The Effect of Cardiopulmonary Physiotherapy and Sports Physiotherapy on Asthma Control: Case Study

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The Effect of Cardiopulmonary Physiotherapy and Sports Physiotherapy on Asthma Control: Case Study

   

Theeb Naif S Alsalem1*, Faisal Saadoon F Alenzy2 and Turki Menwer J Almuhaid3

1Physiotherapist, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia

2Physiotherapist, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

3Physiotherapist, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia

*Corresponding author: Theeb Naif S Alsalem, Physiotherapist, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.

Citation: Alsalem TNS, Alenzy FSF, Almuhaid TMJ. (2022) The Effect of Cardiopulmonary Physiotherapy and Sports Physiotherapy on Asthma Control: Case Study. J Neurol Sci Res. 3(1):1-26.

Received: May 02, 2022 | Published: May 20, 2022

Copyright© 2022 by Alsalem TNS, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: The World Health Organization estimations show 235 million people who currently suffer from asthma, and the numbers of asthma deaths are increasing in the next 10 years. Asthma is a chronic disease characterized by intermittent attacks of breathlessness that is triggered by the allergies and cold air commonly. Asthma is well known disease to restrict physical activity, although exercising is one of the ways to manage the disease and minimize the symptoms and attacks.
Methods: Twelve weeks program and each week consist of aerobic training twice, a swimming session, Inspiratory Muscle Training session, breathing exercises and Yoga session in every second week, the patient was introduced to Buteyko Technique as home exercises. The patient was asked to avoid all the allergies (Triggers). The patient was assessed on baseline and on the end of the program using the lung function test and Asthma Control Questionnaires (ACQ).
Discussion: The patient completed the entire program chosen for him and the baseline assessment showed that the patient suffered from symptoms such as coughing and chest tightness especially at night. The lung function test showed improvement on the FEV1 predicted from the baseline (85%) and after the program assessment (92%) with an increase of 7%. The asthma control questionnaires showed also an improvement as the score at the baseline was 2.28 and after the program it is 1.14, which considered as borderline of adequate asthma control.
Conclusion: Twelve-week supervised program of interventions can lead to improvement of lung function test parameter, control and quality of life in asthmatic motivated patients. From the findings a well-structured program influenced from the patient hobbies will keep the patient motivated and will increase the patient physical activities without any restrictions.

Introduction

Asthma is very common disease and the idea of helping patient to manage it and push away as far as possible all the restriction on physical activity and sport is by itself the biggest motivation for me, imagining the patient life with limited sports activity motivate me as well. And by educating the patient to the view of physiotherapy to this disease and the ability to manage it by training programs is my goal. By managing the disease the patient productivity will increase in the levels of work, his or her favorite sports or even simple task of the day like using the stairs. And to give an example there are athletes who have asthma like the American football star player named Jerome Bettis. If they can do it so any patient can. First of all the asthma as defined on WHO (World Health Organization) is “a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day”. Asthma is a widely common disease among almost every society and the numbers are getting higher every year, internationally an estimated 300 million patient who suffer of asthma with an annual 25000 deaths, and by 2025 the number will increase 100 million, And studies shows the increase in the incidence of asthma over the last 20-30 years.  And as far as I was growing up in my hometown the majority of the people think the treatment is only by inhalers. The risk factors of asthma are Genetics or environmental and the Causes of the symptoms are facing the patient in everyday life and the patient need to manage it to provide the patient much easier, happy and symptoms free life. To achieve that we as physiotherapist have to convince the patient that by exercising (which is a trigger) will improve controlling the symptoms.

The topic is physiotherapy management of asthmatic patients in an adult age, physiotherapy approach to the lung diseases is sufficient by all level and it can manage and decrease the symptoms such as coughing, wheezing, shortness of breath, chest tightening and trouble in sleeping. The leading causes of symptoms are the infections, allergies, smoking (primary of even secondary), air pollutions and Exercises. By controlling asthma the patient should have few or no symptoms and minimal usage of medications.

The objectives are to achieve well-controlled asthma the patient has to go through training program and control by spirometer it every week for 10 supervised weeks and 2 unsupervised weeks. By the end of the program my patient should have the characteristics of the well-controlled asthma. And gradually returns to his favorite hobbies and sports. Respiratory diseases are common because of the higher rates of pollutions in the air. Asthma and heart disease have a relationship according to a study found that a patients who have to take daily medications are 60% more likely to have a heart attack in 10 years. So by treating and managing asthmatic patients it is already preventing the patients from having heart problems in the future. In this research these question will answered precisely and detailed:

  1. What is asthma?
  2. What is the different between asthmatic lung and healthy lung?
  3. What is the pathophysiology of the asthma?
  4. What are the signs and symptoms of asthma?
  5. What are the diagnostic methods?
  6. What are the classifications between the asthmatic patients?
  7. What are the risk factors and the triggers?
  8. Is there relationship between asthma and other disease?
  9. What are the pharmacological treatment options for the patients?
  10. How can the physiotherapist help the patient reduce the symptoms?

