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Clinical Exercise Prescription > COPD > Flashcards

COPD Flashcards

1
Q

COPD definitions

A

A condition that makes it harder to breathe due to damage to airways and destruction of lung tissue (parenchyma)

  • The collective (and preferred) term for patients with airflow obstruction and inflammation in the lungs, who were previously diagnosed with chronic bronchitis or emphysema
  • A preventable condition, which is poorly reversible, and progressive in nature
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2
Q

how is COPD diagnosed

A

There is no single diagnostic test for COPD

• A clinical judgement, based on history, examination and confirmation of airflow obstruction using spirometry

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3
Q

what is GOLD 1

A

Mild
FEV1/FVC <0.70
FEV1 > 80% predicited

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4
Q

What is GOLD 2

A

Moderate
FEV1/FVC <0.70
80% > FEV1 > 50% predicited

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5
Q

what is GOLD 3

A

Severe
FEV1/FVC <0.70
50% > FEV1 > 30% predicited

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6
Q

What is GOLD 4

A

Very severe
FEV1/FVC <0.70
FEV1 < 30% predicited or FEV1 <50% predicited plus chronic repsiratory failure

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7
Q

COPD prevalence UK

A
  • 1 million diagnosed with COPD
  • Approximately 2 million undiagnosed cases
  • 1 in 8 people over 35 y has undiagnosed COPD
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8
Q

comorbidities associated with COPD

A

CVD, chronic inflammation, CHF, muscle atrophy, osteoporosis, metabolic disease, depression

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9
Q

effect of tabacco on COPD

A

Tobacco attributable to:
• 73% of COPD mortality in high-income countries
• 40% of COPD mortality in low/middle-income countries

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10
Q

effect of pollution on COPD

A

Accounts for ~20% of COPD (rises to 31% in “never smokers”

Accounts for ~35% of COPD in low/middle income countries

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11
Q

effet of COPD on exercise

A

impaired ability ot empty lung during exercise (dynamic hyperinflation)

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12
Q

evidence of PA on COD

A

hosptial admission shorter
time to death longer
27% reduced risk of death for moderate PA
20-40% reduction of hosptial admission for PA

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13
Q

causes of muscle dysfunctin in COPD

A 
malnutrition 
hypercapnia 
hypoxia
medicatins 
disuse/Physical inactivity 
oxidative stress
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14
Q

objectives of pulmonary rehab

A
  1. To control, alleviate and, if possible, reverse the symptoms and pathophysiologic processes leading to respiratory impairment
  2. To improve quality of life, and attempt to prolong the patient’s life
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15
Q

essential components of pulmonary rehab

A
  1. Exercise training
  2. Education
  3. Psychosocial/behavioural interventions
  4. Outcome assessment
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16
Q

practical goals of pulmonary rehab

A
  • Reduce the cost of breathing
  • Improve pulmonary function
  • Normalise arterial blood gases
  • Alleviate dyspnoea
  • Increase efficiency of submaximal exercise/tasks
  • Improve exercise capacity and ability to perform daily activities
  • Correct poor nutrition
  • Restore a positive outlook/improve emotional state
  • Decrease health-related costs
  • Lengthen quality and quantity of life
17
Q

what should the exercsie program be like

A
  • Use dyspnoea scale first: level 2-3
  • HR or VO2 can be used to set exercise intensity from a GXT Caution needed
  • Try to exercise at > 50 % peak VO2 Caution and common sense needed
  • Circuit based activities of 1-10 min
  • Rest intervals allow a greater intensity to be tolerated
  • Rest intervals allow for recovery of oxygen saturation
  • Aim to accumulate 5-10 min on 3-5 days per week
  • 4-12 weeks typically needed for any improvement
  • Progression = increase work intervals, then decrease rest periods
18
Q

effect after 1 month detraining

A

significant falls in performance

19
Q

effect of smoking on chronic bronchitis

A

-reduced size of cila
-reduced cilla mortaility
-increase goblet cells = more mucus
-inflammation - increase endothelial space
-increase size and amount of submucus glands
= reduced size of airway
= more mucus with trapped pathogens and dust

20
Q

effect of chronic bronchitis on the heart

A

increased pulmonary artery pressure
increased RV afterload
decreased LV afterload
increased cardiac output

21
Q

body response to hypoxic tissue

A

when tissue becomes hypoxic, the blood vessels that perfuse that tissue will vasodilate

22
Q

hypoxic pulmonary vasoconstriction

A

when tissue in lungs becomes hypoix - vasoconstriction

not efficient to sned blood to damaged aveolar so VC

23
Q

effect of hypoxic pulmonary vasoconstriction on heart

A

increased pulmonary arterial pressure

right ventricle afterload increases

24
Q

Emphysema and smoking

A

eleastin reponds to smoking
causes release of free radicals
macrophages release pro-inflammatory cytokies
- signal chemotaxis - neutrophils which release protease which break down the elastin and paracyimal tissue
causes endothelaila dysfunction

25
Q

endothelial dysfunction in emphysema

A

cant vasodilate
hypoxic vasoconstriction
decreased perfusion

26
Q

kidneys response to emphysema

A

release EPO
increase red blood cells - polycythemia
increases thickness of blood = more likely to clot

27
Q

air trapping in emphysema

A

alveolar emptying time relies on expiratory time
insufficent during exercsie
already air in lungs from previous breath
decreased inspiration capacity
reduced breath depth
inpaired ability to empty lungs
worsen length-tension relationship of diaghragm and increases cost of breathing

28
Q

effect of air trapping on VO2

A

40% of submax VO2 is due to the cost of breathing

10-15% nromally

29
Q

what id dynamic hyperinflation

A

imapired ability to empty lung during exercise

30
Q

effect of COPD on lung function

A

resting and dynamic increase end expiratory lung volume so tidal volume is shifted up the pressure-volume curve where there is an increased eleastic loading
= decreased inspiratory reserve volume

31
Q

overall positive effects

A

increased lung capacity

increased residual volume

32
Q

overall negative effects

A 
decreased chest wall compliance 
increased inspiratty resistnce 
decreased peak flow rate 
decreased FVC 
decreased FEV1
33
Q

areas for theraupetic targets

A

anxiety
deconditioning
activity limitation
exacerbatins - smoking

Clinical Exercise Prescription (12 decks)

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