Chronic Obstructive Pulmonary Diseases Flashcards
does obstructive disease produce obstruction of expiratory or inspiratory flow?
expiratory
airflow obstruction can be related to:
retained secretions
inflammation of muscosal lining or airway walls
bronchiole constriction
weakening of support structures of airway walls
air sac destruction
air sac overstimulation w/destruction of surfactant
with obstructive disease, there is a decrease in the size of what structures?
bronchiole lumens
with obstructive disease, there is an increase in the size of what structures?
alveolar sacs
what conditions lead to decreased size of the bronchiole lumens and increased size of the alveolar sacs and resistance to expiratory flow?
COPD and obstructive diseases
what leads to hyperplasia of the mucus secreting cells, reactive airways, destruction of terminal bronchioles, and actual alveolar sacs destruction
obstructive disease
what disease is associated with enlarged submucosal glands?
chronic bronchitis
what disease is associated with smooth muscle constriction?
asthma
what disease is associated with destroyed alveolar walls and fused into one large sac?
emphysema
what is the most common cause of COPD?
smoking
can genetics cause COPD?
yes
what is one pack year?
smoking 20 cigarettes a day for a year
is how many cigarettes you smoke or how old you were when you started smoking more important?
how old you were when you started smoking
what is the cycle involved in COPD starting with inhalation exposure?
inhalation exposure –> inflammatory response–> increase in protease activity and decrease in anti protease activity–> breakdown of elastin and CT–> hyperplasia of mucus-secreting cells
what are the physical impairments of COPD?
inflammation, decreased elastic lung recoil, decreased O2 perfusion, rib cage takes on barrel shape, diaphragm flattens, pelvic floor dysfxn
why is there a decrease in O2 perfusion in COPD?
bc there is a lack of gas exchange from decrease elastic recoil
why is there pelvic floor dysfxn in COPD?
bc they have more forceful exhalations that increase abdominal pressure and puts pressure on the pelvic floor
what are the accessory muscles of inspiration?
SCM, scalenes, upper trap, and pec group
t/f: decreased strength of both skeletal and respiratory musculature are “independently associated w/poorer exercise capacity and lower extremity functioning across the spectrum”
true
what is usually the cause of an inability to exercise in COPD?
LE weakness
what factors affect aerobic metabolism and poor muscle endurance?
a shift from type 1 to type 2
reduction in mitochondrial density per fiber bundle
reduction in capillary density
high pro-inflammatory mediators
what are the psychological impairments of obstructive disease?
SOB causes anxiety and depression which leads to sickness and further weakness
what disease leads to lung hyperinflation?
obstructive disease
what are common physical signs of obstructive lung disease?
elevation of the shoulder girdle
horizontal ribs
barrel-shaped thorax
low, flattened diaphragm
would radiographic mechanical changes in structures of obstructive lung disease be found early on?
no, only in ppl with severe disease
are the results of radiographs or spirometry more important in early obstructive lung disease?
spirometry
what is the gold standard for dx of bronchiectasis? (KNOW THIS)
CT
what are the symptoms of obstructive lung disease?
dyspnea on exertion, esp during functional activities
may have increased anxiety levels
secretion production and cough
is COPD associated with larger or smaller lung volumes and capacities?
larger
is vital capacity normal or increased/decreased in obstructive disease ?
normal to decreased
are residual volume and functional residual capacity normal or increased/decreased in obstructive disease?
increased
is total lungs capacity normal or increased/decreased in obstructive disease?
normal to increased
is the RV/TLC ratio normal or increased/decreased in obstructive disease?
increased
does FEV1/FVC ratio increase or decrease with disease progression of COPD?
decreases
what is the FEV1/FVC ratio in obstructive disease?
<70%
what is normal FEV1/FVC ratio?
75%
with obstructive disease, is there a difference with in PFTs pre and post bronchodilators?
there can be
what % of change in PTFs pre and post bronchodilators would indicate a meaningful change?
12%
t/f: the use of bronchodilators prior to exercise w/PT may improve pt’s exercise tolerance
true
COPD is the __ leading cause of death
4th
t/f: COPD is preventable and treatable
true
what is COPD?
chronic airflow limitation caused by mix of parenchymal alveolar disease (emphysema) and small airway disease (obstructive bronchiolitis)
COPD is a combo of what 2 obstructive diseases?
emphysema and obstructive bronchiolitis
what are the risk factors for COPD?
cigarette smoking, air pollution, inhalation of smoke or noxious particles
what is the most common risk factors for COPD?
cigarette smoking
what is emphysema?
condition of the lungs characterized by destruction of alveolar walls and enlargement of air spaces distal to the terminal bronchioles
what are the subtypes of emphysema?
centrilobular (centriacinar)
panlobular (panacinar)
distal acinar (paraseptal)
what is the most common cause of emphysema?
heavy smoking
what is the most common subtype of emphysema?
centrilobular
t/f: the lungs can repair itself with emphysema
true
what is effected by centrilobular emphysema?
the central part of the respiratory unit
what is effected by panlobular emphysema?
