Authors (including presenting author) :
Chau SK, Lee SL, WC Choi, Chiu YY (1)
Affiliation :
(1) The Duchess of Kent Children’s Hospital at Sandy Bay (DKCH), Hong Kong
Introduction :
Formal pulmonary rehabilitation (PR) programs are very rare in pediatric settings and there is a lack of data evaluating its role and benefit in children with chronic respiratory conditions.
Objectives :
The aim of our retrospective analysis was to evaluate the effects of a structured PR program in children with chronic respiratory disease
Methodology :
A retrospective chart review was performed on all pediatric patients referred for PR program from June 2015 to July 2019 in The Duchess of Kent Children's Hospital at Sandy Bay (DKCH), Hong Kong. Patients who had completed the program for ≥ 3 weeks’ duration were recruited for analysis. The session lasted 45-60 minutes, up to 2 - 3 times per week. It consisted of several components:
1. Breathing training exercise using respiratory aids like incentive or biofeedback type of breathing exerciser;
2. Exercise involving aerobic type of endurance training and resistance type of strength training (ergometer, treadmill, trampoline jumping, and muscle training with weight cuff);
3. Educational training and reinforcement on age appropriate airway clearance techniques, by manual and / or mechanical means.
Demographics and clinical records were reviewed. Pulmonary function tests (PFT) and 6-min walk test (6MWT) were evaluated before and after the PR program.
Result & Outcome :
Fifteen out of 21 patients completed the program for a minimum of 3 weeks, mean duration was 39.8 ± 15 days. There were 8 girls and 7 boys; with a mean age of 9.2 years (5.2-14.2 years). Ten had suppurative lung diseases and 5 had other chronic lung conditions. Pre- and post- PFTs were obtained in all patients and showed statistically significant improvement with mean (±SD) of predicted FEV1% increased from 65.4 ± 17.0 % to 78.3 ± 23.8 %; predicted FVC % increased from 74.1 ± 19.0 % to 86.9 ± 24.5% ; and predicted PEFR % increased from 67.0 ± 24.7% to 80.6 ± 30.8 % (p=0.0001). The improvement in PFT parameters remained statistically significant irrespective of the underlying diagnosis of suppurative versus non-suppurative lung conditions. Only 11 patients had completed 6MWT measurements, the mean distance increased from 453 to 540m (p=0.0011). No adverse events were reported during exercise training. Positive feedbacks were obtained from 12 patients, including reduction in sputum amount and/or subjective improved exercise tolerance. This study showed that structured PR program for pediatric patients can improve lung function and endurance significantly, suggesting a role for PR to be incorporated in the management of children with chronic respiratory conditions.
