13-14. Pulmonary Disease Flashcards
Does exercise develop a large lung? Does lack of exercise create pulmonary disease?
No
What is the primary cause of pulmonary disease in the U.S.?
Smoking
List at least 3 smoking-related diseases.
- CAD / Atherosclerosis
- Lung cancer
- COPD
- Bladder cancer
- Premature skin aging
- Erectile dysfunction
- Oral pharyngeal cancer
Compare the frequencies of the 3 main smoking-related diseases.
- Lung cancer = 15/10K
- Atherosclerosis = 150/10K
- COPD = 2.5-5K / 10K
What are the primary physiologic functions of the lungs?
- Ventilation (air pumping)
- Diffusion of gases
How would a physiologist broadly divide the diseases of the lung? What is the primary deficit in each of these conditions?
- COPD: impaired ventilation
- Emphysema: impaired diffusion of gases
What are the 2 conditions that impair ventilatory function? Which is more common?
- Airway obstruction (COPD) = more common
- Volume restriction = more uncommon
Using FVC and FEV1 as measurements, how would you distinguish the 2 patterns of ventilatory impairment?
- Airway obstruction: FEV1 / FVC greater than 90%
- Volume restriction: FEV1 / FVC less than 70%
What diseases are grouped in COPD?
- Emphysema
- Chronic bronchitis
- Asthma
What distinguishes asthma from other COPDs?
Asthma is rapidly precipitated (minutes) and reversible
How can one measure impairments of diffusional function in the lung?
- Pulmonary function tests
- D(Lco)
How does a patient w/ significant diffusional impairment differ from a normal person in terms of oxygen hemoglobin saturation during exercise?
No difference b/c arterial oxygen saturation never drops
What is the normal value for FEV1?
80%
At max exercise, what % of the max ventilatory volume is used?
70-80%
What 2 basic morphological changes in alveolar septal structure are diffusional disease derived from? How does each affect ventilation?
- Thickened lungs –> impaired diffusion
- Stiff lungs –> impaired ventilation
What are the general steps in treating pulmonary disease in adults?
- Remove damaging agents (smoking, allergens, cold air)
- Suppress active inflammation or infection (antibiotics, steroids)
- Avoid future damage and infections
- Manage fixed residual airway obstruction (bronchodilators, steroids)
- Supplemental oxygen
- Exercise rehab
What is generally the fatal complication of COPD? What interventions help avoid this?
LOOKUP
What has been added to bronchodilator therapy in the last 20 years that significantly improves control and slows disease progression?
LOOKUP
Can the improvements created by pulmonary rehab (exercise training) in COPD be recreated by some combo of pharmaceutical therapy?
No
What is D(Lco)?
- Rate of disappearance of a small breath of carbon monoxide into the bloodstream
- Desaturation of arterial blood below 95% during exercise
What are the most provocative causes of exercise-induced asthma?
- Intense exercise w/ no warm up
- Cold, unfiltered air
How do you treat exercise-induced asthma?
Combo of bronchodilators and anti-inflammatories
What CAN’T exercise training do for pulmonary patients? Why not?
Improve ventilatory of diffusional impairments b/c damage usually permanent
What CAN exercise training do for pulmonary patients?
- Increased peak inspiratory pressures
- Decreased ventilatory muscle fatigue
- Habituation to high ventilatory muscle tensions
- Less demand for ventilation for any given task