the distal component of the respiratory unit
what is affected by distal acinar emphysema?
closer to the septum
how does a patient with emphysema present?
older
thin
severe dyspnea
quiet chest
hyperinflation
flat diaphragm
how does a patient with chronic bronchitis present?
overweight
cyanotic
elevated hemoglobin
peripheral edema
rhonchi and wheezing
what is chronic bronchitis?
presence of a productive cough for 3 months in each of 2 successive years provided that the other causes of mucus production have been ruled out
hypertrophy of submucosal glands
hypersecretion of mucus
does the hypersecretion of mucus in chronic bronchitis begin in large or small airways?
large airways first, then small airways
what is the Reid index?
the ratio of gland to bronchial wall thickness?
normally 3:1
what is a normal Reid index?
3:1
how high can a Reid index be in chronic bronchitis?
8:10
what is the pathophysiology of COPD?
decreased elastic recoil
trapped mucus
air can’t get out
what are the symptoms of COPD?
productive cough
dyspnea
describe the cough associated with COPD?
productive
starts intermittently and progresses to daily
sputum initially thin and watery and becomes more purulent
purulent during period of infection
describe the dyspnea associated with COPD?
increased effort to breath, heaviness, air hunger, and gasping
persistent and progressive
1st noted with strenuous exercise and progresses to w/walking and functional activities
expiration of greater than ___ seconds is abnormal
4
what are the signs for COPD?
barrel chest
flattened hemidiaphragms
tripoding
pursed lip breathing
central cyanosis
jugular vein distention
ankle swelling
what are the diagnostic tests for COPD?
auscultation
breath sounds
CT scan for early detection
in COPD, what would you hear upon auscultation?
prolonged expiratory phase
possible wheezing on expiration
what breath sounds are associated with COPD?
diminished breath sounds in all lung fields
rhonchi and localized wheezing with secretions
what is tripoding?
leaning over to try to catch your breath, commonly seen in COPD
in the advanced stages of COPD, what additional signs would be present?
central cyanosis
jugular vein distention
ankle swelling
what would you see on a CT of COPD?
focal emphysema and air trapping
describe stage 1 (mild) COPD
FEV1: >80
FEV1/FVC: <0.7
chronic cough, sputum
describe stage 2 (moderate) COPD
FEV1: 50-80
FEV1/FVC: <0.7
chronic cough, sputum, dyspnea
describe stage 3 (severe) COPD
FEV1: 30-50
FEV1/FVC: <0.7
chronic cough, sputum, dyspnea
describe stage 4 (very severe) COPD
FEV1: <30
FEV1/FVC: <0.7
chronic cough, sputum, dyspnea
a decrease in what levels would characterize disease progression in COPD?
O2
with emphysema, will PaCo2 initially be high, low, or normal?
normal
with chronic bronchitis, will PaCo2 increase or decrease with progression?
increase
when do blood gas abnormalities usually worsen?
during exercise, sleep, and acute exacerbations
PaO2 of <60 with or w/o PaCo2 of >50 is indicative of what?
respiratory failure
what is the main goal in medical treatment of COPD?
relief of symptoms
what are the goals of medical treatment for COPD?
relief of symptoms
disease progression prevention
improve exercise tolerance
enhance health status
prevent and treat complications
reduce mortality
what is hematocrit of >55% indicative of?
polycythemia
what is the medical treatment for COPD?
smoking cessation
pharmacotherapy
flu vaccine
treatment for sleep disorders
supplemental o2 in later stages
pulmonary rehab and exercise training
surgical excision of bullae or lung volume reduction surgery (LVRS)
bronchodilators, antiinflammatories, combo, or antibiotics
what is the prognosis for COPD?
progressive disease with expected worsening over time
what is the BODE index?
body mass
obstruction
dyspnea
exercise
score of 7-10 has high mortality rate
what are implications for PT treatment with a pt with COPD?
secretion clearance
controlled breathing at rest and with activity
ambulation w/rolling walker
education on use of recovery from SOB positions
endurance training
strength training
if we have a pt with COPD, when would we not want to do secretion clearance?
when they have hemoptysis (bloody cough)
what is bronchiectasis?
irreversible dilation of the bronchia w/ chronic inflammation and infection
often idiopathic or associated with prior lung infection/injury
distortion of conducting airways, thickening, herniation, or dilation
what is localized bronchiectasis?
due to intraluminal obstructive process
inhaled foreign body
tumor
what is diffuse bronchiectasis?
underlying systemic cause
what are the 3 mechanisms of bronchiectasis?
1) bronchial wall injury/structural weakness
2) traction from adjacent lung fibrosis
3) bronchial lumen obstruction
what mechanism of bronchiectasis results following an infection or inhalation accident or genetic condition?
bronchial wall injury/structural weakness of bronchial walls
what mechanism of bronchiectasis results following fibrotic changes from restrictive lung disease?
traction from lung fibrosis
what mechanism of bronchiectasis results following a slow growing tumor in the airway and fibrotic changes?
bronchial lumen obstruction
what conditions are associated with bronchiectasis due to traction?
restrictive pulmonary diseases, sarcoidosis, usual interstitial pneumonitis (idiopathic pulmonary fibrosis), infections, tuberculosis, and radiation fibrosis
what are the triad of symptoms associated with bronchiectasis?
