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Functional Assessment in Pulmonary Medicine

Functional Assessment in Pulmonary Medicine - Dr.Gyanendra...

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Dr. Gyanendra Agrawal Senior Resident Dept of Pulmonary Medicine FUNCTIONAL ASSESSMENT IN PULMONARY MEDICINE
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Clinical Exercise Testing Increasingly being used in clinical practice: à Impact in the clinical decision making process à Resting cardiopulmonary measurements do not provide a reliable estimate of functional capacity Provide objective measures for diagnosis Provide objective measures for diagnosis, treatment and prognosis
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Types of Clinical Exercise Testing 6 minute walk test Sh ttl lk t t Shuttle walk test Exercise induced bronchoconstriction Cardiac stress test C di l i t t Cardiopulmonary exercise tests
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Indications of 6MWT Before and after treatment comparisons à Lung resect n , Tx à COPD, rehabilitat n To measure functional status à HF, COPD, PVD à Cystic fibrosis To predict hospitalization and death à HF, COPD à Pulm HTN
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Safety Absolute CI à USA or heart attack during previous month Relative CI Resting tachycardia (HR 120 beats/min) or à à Uncontrolled hypertension Ph i i d b Physician need not be present Technician should be certified in CPR
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Performing 6MWT Should be performed indoors along long, flat, straight corridors (30 m) Instruct and demonstrate properly à Walk AS FAR AS POSSIBLE for 6 minutes, but don’t run or jog à Permitted to slow down, to stop, and to rest as necessary à May lean against the wall while resting St d d h f t Standard phrases for encouragement à “You are doing well” à “Keep up the good work” Keep up the good work If practice test is done wait for ~ 1 hr, and report the highest 6MWD Am J Respir Crit Care Med 2002;166:111–117
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Variables Measured 6MWD Secondary measures include à Fatigue and dyspnea, measured by modified Borg or VAS à Arterial O 2 saturation Optimal reference equations from healthy population not yet available 6MWD range from 400 to 700 m Statistically significant mean increase in 6MWD in a group of COPD patients 70 m group of COPD patients 70 m Am J Respir Crit Care Med 1997;155:1278–1282 Respir Care 2003;48(8):783–785
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Interpretation A low 6MWD is nonspecific and non diagnostic The following tests may then be helpful: à Pulmonary function Cardiac function à à Ankle–arm index M l t th à Muscle strength à Nutritional status O h di f i à Orthopedic function à Cognitive function
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WHY 6MWT ???
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Walk tests Time based tests à 2MWT 5MWT 2MWT, 5MWT à 6MWT, 9MWT, 12MWT d d Fixed distance tests à 100 m, Half mile à 2 km walk test Velocity determined tests Controlled pacing incremental tests l h l lk à Incremental shuttle walk test
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6MWT on treadmill Proposed when long corridor not available Advantages: à Continuous cardiovascular and oximetry monitoring à Ease of supplemental O 2 device carriage Disadvantages: à Difficult in elderly coordination problems ifficult in elderly coordination problems à Not interchangeable with conventional 6MWT (14% less 6MWD) If desired, an endurance constant work protocol at 0% elevation and steady speed is preferable Am J Respir Crit Care Med 1999; 160:1540–1543
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Shuttle walk test
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