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GENERAL PRACTITIONER'S SECTION
REHABILITATION IN COPD PATIENTS
OP Kapoor
In the past, ‘rest, rest and rest’ was the main treatment advised to patients of chronic ischaemic heart disease. Patients who presented with acute myocardial infarction were advised six weeks strict bed rest. In modern times, rest plays no role in the management of IHD. Even patients having an attack of acute myocardial infarction are advised strict bed rest only for a day or so.
But practitioners, even today, continue to make the same mistake in patients having weak lungs due to chronic obstructive pulmonary disease. In the past, even I used to ask the patients to live within their respiratory reserve and not to strain their weak lungs.
All these views have changed in the last few years. The management of COPD has improved dramatically. Now, the patients are advised rehabilitation. This means that they should be asked to walk as much as possible. It is to be remembered that even patients having angina pectoris should be advised to walk as much as possible (just short of getting angina pectoris!). It is worth noting that COPD patients learn to live with low SPO2 levels. Many of these patients are old and would love to go to the temple, church or mosque daily. But their family physicians advise them against this and frighten them that this would put a strain on their lungs!
My last patient of COPD was a 75 year old Jain, who liked to go to temple daily. I encouraged him to do so (with the help of inhalers of course!). During his next yearly visit, he was very thankful because he could walk to the temple daily which was 1/2 km away from his house. When I examined him, the pulse oximeter showed his reading as 92% (which was his usual reading normally). Thus, this patient adapted to a 1 km walk daily with SPO2 level of 92%. But it is to be remembered that (though some of these patients have associated ischaemic heart disease) often COPD patients live very long, i.e. for ten years or even more, provided their acute exacerbations (occurring maybe once or twice a year) are treated very enthusiastically! Therefore, it is worthwhile remembering that even in chronic lung disease of COPD, the advice should be to walk, walk and walk and NOT to lead sedentary crippled
PROSPECTIVE OBSERVATIONAL COHORT STUDY OF TIME SAVED BY PREHOSPITAL THROMBOLYSIS FOR ST ELEVATION MYOCARDIAL INFARCTION DELIVERED BY PARAMEDICS
Thrombolysis delivered by paramedics with support from the base hospital can meet the national
targets for early thrombolysis. The system has been shown to work well and can be introduced
without delay.
BMJ, 2003; 327 : 22.