1) cough
2) sputum production
3) hemoptysis
when is sputum greatest in bronchiectasis?
in the morning
what are the diagnostic tests for bronchiectasis?
HRCT (GOLD STANDARD)
PFTs
blood work
sputum testing
gastroesophageal evaluation
what is the gold standard for diagnosing bronchiectasis? (KNOW THIS)
HRCT
what is the criterion for dx of bronchietasis on HRCT?
internal luminal diameter of one or more bronchi exceeds that of adjacent pulmonary artery
what is the signet ring sign? (KNOW THIS)
cylindrical, varicose, and saccular
dilated bronchus and adjacent arteriole seen on CT
what is the most severe form of bronchiectasis?
saccular
what type of bronchiectasis may form a honeycomb pattern?
saccular and cystic
what is being looked for in a sputum test for bronchiectasis?
Haemophilus influenzae and Peudomonas aeruginosa
what will blood work show in bronchiectasis?
ventilation-perfusion mismatch
what would be heard in a pt with bronchiectasis upon auscultation?
crackles over the involved lobes
rhonchi during periods of mucus retention
shallow breathing to avoid coughing
what is the goal of medical management of bronchiectasis?
decrease the # of exacerbations and improve QOL
how are acute exacerbations of bronchiectasis treated?
with antibiotics if needed
what is the long term management for bronchiectasis?
nebulizer meds
bronchodilators as needed
pulmonary hygiene
what does the prognosis for bronchiectasis depend on?
the underlying disease/condition
what two obstructive diseases have the poorest prognosis?
CF and bronchiectasis
what are the prevention measures for bronchiectasis?
genetic screening
what are the implications for PT treatment of bronchiectasis?
secretion clearance
controlled breathing
strength and endurance training
what is CF (cystic fibrosis)?
a multisysmteic disease affecting organs that have epithelial surfaces
mucus stasis in conducting airways of lungs, nasal sinuses, sweat glands, small intestine, pancreas, and biliary system
failure of the airways to clear mucus
what systems are most affected by CF?
pancreatic and pulmonary
CF is characterized by the abnormal transport of ___ and ___
salt, water
what are the symptoms of CF?
failure of the airways to clear mucus normally
persistent cough that becomes productive with tenacious, purulent, green sputum
recurrent lung infiltrates
meconium ileus at birth
malabsorption of nutrients
maldigestion and fecal impaction in terminal ileum
failure to thrive with steatorrhea (fatty stool)
pancreatic insufficiency
what are the diagnostic tests for CF?
sweat test (looks for elevated chloride)
newborn screen
radiographic tests (obstructive and restrictive signs)
ABGs (decreased gas exchange)
is CF obstructive or restrictive?
both
what are the goals of medical management of CF?
controlling lung infection, promoting mucus clearance, improving nutritional status, pancreatic status, and nutritional supplementation
what is the prognosis for CF?
dramatic increase in median age of survival
how is CF prevented?
genetic screening
screening of CF carrier status
what are the implications for PT with CF?
secretion clearance techniques
controlled breathing techniques
exercise and strength training
inspiratory muscles training
thoracic stretching exercises
postural reeducation
what is asthma?
chronic inflammatory disorder of airways
“episodic” obstructive lung condition
what causes asthma attacks?
viral/allergen exposure, exercise, inhalation of cold air
what are the symptoms of asthma?
wheezing, chest tightness, SOB
what are the diagnostic tests for asthma?
PFTs to evaluate the current fxn and reversibility of the obstruction after bronchodilators administration
what are the special types of asthma?
seasonal, exercise-induced, asthmatic bronchitis
the following lung fxn is indicative of what step of asthma? :
FEV1 or PEF ≤60% predicted
PEF variability >30%
step 4 (severe persistent)
the following lung fxn is indicative of what step of asthma? :
FEV1 or PEF >60% to <80% predicted
PEF variability >30%
step 3 (moderate persistent)
the following lung fxn is indicative of what step of asthma? :
FEV1 or PEF ≥80% predicted
PEF variability 20% to 30%
step 2 (mild persistent)
the following lung fxn is indicative of what step of asthma? :
FEV1 or PEF ≥80% predicted
PEF vari
step 1 (mild intermittent)
what is the medical management for asthma?
emphasis on long term management
objective measures of fxn and monitoring
ID and elimination of causes
comprehensive pharmacological therapy
therapeutic partnership
what % of children with asthma will continue to have symptoms into adulthood?
50%
how is asthma prevented?
adhering to medical and pharmacological recommendations
avoidance of personal asthma-triggering substances
what are the implications for PT with asthma?
intervention shouldn’t begin until medical regimin has been established
secretion clearance
controlled breathing
exercise and strength
thoracic stretching
postural reeducation
