Kroonilise obstruktiivse kopsuhaigusega patsiendi taastusravi
Rehabilitation of the patient with chronic obstructive pulmonary disease
Ano de publicação: 2020
Chronic obstructive pulmonary disease (COPD) is the 3rd leading cause of death in the world (WHO 2018). In developed countries, 9-10% of the population aged 40 years and older suffer from COPD, and the incidence of the disease is increasing. According to studies, the risk of incapacity for work in people with COPD is up to 10 times higher compared to the general population (1) .
Rehabilitation is one of the most effective measures to improve the quality of life and physical capacity of COPD patients. In several international treatment guidelines, the highest class recommendation for the implementation of rehabilitation treatment is given for COPD patients. In the Estonian treatment manual "Treatment of Chronic Obstructive Pulmonary Disease" prepared in 2019, great attention has been paid to the importance of rehabilitation and a strong recommendation has been made to implement rehabilitation for all symptomatic COPD patients (2). During the preparation of the recommendation, the need to specify COPD-specific rehabilitation interventions, their intensity, content and patient logistics emerged. After the publication of the treatment manual, it became clear from the feedback of professional societies and associations that the rehabilitation of lung patients in Estonia is undervalued and underutilized: there is no well-established logistics for the rehabilitation of chronic lung patients (including COPD patients). Access to rehabilitation for COPD patients is limited, and the patient's nutrition and psychological and social background are not taken into account when treating a COPD patient, which is why the treatment of the patient is not comprehensive. The reason for this is, first of all, the lack of information of healthcare professionals (including physiotherapists) and patients about the nature and possibilities of pulmonary rehabilitation. Lack of human and financial resources can be mentioned as another important factor in dealing with COPD. Pulmonary rehabilitation is an up-to-date evidence-based treatment method that allows to significantly reduce the number of repeated hospitalizations due to exacerbation of COPD and save the financial resources of the healthcare system. Therefore, rehabilitation is one of the most cost-effective treatment options for COPD patients. also, the patient's diet and psychological and social background are not taken into account when treating a COPD patient, which is why the treatment of the patient is not comprehensive. The reason for this is, first of all, the lack of information of healthcare professionals (including physiotherapists) and patients about the nature and possibilities of pulmonary rehabilitation. Lack of human and financial resources can be mentioned as another important factor in dealing with COPD. Pulmonary rehabilitation is an up-to-date evidence-based treatment method that allows to significantly reduce the number of repeated hospitalizations due to exacerbation of COPD and save the financial resources of the healthcare system. Therefore, rehabilitation is one of the most cost-effective treatment options for COPD patients. also, the patient's diet and psychological and social background are not taken into account when treating a COPD patient, which is why the treatment of the patient is not comprehensive. The reason for this is, first of all, the lack of information of healthcare professionals (including physiotherapists) and patients about the nature and possibilities of pulmonary rehabilitation. Lack of human and financial resources can be mentioned as another important factor in dealing with COPD. Pulmonary rehabilitation is an up-to-date evidence-based treatment method that allows to significantly reduce the number of repeated hospitalizations due to exacerbation of COPD and save the financial resources of the healthcare system. Therefore, rehabilitation is one of the most cost-effective treatment options for COPD patients. The reason for this is, first of all, the lack of information of healthcare professionals (including physiotherapists) and patients about the nature and possibilities of pulmonary rehabilitation. Lack of human and financial resources can be mentioned as another important factor in dealing with COPD. Pulmonary rehabilitation is an up-to-date evidence-based treatment method that allows to significantly reduce the number of repeated hospitalizations due to exacerbation of COPD and save the financial resources of the healthcare system. Therefore, rehabilitation is one of the most cost-effective treatment options for COPD patients. The reason for this is, first of all, the lack of information of healthcare workers (including physiotherapists) and patients about the nature and possibilities of pulmonary rehabilitation. Lack of human and financial resources can be mentioned as another important factor in dealing with COPD. Pulmonary rehabilitation is an up-to-date evidence-based treatment method that allows to significantly reduce the number of repeated hospitalizations due to COPD exacerbations and save the financial resources of the healthcare system. Therefore, rehabilitation is one of the most cost-effective treatment options for COPD patients. which makes it possible to significantly reduce the number of repeated hospitalizations due to exacerbation of COPD and save the financial resources of the healthcare system. Therefore, rehabilitation is one of the most cost-effective treatment options for COPD patients. which makes it possible to significantly reduce the number of repeated hospitalizations due to exacerbation of COPD and save the financial resources of the healthcare system. Therefore, rehabilitation is one of the most cost-effective treatment options for COPD patients.
