Chronic Obstructive Pulmonary Disease

Question 1

What is apart of the conducting division?

Answer 1

• Nose
• Pharynx
• Larynx
• Trachea
• Bronchi
• Bronchioles

Question 2

What is apart of the respiratory division? (Gas exchange)

Answer 2

• Alveolar space

- Alveoli

Question 3

What is apart of the upper respiratory tract?

Answer 3

• Nose
• Pharynx
• Larynx

Question 4

What muscles are responsible for inhalation?

Answer 4

• Diaphragm
• Sternocleidomastoid (elevates sternum, clavicle and rib #1)
• Scalenes (elevates rib 1 & 2)
• External intercostals (elevates ribs)

Question 5

What muscles are responsible for exhalation?

Answer 5

• Elastic recoil of the lungs
• Internal intercostals (depresses ribs like dropping a bucket handle)
• External oblique, internal oblique, rectus and transverse abdominus (moves inferior ribs down, compresses abdominal cavity, pushes relaxed diaphragm superiorly)

Question 6

What are some other factors of the lungs?

Answer 6

• Gas exchange
• Communication of air flows across vocal cords
• Smell
• pH balance (eliminating CO2)
• BP regulation (angiotensin II pathway)
• Platelet production
• Blood and lymph flow
• Blood filtration

Question 7

What is PEFR ?

Answer 7

Peak expiratory flow rate

Question 8

What is PIFR?

Answer 8

Peak inspiratory flow rate

Question 9

What is FEV1?

Answer 9

Forced expiration volume in 1 second

Question 10

What are some reasons for restrictive lung disease?

Answer 10

• Change in the lung parenchyma (fibrosis)
• Disease of the pleura (outside the lung)
• Changes to the chest wall (obesity)
• Neurological issues (Muscular dystrophy)

Question 11

What are some reasons for obstructive lung disease?

Answer 11

• Increased resistance to airflow
• Disorder of the lumen
• Change to the wall of the airways
• Change in the peri bronchial region

Question 12

What some typical COPD?

Answer 12

Chronic bronchitis, emphysema, asthma and hypoxemia

Question 13

What is chronic bronchitis?

Answer 13

Irritation of mucosal gland and over production. There is more mucus in the airways that we can clear and CO2 gets stuck (air trapping)

Question 14

What is emphysema?

Answer 14

Immune response to irritants - elastase eats the connective tissue and the alveoli walls weaken and rupture

• Less air can get in and less CO2 air can get out
• Hypoxia and hypercapnia occurs as well

Question 15

What is hypoxemia?

Answer 15

Low partial pressure of oxygen. Vasoconstriction due to potassium accumulation causing calcium channels to blood
-Causes pulmonary high blood pressure

Question 16

What is asthma?

Answer 16

Bronchoconstriction of the airways, immune response to IgE, mast cells, histamine -> contraction of smooth muscle

• Is reversible through bronchodilators
• 4 x 4 method

Question 17

What is exercise induced bronchoconstriction?

Answer 17

A decrease of 10% in FEV1 post exercise (13% for children)

Question 18

What is a form of exercise testing for this population?

Answer 18

BODE index
-BMI
-Degree of obstruction (FEV1 as a %)
-Dyspnoea (0-4 scale)
-Exercise and endurance (6MWT)
Graded treadmill (Naughton) or RAMP
Avoid arm ergometer

Question 19

What is the oxygen saturation termination criteria?

Answer 19

<85% during exercise

Question 20

What are some common things to look for in this population?

Answer 20

Fine tremor = bronchodilators
Warm and sweaty hands = hypercapnia
Nicotine staining = still smoking
Cyanosis = poor peripheral blood perfusion
Clubbing = hypoxia

Question 21

What is pursed lip breathing?

Answer 21

Inhale through nose for 2 seconds, exhale for 4 seconds with narrow passage
-Can be used to decrease SOB

Question 22

What benefits can you expect from exercise?

Answer 22

Increased ADLs, cardiovascular reconditioning, improved ventilatory efficiency, improved lactate and ventilatory thresholds, desensitisation to dyspnoea, decreased fear of activity, increased muscle strength, balance and body composition