Physiotherapy for end stage COPD

[clinicalpt]

Hi
What are the symtoms of end stage of COPD?

I am not cardiorespiratory physio at all. sorry. basic question.

Recently, one patient was admitted with pneumonia a few days ago.
Past medical history:emphysema, COAD.
he has brethlessness for years. He has been using home oxygen.
not usually cough, but cough occasionally now. moist, non-productive cough.
not sputm usually, but sputum 1/5 cup now white/sometimes yellow(according to him) but, he couldnt cough up any sputum today. couldnt check that.
wheezy sound usually in expiration, now same.
smoking history for 40 years but quit 20 years ago.
SPO2=96% with 3L O2 currently,
ascultation; lt lingunal lobe and rt lower lobe crackles
chest x ray; havent arrived yet.
afebrile. vital signs were okay.
using ventolin.
premobility; using 4 wheel frame. able to walk oaround home with oxygen(limited by SOB)

I gave him ACBT and tried marching on the spot but he was able to perform only about 15 seconds due to breathlessness and stopped. I think it was prabably too much for him. (a nursing staff reported that he lost appetite after physio. didnt have lunch much yesterday. today, he was unwell. havent treated him today. only advised to cough hourly to remove his sputum if possible) His huffs were not effective and he has poor chest expansion. Because his huffing is not efficient, i am thinking to educate how to do huffing again and if the sputum is too thick to cough up, thinking to start to use nebuliser. also ACBT with (just sidelying) postural drainage.

I think that his problem will be SOB, crackles in two lobes, increased sputum but not able to remove himself, poor chest expansion, decreased exercise tolerance, still using oxygen(will use oxygen for life though)

i think that treatment could be removal secretion including ACBT, breathing exercise with relaxed accessary muscles, mobilisation as the patient tolerates.

if you were his physio, what would you assess and treat? what's precaution and contraindication for him? For this kinds of patient(end of COPD?), better not to mobilise?

a bit unorganised... sorry for that.
would like to listen your opinion... thanx in advance.

[geste123]

hy..i thnk u have to combine pulm rehab as well as brochial hygiene therapy fr ths patient..chk out his exercise tolerance, both on O2 and off O2. u cn make him do some exercises with n without O2,,,thn chk fr his exercise endurance. once u get that, u cn design a exercise prog fr him...it really helps in maintaining his physical ability...ths shd be done along wth gud old Postural drainage techniques with ACBT..dis combination is really effective..
if he's really frail n wasted...thn try NMES to get his muscles bak..