Role of Pulmonary Rehabilitation in Silicosis

ROLE OF PULMONARY REHABILITATION IN SILICOSIS

INTRODUCTION:

Physiotherapy is an emerging branch in modern medical and health science. There are articles suggesting role of physiotherapy in musculoskeletal, neurological, cardiovascular, respiratory, pediatric, geriatric and many more areas. [1] Role of Physiotherapy is well established in occupational lung disease. Silicosis is an ancient occupational lung disease with high incidence and prevalence till the date, still the role of pulmonary physiotherapy is yet not established up to the mark.[2]

Silicosis is an occupational lung disease occurs by inhalational of dust containing particles of crystallite silica (free silica/SiO2), which is present various industrial and mining work. For understanding Pathology, Signs and Symptoms have a look at below videos of American Lung Association https://www.youtube.com/watch?v=1FZS8s3KdTA&feature=youtu.be and Dr.G Bhanu Prakash Animated Medical Videos https://www.youtube.com/watch?v=6yEtisMfyMY Also check what Occupational Safety and Health Administration states abut silicosis at https://www.osha.gov/Publications/silicosis.html

Diagnosis of silicosis can be made by History of patient which may include duration of exposure, type of mining/grinding work, various other Laboratory and Radiological Investigation. Pulmonary function testing, exercises tolerance testing and chest examination are some of tool which can proved a physical therapist idea about lung health, lung capacity and compliance.[3][4]

As silicosis is progressive disease, for management of silicosis there is no any well established and proven therapies which can reverse the disease. But preventive measure or providing a risk free work environment is consider as an important aspect in prevention/management. In patient who has already developed silicosis can be treated with respiratory Physiotherapy for several symptoms present in patient[2]. Role of Physiotherapy in various occupation lung diseases is available in various research.[3]

PROBLEMS LIST IN SILICOSIS:

Following are the few of problems facing by patients which can be addressed by various therapeutic approaches.

  • Dyspnea
  • Altered lung function
  • Increased work of breathing and respiratory rate
  • Chest pain & tightness
  • Mucus accumulation
  • Altered breathing mechanics
  • Altered quality of life
  • Fatigue

ROLE OF PULMONARY REHABILITATION

According to An Official American Thoracic Society “Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health-enhancing behaviors. It is believed that tailor made pulmonary rehabilitation has significant impact on above mentioned problems in not only COPD but also in occupational lung disease such as silicosis[5].

Several health benefits can be obtained from pulmonary rehabilitation[6][7] such as...

  1. Sessions are planned in a group so patient can meet other patient with similar problems which gives them motivation and support of others.
  2. Decrease the disease burden and help patient to cope up with disease
  3. Patient can learn strategies to manage several problems by his own which may make the independent living better.
  4. Energy management and energy conservation helps patient to live life with an ease.
  5. It may decrease need of hospital visits.

- Pulmonary rehabilitation mainly includes:

A.Patient Education & Behavioral management

B. Exercises Training

- It further can cover various aspects of management such as

C. Nutritional counseling

D. Education about your disease and how to manage it

E. Breathing strategies

F. Psychological counseling and/or group support.

Patient Education & Behavioral management

Patient education improves the patients’ understanding about his health status and disease[8]. There are many means by which patient education can be delivered effectively such as use of audio-visual device, PowerPoint presentations, Posters or charts, Models or props, written literature-pamphlets etc. According to the need of group of people and rehabilitation set up the most effective way should be chosen. Number of session should be kept more than one as it’s important that patient understand the education program and being able to implement it in routine. Repetitive sessions, discussion session. One to one interaction etc will help the information to reach to every individual and understand it thoroughly.

Patient education of silicosis patient should included

  • Normal structure and function of respiratory system
  • What is silicosis, How silica particles have affected respiratory system and prognosis of disease
  • How aerobic exercises, resisted exercises, breathing exercises will improve overall health status and lung function and capacities.
  • What are the necessary life style changes, how will make life easy
  • What are safety precautions required
  • How to be prepared for emergencies
  • What are the agencies which can provide psychological & socio-economical assistance.

Exercises Training

Exercises training comprise of main 4 components:

  1. Aerobic training
  2. Resisted training
  3. Breathing exercises
  4. Stretching exercise

Exercises training have many health benefits in patient with silicosis such as..

  1. Helps to maintain/improve cardiovascular health
  2. Helps to improve blood circulation
  3. Helps to improve lung function
  4. Help to reduces fatigue intensity and frequency of episodes
  5. Helps to improve breathing pattern
  6. Helps to maintain/improve muscle length
  7. Helps to reduce chest tightness
  8. Helps to improve quality of life by various means

• Dosage of all exercises should be decided according to the patient exercise testing prior to enrollment in exercises program https://www.physio-pedia.com/Pulmonary_Rehabilitation ([5])

Thus, silicosis is not any uncommon disease yet, pulmonary rehabilitation and role of physiotherapy is yet required to establish. The scope of further research and development in this area is wide.

  1. 1.      Kanu K,Kumar K R, Physiotherapy–of the 21st century is an emerging branch of health services, MOJ Yoga & Physical Therapy, Volume 4 Issue 1 - 2019
  2. 2.0 2.1 https://www.cdc.gov/niosh/learning/b-reader/pathology/silicosis/1.html
  3. 3.0 3.1 Trivedi S,Effect of Pulmonary Rehabilitation on Functional Capacity of Lungs and Dyspnea in Patient with Silicosis in Anand District of Gujarat,Indian Journal of Physiotherapy and Occupational Therapy. July-September 2017, Vol. 11, No. 3,DOI Number: 10.5958/0973-5674.2017.00105.8
  4. Ochmann U. Long-Term Efficacy of Pulmonary Rehabilitation in Patients with Occupational Respiratory Diseases. Respiration  2012;84:396–405  Published online: May 31, 2012
  5. 5.0 5.1 An Official American Thoracic Society/EuropeanRespiratory Society Statement: Key Concept sand Advances in Pulmonary Rehabilitation. JANUARY 2013 AND FEBRUARY 2013 
  6. https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/pulmonary-rehab
  7. Trivedi S.,Effect of Singing along with Pulmonary Rehabilitation on Quality of Life and Dyspnea in Patient with Chronic Obstructive Pulmonary Disease,International Journal of Health Sciences & Research (www.ijhsr.org),Vol.7; Issue: 7; July 2017
  8. Gallefoss F.,The effects of patient education in COPD in a 1-year follow-up randomised, controlled trial, Patient Education and Counseling 52 (2004) 259–266,doi:10.1016/S0738-3991(03)00100-9