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Asthma is a very common diagnosis and results from an airway restriction due to “mucous, smooth muscle constriction, inflammation, and bronchial edema” (Smith-Gabai, 2011, p.158). The associated symptoms with asthma are wheezing and or shortness of breath (Smith-Gabai, 2011). It’s important to inform your patients of the potential symptoms associated with asthma so they are prepared to know how to properly treat themselves. The first recommendation that I would suggest to my client would be consult with their primary care doctor and to obtain medication in the event that an asthma attack occurs (Smith-Gabai, 2011). The medication such as an inhaler and should be on them in case they have an attack. If the client enjoys participating in exercising the modification I would suggest to the client would be to begin their exercise regimen with a pre workout warm up and post workout cool down (Smith-Gabai, 2011). This will ultimately help the client prevent an asthma attack from occurring. Another lifestyle modification that I would suggest would be to learn their specific environmental triggers such as cigarette smoke, exercise or various fragrances that may trigger their asthma attacks (Smith-Gabai, 2011). Overall being proactive and aware of their specific triggers will help them better manage their symptoms. Learning how to adjust and live with asthma will be a hard adjustment but will allow them the ability to improve their overall health and control any asthma attacks they may have.

Resources:

Smith-Gabai, H. (2011). Occupational therapy in acute care. Bethesda, MD: American Occupational Therapy Association, Inc.

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While working PRN at a SNF, I had the opportunity to encounter a few patients with COPD. As an OT, the main objective is to provide energy conservation techniques that will allow them to carry out everyday tasks. Performing activities at seating level is a great way to conserve energy. Sitting at the edge of the bed and using a shower bench are examples of recommendations I would suggest to this population. Another recommendation is teaching breathing and relaxation techniques like "pursed lip breathing' to maintain O2 levels . Finally, proper nutrition and ways to incorporate and execute a balanced diet can also be addressed with this population.

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Following the development of COPD and hospitalization there may be many modifications to daily lifestyles that may need to be made. Some of the key accommodations would be daily activity and energy exertion.  Energy conservation techniques would me very important as well as including breathing techniques to keep O2 saturation levels within a functional parameter. Frequent rest stops may be needed for the patient when planning activities out of the house and places to rest within the house if person becomes overly exerted. Medical equipment such as the a walker with a seat may be needed for activities out of the house where chairs are not readily available and patient is weak. Additionally, feeding adaptations may be needed as much energy can be exerted during feeding. High calorie foods maybe be more appropriate to avoid the need for large consumptions of food to reach daily needed caloric intake. As the disease progresses nasal oxygen may be needed to maintain oxygen levels and activity level may continue to decline. In the event that a patient is diagnosed with COPD they would need to be made aware of these necessary accommodations as well as education of the evolution of the disease and realistic expectations for outcomes.

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Bronchiectasis is a chronic condition where the walls of the bronchi are thickened. It is caused by inflammation and infection in the bronchi. It is stated that this can cause scarring which does not allow the mucus to drain normally. This may lead to infection.  This condition is commonly treated with antibiotics as well as mucus thinning medications.  The modifications that would be important to make would be to incorporate self- care strategies like taking oral and inhaled medications.  Making sure that you preform mucus clearance techniques and well as getting  lots of rest and fluids. The main thing that should be worked on is promoting sputum clearance.

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If I was hospitalized tomorrow with cystic fibrosis there are many things I would need to change about my lifestyle. Cystic fibrosis is a mutation in chromosome 7 which results in disorders of chloride and sodium transport. I would need to exercise for clearance of airways while conserving energy. I would need to be careful to avoid dehydration. It would be important to remember to take all of my medications as they can help to clear my airways. I would need a diet that was high in calories, fat, salt, and vitamins. I would need to be educated on infection prevention and have access to emotional support. I would need to get the annual flu shot and I may even need organ transplants.
If I was an occupational therapist treating a patient with cystic fibrosis I would encourage the patient to engage in routine occupations and maintain lifestyle modifications. Modifications/accommodations  could include; teaching the patient how to manage their daily schedule and medications, developing energy conservation techniques while keeping up with mobility and exercise, maintaining a strict infection control environment at home, keeping up with a proper diet and staying hydrated, and educate them on their disease while working on their psycho-social and emotional reactions to their disease.

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COPD affects millions of people and a large population aren't aware they have the disease. This disease is characterized by shortness of breath, general weakness, the inability to exercise, and little exertion when performing day to day tasks. It's very difficult for COPD patients to dress themselves, ambulate without getting fatigued, and tolerate activities that require any type of movement. As an Occupational Therapist, the focus can be to work on ROM on areas of the body that feel weak as well as standing tolerance and dressing while seated. For dressing we would have to find a way to build endurance so the patient doesn't take an extended amount of time to dress. We can also incorporate relaxation techniques and educate the patient on breathing techniques as well. Last, an Occupational Therapist can do a home assessment and ensure that the main living areas are accessible and ambulation is easy in the home. If the home has stairs, the patient could live on the lower level so they don't exert themselves going up the stairs. The patient could also modify their bed, chairs, or any seats in their home so little exertion is used to get off the bed or chair.

