Effect of 4-Week Pulmonary Rehabilitation on Dyspnea, Fatigue, Quality of Life and Radiological Findings in a Patient with Pulmonary Renal Syndrome Suffering from Pneumonia - A Case Study

Abstract

Background: Pulmonary renal syndrome (PRS) is a rare, autoimmune disease, defined as combination of pulmonary symptoms (cough, chest pain and dyspnea- at acute stage) and rapidly progressive glomerulonephritis. Pneumonia is an inflammatory condition caused by infectious agents leading to fever, cough and shortness of breath. We report a case of a 42 years old female suffering from PRS and recently diagnosed with bacterial pneumonia. Medically she was managed through antibacterial and oral corticosteroids. At initial encounter of pneumonia, she was in intensive care unit and had cough, dyspnea, pyrexia and fatigue with oxygen saturation (SpO2) of 94% on 15 liters of oxygen via non rebreathable mask. Her chest x-ray demonstrated lobar pneumonia involving right upper lobe. Even after the resolution of pneumonia, she had fatigue, dyspnea and baseline SpO2 of 90-92% on room air. Thus, all the above traits were treated by pulmonary rehabilitation. Purpose: To study the effect of tailor-made pulmonary rehabilitation in pneumonia along with PRS. Method: Physiotherapy was divided into 2 phases: (1) Acute phase: chest physiotherapy (breathing exercises, nebulization, bronchial hygiene, percussion and vibration) (2) Subacute and Late phase: dyspnea management, energy conservation techniques, early mobilization, exercise training (aerobic and strength) Result: 4 weeks of pulmonary rehabilitation resulted in significant improvement in radiological finding, St. George’s respiratory questionnaire (85.39 to 15.53), SpO2 at room air (90% to 99%), Modified Medical Research council score (4 to 1), fatigue severity scale (43 to 21) with an improved inspiratory capacity measured by incentive spirometer. Conclusion: Pulmonary rehabilitation is a structured and multifaceted approach which improves respiratory function, enhance physical fitness, reduces fatigue and the length of hospital stay, prevent recurrence and optimize overall quality of life. Our findings underscore the pivotal role of pulmonary rehabilitation in the treatment of pneumonia alongside Pulmonary Renal Syndrome. Keywords: pulmonary rehabilitation, pneumonia, pulmonary renal syndrome