Rehabilitation refers to a complex multidisciplinary approach that includes assessing the patient's physical and mental status and then implementing interventions (including physical therapy, occupational therapy, nutritional counseling, health behaviors, smoking cessation, patient education) to improve the patient's functional capacity and psychosocial coping. The purpose of this treatment guide is to ensure up-to-date evidence-based treatment for COPD patients and to spread evidence-based information related to rehabilitation among healthcare professionals and patients, thus making the treatment of COPD patients comprehensive.
et|Krooniline obstruktiivne kopsuhaigus (KOK) on maailmas surmapõhjuste seas 3. kohal (WHO 2018). Arenenud riikides põeb vanuses 40 aastat ja vanemd KOKi 9–10% elanikkonnast ja haiguse esinemissagedus suureneb. Uuringute andmetel on KOKi põdevate inimeste töövõimetuse risk kuni 10 korda suurem võrreldes üldpopulatsiooniga (1) .
Taastusravi on üks tõhusamaid meetmeid KOKi-haigete elukvaliteedi ja füüsilise võimekuse parandamiseks. Mitmes rahvusvahelises ravijuhendis antakse KOKi-haigete puhul kõrgeima klassi soovitus taastusravi rakendamiseks. 2019. aastal valminud Eesti ravijuhendis „Kroonilise obstruktiivse kopsuhaiguse käsitlus“ on pööratud suurt tähelepanu taastusravi olulisusele ja antud tugev soovitus taastusravi rakendamiseks kõikidele sümptomaatilistele KOKi- haigetele (2). Soovituse koostamise käigus ilmnes vajadus täpsustada KOKi spetsiifilisi taastusravisekkumisi, nende intensiivsust, sisu ja patsiendi logistikat. Pärast ravijuhendi ilmumist selgus erialaseltside ja ühenduste tagasisidest, et kopsuhaige taastusravi Eestis on alahinnatud ja -kasutatud: puudub kroonilise kopsuhaige (sh KOKi-haige) taastusravi väljakujunenud logistika. KOKi-haigete juurdepääs taastusravile on piiratud, samuti ei võeta KOKi-haige käsitlemisel arvesse patsiendi toitumist ning psühholoogilist ja sotsiaalset tausta, mistõttu ei ole patsiendi käsitlus terviklik. Selle põhjus on eelkõige tervishoiutöötajate (sh füsioterapeutide) ja patsientide vähene informeeritus pulmonaalse taastusravi olemusest ja võimalustest. KOKi käsitluses võib teise olulise tegurina nimetada inim- ja rahalise ressursi puudumist. Pulmonaalne taastusravi on ajakohane tõenduspõhine ravimeetod, mis võimaldab olulisel määral vähendada KOKi ägenemisest tingitud korduvate hospitaliseerimiste arvu ja säästa tervishoiusüsteemi rahalist ressurssi. Niisiis on taastusravi üks kulutõhusamaid KOKi-haige ravivõimalusi.
Taastusravi all mõeldakse kompleksset multidistsiplinaarset lähenemist, mis hõlmab patsiendi füüsilise ja psüühilise seisundi hindamist ja seejärel sekkumiste (sh füsioteraapia, tegevusteraapia, toitumisalane nõustamine, tervisekäitumine, suitsetamisest loobumine, patsiendi koolitamine) rakendamist, et parandada patsiendi funktsionaalset võimekust ja psühhosotsiaalset toimetulekut. Siinse ravijuhendi eesmärk on tagada KOKi-haigetele ajakohane tõenduspõhine ravi ning levitada tervishoiutöötajate ja patsientide seas taastusraviga seotud tõenduspõhist informatsiooni, muutes seeläbi KOKi-haigete käsitluse terviklikuks.