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Chronic bronchitis is one of the most common forms of COPD. It is characterized by air way resistance due to inflammation and edema. People with chronic bronchitis will experience a cough that can last for more than three months in a year, during 2 consecutive years (Smith-Gabai, 2011). If I experienced chronic bronchitis some lifestyle changes that I would address would be keeping my pets off the furniture and out of my bedroom, have my house dusted and vacuumed more often, learn to prep foods while sitting down, and avoid any areas where there is excessive smoke.

As a therapist working with chronic pulmonary disorders, part of the treatment plan should include addressing how to do daily activities differently to reduce anxiety and fear about living with the disorder. For example, educating the patient on how to do the pursed lip breathing technique until stabilization occurs. When working this patient, I would demonstrate technique, and allow the patient to practice it and review. The first step to this process would be to set goals and discuss the treatment plan based upon the patient’s abilities and needs.

Resources:

Smith-Gabai, H. (Ed.). (2011). Occupational Therapy in Acute Care. Bethesda, MD.: AOTA Press.

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Smith-Gabai, H. (Ed.). (2011). Occupational Therapy in Acute Care. Bethesda, MD.: AOTA Press.

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I will discuss emphysema because this extremely debilitating disease is something I unfortunately have experience with. My grandmother passed away from complications of emphysema and it's a very difficult disease to watch someone deal with on a daily basis. Emphysema is "a common type of COPD in which recurrent inflammation destroys the walls of alveoli causing large bullae (air sacs), which leads to air trapping, loss of elastic recoil, hyperinflation, and impaired oxygen exchange" (Smith-Gabai, 2011, p. 155). "Symptoms of emphysema include dyspnea on exertion, malnutrition, weight loss, muscle wasting, clubbing of digits, decreased chest expansion, wheezing, and rapid shallow breathing" (Smith-Gabai, 2011, p. 155). Occupational therapy treatment involves energy conservation. Something as simple as walking to the restroom can be exhausting. Teaching controlled breathing techniques are another way that an OT can assist this population. Modifications to the environment in which they live are very important for this population. There are a number of ways that an OT can help them perform ADL's and IADl's more efficiently while conserving energy. Oftentimes these clients are on oxygen therapy and have problems navigating their environment with tubes and canisters. Another major part of living with emphysema is the psychological toll it takes on the client. They experience high levels of anxiety and depression. OT's can educate on methods to reduce these feelings and ways to better cope with their disease process.

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One of my favorite patients that I've worked with at the hospital where I am employed was a young girl diagnosed with Cystic Fibrosis. Both of her parents had the recessive gene for the disorder and consequently she was diagnosed, as well as two other siblings. The levels of severity between the family members varied drastically, but the little girl in reference was a frequent flyer here at my job, and her CF was far more progressed than the other siblings. Cystic Fibrosis is a pulmonary disorder that ultimately causes a build up of mucous in the airways, making breathing difficult and potentially leading to infections via germ trapping. Working with a child with CF presents interesting barriers for an OT, and opportunities for assisting the patient with coping with a long term diagnosis. One of the biggest hurdles involves with CF is keeping up with breathing treatments, and ensuring a safe environment. I would focus on scheduling with the patient and ways to ensure that the breathing treatments are completed on time, enzymes are taken when they should, etc. Managing the environment is also something that should be focused on; smoke, pollen, dust, etc can all amplify challenges associated with CF. Masking would also be another thing I would focus on with my patient, allow them to do what it is they love but do it in a safe way (ie. wearing a mask when around people). Exercise and education would be long term goals associated with the OT treatment of a CF individual as the overall health and well being of the patient are directly related to how healthy they maintain themselves and how educated they are on the diagnosis/ interventions.

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As a physical education teacher, I deal with asthma on an almost daily basis.  In general, there is increased airway resistance resulting from obstruction from mucous, inflammation, smooth muscle constriction, and bronchial edema.  As occupational therapists, we will do a lot of education with these patients.  We want to teach them to start recognizing and avoiding triggers of their asthma, such as smoke, pollen, strong scents, or cold air.  One trigger we don’t want them to avoid, though, is exercise.  Because exercise and physical activity is such an important part of staying healthy physically and psychologically, we need to teach them techniques to successfully exercise without their asthma causing distress.  Teaching them to utilize warm up and cool down periods will help them avoid broncho-spasm during and after exercise.  While exercising, it is important to breathe through the nose as well to humidify and warm the air rather than breathing through the mouth.  If this is not possible, wearing an mask or scarf over the mouth can be done as well.  If we teach our patients to stay aware of the environment and use the proper techniques, they should start seeing improvement in their daily activities.

