Cardiorespiratory PHTY251 Flashcards
Define COPD
Persistent respiratory symptoms and airflow limitation
This is because of alveolar abnormities
There are 2 branches chronic bronchitis and emphysema
It is common preventable and treatable
Prevalence
2 - 15 % in industries
3rd most common cause of death globally
most common in over 40s
more common in men
Risk factors
Tobacco smoke
Indoor air pollution
marijuana smoking
Antitrypsin deficiency (creates protease antiprotease imbalance causing alveolar destruction
Pathophysiology of emphysema
Caused by cigarette smoke
Releases neutrophils which produces neutrophil elastase. This breaks down the elastin reducing the recoil of the lungs
Volume of proteases increases creating protease antiproteases destroying alveolar attachments. Airways collapse
Reduced elastic recoil means lungs don’t inflate as much. Air gets trapped
Pathophysiology of chronic bronchitis
Inflammation of the bronchi
prevents good airflow into the lungs
this creates more mucus (hypersecretion)
Smoke causes hyperplasia and hypertrophy of mucus secreting glands
This causes problems with ciliated cells
You can get: mucus plugs, mucosal oedema
This increases bacterial colonisation (more infection)
Signs and symptoms of COPD
Progressive shortness of breath
Reduced exercise tolerance
Persistent cough
Chronic sputum production
Weight loss
Peripheral muscle weakness
Expiration is long
FEV1 decreases
Physiotherapy problems for COPD
increased work of breathing
dyspnoea
retained secretions
reduced exercise tolerance
SMART Goals and treatment for COPD
Decrease respiratory rate to 20
Decrease borg scale by 1-2
Use 4 P’s
20ml sputum cleared by end of the session (ACBT and acapella)
Inhaler technique education
Education on smoking and alcohol
Pulmonary Rehab
Aims of COPD management:
Functional management
Control symptoms
reduce exacerbations
Pulmonary rehab to reduce symptoms
What is Cor Pulmonale
Alteration in function of right ventricle
A primary condition like COPD results in hypertension
Low oxygen levels in the lungs leads to vasoconstriction. This increases blood pressure in circulation.
Right ventricle needs to pump harder putting stress on it. Can no longer pump adequately
Define Idiopathic pulmonary Fibrosis
A progressive obstructive lung disease that Effects the interstitum
This is the area between alevolar epithelium and capillary epithelium
Prevalence of IPF
predicted incidence of 5 for every 100,000 people per year
males prodominantly
median age of 60
Pathophysiology of IPF
There is a plasma leak caused by a lesion affecting the alveolar basement layer
There is cellular infiltration and thickening of collagen of the interstitum (Scar tissue)
This makes the lungs stiffer. Can’t expand as much.
The fibroblasts become myofibroblasts which are resistant to apoptosis making it an irreversible scarred lung condition
Signs and symptoms of IPF
Progressive onset
Exertional breathlessness
dry cough
Velcro sounds bilaterally
Sudden opening of small airways causes crackles
Clubbing 50% of cases
Hypoxia
reduced oxygen saturations
signs Cor pulmonale - increased stretching of the heart
Medical management of IPF
Oxygen therapy of breathless patients (pO2 <7.3)
Pulmonary rehabilitation
Palliative care support
Use of some drugs (can be unpleasant) e.g pirfenidone
Could have a lung transplant
Life expectancy is low (average 3 years) therefore it is important to use functional treatment rather than things like “incentive spirometry”. Cannot change outcome
Physiotherapy problems for IPF
Reduced exercise tolerance
Increased work of breathing
Dyspnoea
SMART Goals and treatment
Acute wards: important to have short term goal by day and long term by week
Short term: reduce respiratory rate to 30
reduce borg scale by 1-2
Positions of ease (pillow to prevent active insufficiency)
4 p’s
Long term: prioritise activities
Pulmonary rehab (6-8 weeks)
outdoors mobility in 6-8 weeks
Long term oxygen therapy LTOT
Palliative care
Define Bronchiectesis
Abnormal dilation of the bronchi and bronchioles
This is caused by repeated cycles of airway infection and inflammation
Pathophysiology of bronchiactesis
Experience some kind of infection
This results in immune cells being secreted to the bronchi
immune cells secrete cytokines and proteases
Leads to inflammation
Inflammation damages the elastin and airway walls. Loss of ciliated cells too
There is bronchial dilation trapping the mucus
Better conditions for bacteria
Vicious cycle –> bacteria worsens the condition
Signs and symptoms of bronchiectasis
Persistent cough with sputum
Expectorated sputum
Dyspnoea, chest pain, haemoptysis
breathless
sputum pots and inhalers
clubbing
coarse inspiratory crepitations on auscultation
Scattered wheeze
cor pulmonale
respiratory failure
Medical management of bronchiectasis
Cannot be treated but can be managed
Identify the underlying cause
maintain or improve lung function
reduce exacerbation frequency
inhalers
antibiotics for short or long term
Physiotherapy problems for Bronchiectasis
retained secretions
dyspnoea
reduced exercise tolerance
solutions:
inhaler education
OPEP
4 p’s
Define asthma
Chronic inflammatory disorder of the airways
recurrent symptoms and variable airflow obstruction, airway responsiveness and airway inflammation
Average effects 8 million people in the UK
Risk factors of asthma
Can be modifiable or non modifiable
Non modifiable:
history of atopy (exaggerated allergy response)
develops in males
Persists in females
prematurity and low birth weight
modifiable:
smoking
dust
obesity
infections in infancy
