18 ADVANCE FOR RESPIRATORY CARE & SLEEP MEDICINE PULMONARY HEALTH JANUARY 2017 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 key to a patient’s rehab program in two circumstances: being overweight or 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, burning more calories and preventing 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.” WORKING TOGETHER Once an initial comprehensive assessment is completed, clinicians can fine-tune recommendations for physical 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,” Kane 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 OTs focus on the aforementioned skills, helping patients “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, 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.” Dillon Stickle is on staff at ADVANCE. Contact: email@example.com RELATED CONTENT Exercises for Patients with Cardiopulmonary Compromise Putting patients on the proper course of treatment is a highly individualized process.
Advance for Respiratory Care & Sleep Medicine • January 2017
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