The levels of asthma control are less than what it should, a research was done on 12 weeks showed that there is a significant effect on the patients symptoms, as measured and controlled by the Asthma Control Questionnaire (ACQ) in the beginning and at the end of the program, and it led to improve the quality of life and motivate even more patients to control their symptoms. I will follow up this research on a patient who has a mild asthma done by the same methods and questionnaires and hopefully it will have the same results [1].

Theoretical Background

The thoracic wall is formed from the spinal column and twelve thoracic vertebrae from the posterior side and from the anterior side the sternum and twelve pairs of ribs and costal cartilages. From the anterior side the first seven pairs of ribs are connected to sternum, and from the 8th to the 10th are connected to each other by the costal cartilage, and the 11th and 12th ribs are floating ribs to allow the full chest expansion.

Figure 1: The thoracic wall [2].

The main blood supply to the sternum it supplied from the superior side by pair internal thoracic arteries that connecter with the lateral thoracic, the acromio-thoracic and the transverse cervical arteries. The internal thoracic artery is branched from the sub clavian artery and it goes posterior to the costal cartilage with the sternum. Ventral skin and muscles are supplied from the superior side by sub claivian vessels.

Figure 2: The main blood supply [2].

There is to mail groups of muscles in the chest wall, inspiratory and expiratory, and that classification comes from the functions. The inspiratory muscles (e.g. sternocleidomastoid and scalene muscles) expand the chest volume by pulling up the superior side of the rib cage. The Expiratory Muscles (e.g. rectus abdominis, internal oblique and external oblique muscles) decrease lung volumes pulling or narrowing the rib cage by downward motion. 

Figure 3: Muscles in the chest wall, Inspiratory and Expiratory [2].

 The diaphragm divides the thoracic and the abdominal cavities and it has a dome shape and supplied by the phrenic nerve. Pass through it the aorta, inferior vena cava, esophagus, vagus nerve and the gastric vessels. The diaphragm movements are concentric (by deep and slow inspiration) and controlled eccentric (exhaling “speaking”).

There are other muscles, which help the breathing and they are attached to the clavicle, scapula and the humarus such as pectoralis major, latissimus dorsi, serratus anterior and trapezius muscle. The movements of the thorax go on 3 planes: antero-posterior, supero-inferior and transversal. During the Inspiration there is trunk extension and during Expiration there is trunk flexion. During rest the diaphragm works (75%) and the intercostal (25%). The movements of the chest cavity seen in breathing during the inspiration and expiration. In inspiration, the inspiratory muscles contract and the diaphragm descends and that makes the rib cage elevate. Elevation of the rib cage increases the volume of thoracic cavity. With that the lung gets stretched and the intrapulmonary volume increases that makes the pressure drops to -1 mmHg. With that the air flows into the lungs until the intrapulmonary pressure equals to the atmospheric pressure, and that is the end of the inspiration and the start of the expiration which the muscles will act the opposite and relax so the diaphragm will raise and the rib cage will descend due the recoil of the costal cartilages. That will lead decreasing of the thoracic cavity volume and due that the intrapulmonary pressure raises to +1 mmHg. Then the air flow out of the lung until the intrapulmonary pressure is zero.

Upper and lower airways (23 generations). The upper starts from the nose until the larynx, and it consist of the nose (which warms and filters and humidifies the air) and sinuses, glottis, pharynx and larynx. The lower airways starts from the Trachea which is 16-20 cartilaginous c-shaped rings opened from the posterior side then 2 main bronchi then it branches more to 5 labor bronchi the top 10 segmental bronchi then to primary and terminal bronchioles which does not have cartilage, so far all the above is called the conducting system (1-16 generation) which has no gas exchange at all. After that comes the exchange surfaces (17-23 generations) which is the respiratory bronchioles and alveolar ducts and the alveolar sacs, and what connects the alveoli to another alveoli is called pores of kohn, and from alveoli to bronchioles is channels of Lambert. And a section of the airway walls consist of the epithelium, goblet cells, ciliated cells, glands, hyaline cartilage, smooth muscles and elastic fibers.