Cardiorespiratory PHTY251

Question 1

Define COPD

Answer 1

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

Question 2

Prevalence

Answer 2

2 - 15 % in industries
3rd most common cause of death globally
most common in over 40s
more common in men

Question 3

Risk factors

Answer 3

Tobacco smoke
Indoor air pollution
marijuana smoking

Antitrypsin deficiency (creates protease antiprotease imbalance causing alveolar destruction

Question 4

Pathophysiology of emphysema

Answer 4

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

Question 5

Pathophysiology of chronic bronchitis

Answer 5

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)

Question 6

Signs and symptoms of COPD

Answer 6

Progressive shortness of breath
Reduced exercise tolerance
Persistent cough
Chronic sputum production
Weight loss
Peripheral muscle weakness

Expiration is long
FEV1 decreases

Question 7

Physiotherapy problems for COPD

Answer 7

increased work of breathing
dyspnoea
retained secretions
reduced exercise tolerance

Question 8

SMART Goals and treatment for COPD

Answer 8

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

Question 9

Aims of COPD management:

Answer 9

Functional management
Control symptoms
reduce exacerbations
Pulmonary rehab to reduce symptoms

Question 10

What is Cor Pulmonale

Answer 10

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

Question 11

Define Idiopathic pulmonary Fibrosis

Answer 11

A progressive obstructive lung disease that Effects the interstitum
This is the area between alevolar epithelium and capillary epithelium

Question 12

Prevalence of IPF

Answer 12

predicted incidence of 5 for every 100,000 people per year
males prodominantly
median age of 60

Question 13

Pathophysiology of IPF

Answer 13

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

Question 14

Signs and symptoms of IPF

Answer 14

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

Question 15

Medical management of IPF

Answer 15

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

Question 16

Physiotherapy problems for IPF

Answer 16

Reduced exercise tolerance
Increased work of breathing
Dyspnoea

Question 17

SMART Goals and treatment

Answer 17

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

Question 18

Define Bronchiectesis

Answer 18

Abnormal dilation of the bronchi and bronchioles
This is caused by repeated cycles of airway infection and inflammation

Question 19

Pathophysiology of bronchiactesis

Answer 19

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

Question 20

Signs and symptoms of bronchiectasis

Answer 20

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

Question 21

Medical management of bronchiectasis

Answer 21

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

Question 22

Physiotherapy problems for Bronchiectasis

Answer 22

retained secretions
dyspnoea
reduced exercise tolerance

solutions:
inhaler education
OPEP
4 p’s

Question 23

Define asthma

Answer 23

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

Question 24

Risk factors of asthma

Answer 24

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

Question 25

Pathophysiology

Answer 25

There is thickening of the airway
caused by hypertrophy and oedema
The smooth muscle of the airways constrict
Basement membrane also thickens
Excess mucus forms

Airway narrowing means it is an obstructive disease

Question 26

Signs and symptoms of asthma

Answer 26

Use of inhalers

increased work of breathing
cough
cyanosis
audible wheeze
tachycardia

Question 27

medial management of asthma

Answer 27

FEV1:FVC <70%
aims to improve FEV1 by 12% using bronchodilators

no daytime or nighttime symptoms
reduce exacerbations (no attacks)
no activity limitations
normal lung function

Question 28

Physiotherapy problems of asthma

Answer 28

increased work of breathing
reduced exercise tolerance
dyspnoea
mucus plugging

treatments:
education on condition
exercise training
breathing techniques
4 p’s
measure peak flow
consider psychosocial factors