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Since I’m interested in pediatrics, I will talk about cystic fibrosis as it is one of the pulmonary conditions that affects children. Cystic fibrosis is a genetic disorder that disrupts chloride and sodium transport across cell membranes causing the lungs to fill with mucous. One aspect of treatment includes percussion and postural drainage techniques as well as huffing, or weak coughing, to clear the lungs of mucous. I would include these techniques at the beginning of each treatment session and work with the child on how to incorporate them throughout their daily routines to help keep their lungs clear. Fairman, Bendixen, Younkin, and Krecko (2016) suggest using reminder apps with children to help them remember to complete their health care routines, so one suggestion I would have for the child and family is to use that technology to help the child take control of their health. Particularly as a child approaches adolescence, I think giving them as much control over their condition as possible is important to increase independence and psychological well-being. Besides reminding the child to clear their lungs or take medications, the alerts could also include reminders about how to most efficiently complete their daily occupations, which may be helpful before the modifications have become habit. For example, just before lunch time each day, an alert could go off that reminds the child of energy conservation techniques such as resting their elbows on the table when bringing food to their mouth and using pursed lip breathing throughout the meal.

Reference: Fairman, A. D., Bendixen, R., Younkin, H., & Krecko, J. R. (2016). Use of assistive technology with transition-aged youth. SIS Quarterly Practice Connections. 1(2), 2–4. Retreived from https://www.aota.org/Publications-News/SISQuarterly/Technology/5-16-transition.aspx.

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Andrew Johnson - Pulmonary Hypertension 

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Andrew Johnson - Pulmonary Hypertension 

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I am going to discuss pulmonary hypertension which is a condition in which there is an elevation in pulmonary artery pressure. This causes the right side of the heart to have to work harder to supply the lungs. This increased work load causes muscle hypertrophy in the right ventricle of the heart and can lead to heart failure. Unfortunately there is no cure for pulmonary hypertension, but there are treatment options that can allow individuals who have pulmonary hypertension to alleviate the symptoms. One of the main concerns that would need to be addressed by an OT would be the clients desired activity levels. Activity levels relate to the client’s workplace, social environment, and home environment. To avoid increasing the risk for heart failure, the client should be educated on proper activity levels. In addition, modifications would need to be made in a variety of other areas of the client’s daily life depending on the client’s treatment choice. In the initial evaluation of the client, I would ask about their workplace, home environment, and social environment, as well as their desired leisure activities. In addition to performing functional tests, I would recommend subsequent visits in order to improve activity tolerance and to educate the client, as well as discuss strategies with the client, on how to best modify lifestyle choices in order to accommodate their new reality.

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Some general symptoms of COPD would be shortness of breath, coughing, wheezing, easily getting infections in the lungs or respiratory system, chest tightening, fatigue, and the overall inability to participate in exercise or other activities. It would be my opinion that as therapists, the fatigue and the overall affect of the patient not being able to participate in activities they enjoy, whether it be exercise or something like gardening, is the part that we really care about. Many times, we as therapists must come up with accommodations or modifications to enable the patient to be able to participate. I have difficulty choosing one modification because we as therapist base everything off of what the patient wants or needs to accomplish. Therefore, I have a few suggestions. If a patient likes to do an activity that normally requires standing, find a way to sit down and do this activity. I like Rich's idea of chairs in every room. You can have the patient use a walker, that way they can always pause and have a base to rest against. You could even have the patient learn yoga or meditations to help with relaxation and breathing techniques. Overall, adapt the activity to enable the patient to participate, whether it is sitting instead of standing, with the aid of a walker, or learning to control the breathing better.

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Emphysema is a type of COPD, which includes symptoms of weight loss, muscle wasting, clubbing of digits, decreased chest expansion, wheezing, and rapid shallow breathing.  Lifestyle changes that would need to be made would be dietary changes, try to avoid cold weather, breathing in fumes and sprays, and avoiding large crowds of people. Occupational therapists can help these clients by helping with controlled breathing techniques, energy conservation strategies, and pulmonary rehabilitation.

These clients will have to accommodate at their workplace by allowing themselves more time to complete tasks. Allowing breaks to rest and help conserve their energy. Having a place to go and sit to practice their breathing techniques throughout the day.

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I'll pick COPD as I have had the most experience with that diagnosis as compared to other pulmonary issues. Energy conservation is key.  Suggestion:  The pursed lip breathing technique to help manage breathlessness. Breathing in through the nose for 4 seconds, and out through the mouth (with the lips close together) for 6-10 seconds. Repeated until breathing feels stabilized. Also, if the patient can spare the money, purchasing a pulse oxygen monitor and training them to make sure the oxygen saturation is close to 95% but at least above 90% at all times. Accommodation in the house: Having available chairs in all rooms to provide for frequent rest breaks.  At work: requesting workplace accommodations to provide the same seating options for rest breaks. This can only be accomplished if their job can be done while seated.