, but most Arkansans with COPD cannot get coverage for pulmonary rehab or the benefits it may provide. To understand some of the benefits that pulmonary rehab may afford these patients, the public relations staff recently interviewed a respiratory therapist involved in this area of practice.

Kathy Cumnock is a Registered Respiratory Therapist in the Baptist Pulmonary Rehabilitation program. Being an asthma educator led her in the direction of pulmonary rehabilitation education.

When asked about the overall goal of the pulmonary rehab program she replied, “Goals are different for each patient. At Baptist Pulmonary Rehab, the patients set their own goals. For example, one patient’s goal was to be able to go to his favorite fishing spot, which required him to walk up and down a bank while carrying his fishing equipment. I helped this patient meet his goal by having him work with weights and climb stairs over a period of time. These patients still need to do the fun things in life and not let their pulmonary disease restrict them.”

Before patients are able to accomplish their goals, certain criteria must be met in order to be enrolled in the Baptist Pulmonary Rehab program. These criteria include:

• Pulmonary disease diagnosis
• Pulmonary function study (completed within the last year)
• FEV1 less than 65%,
• FVC less than 65%
• DLCO less than 65%.
• Abilility to walk 100 feet. (If not able to walk 100 feet, physical therapy needs to work with patient first.)
• Non-smokers (Smokers must sign a statement, stating they will try to quit and meet with the nicotine nurse on a regular basis).
  

Ms. Cumnock explained that if a patient did not meet criteria for the pulmonary rehab program, she would meet with the medical director twice a month to see what could be done for the patient. For example, if a patient had an FEV1 of 70% instead of less than 65%, the patient would be placed in a maintenance group which would provide support and education about the disease process.
Patients with various pulmonary disease processes are put in the same group sessions. It does not matter the severity of the disease process, or whether it is restrictive, or obstructive in nature, each patient learns from the other patients. Family members are also welcome to come to any of the sessions, as this will help them learn how to best help the patient manage and cope with his or her disease process.

Once accepted into the program, patients will undergo 18 sessions of Pulmonary Rehabilitation, usually scheduled 2 or 3 times weekly. Patients will test during the first session, and again at the last session, to measure progress gained through pulmonary rehab. These tests include:

• Knowledge of pulmonary disease
• Shortness of Breath/fatigue test
• 6 minute walk test

On average, patients will experience an increase of 100 feet in their 6 minute walk test. But progress can also be gained in other areas such as improved attitude, and a better understanding of the disease process. This allows patients to cope and manage their chronic disease process through increased knowledge.

During these sessions patients go through many education and exercise classes. Educational components contain medications, equipment, disease process, and how to conserve energy. “Patients still need to have energy to do the fun things in life, stated Ms. Cumknock. . For example, getting ready in the morning, one could lay out clothes the night before, or have a chair to sit in while taking a shower, or place items used daily within a comfortable reach. These simple things would give someone with chronic disease enough time in the morning to get ready and conserve energy“.

The exercise component of the program focuses on increasing and individual’s strength and endurance in performing activities of daily living. At Baptist Rehab, patient’s use a tread mill, semi-recumbent bicycle, weights, and upper body elliptical machine to help accomplish this objective. During each exercise session, patients are monitored for dyspnea, blood pressure changes, cardiac arrythmias and oxygenation status. Once the 18 sessions are completed, patients are encouraged to join a maintenance group that will allow them to continue with exercises and give them the support and fellowship of others with chronic pulmonary disease.

Kathy Cumnock is a dedicated registered therapist doing a wonderful job in pulmonary rehabilitation. Hopefully, passage of Senate Bill 1440 will allow her and others in respiratory care to provide this much needed service to other pulmonary patients in Arkansas.