COPD and Restrictive lung disease Flashcards
What are sections and sub sections of the respiratory system?
Trachea, Carina, R & L main stem, lobar bronchi, segmental bronchi, subsegmental bronchi, terminal bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs
What are the normal lung units?
Alveoli sacs for gas exchange: elastic in nature, exchange CO2 and O2 for ATP production, 300 million clusters in adult lung
What is COPD?
Disease that affects both mechanical function and gas exchange of respiratory system.
Trouble getting air out: long expiratory time (1:4+)
What is epidemiology-COPD risk factors and physical symptoms?
Smoking (>85%), air pollution, family history, occupational dusts
Dyspnea on exertion, fatigue, chronic cough, wheezing &/or rhonchi, expectoration of mucus
What is COPD pathophysiology?
Loss of normal elastic recoil and bronchial tubes collapse (air trapping promotes hyperinflation)
Changes in PFT: decreased ERV, increased RV
Decreased bronchial lumen
Respiratory muscles must work harder
Changes in CXR and PFTs
What happens when there is decreased bronchial lumen and respiratory muscles must work harder?
Lumen: increased mucus production, inflammation of mucosal lining (thickening), spasm (constriction) of bronchial smooth muscle
Muscles: enlarged thorax is already inflated, must overcome resistance to airflow obstruction, alveolar ventilation is decreased
What are COPD signs and symptoms?
Hypoxemia: pulmonary artery hypertension
Polycythemia: increased RBC count, viscosity (increases resistance)
Cor pulmonale
Cor pulmonale AND respiratory failure
What is COPD treatment?
Remove the irritant
Inhaled medications: B agonists, anticholinergics, corticosteroids, antibiotics
Exercise training
What is pathophysiology of emphysema?
Alveolar/parenchymal disease: enlargement of air spaces distal to terminal bronchioles, loss of elastic fibers, and destruction of alveolar septal walls
Lung function altered: elastic recoil, collapse of airways with exhalation and chronic air flow obstruction
Abnormal PFTs and CXR: hyperinflation with flattened diaphragm on x ray
What are the 2 types of emphysema?
Centriacinar (centrilobular): affects respiratory bronchioles, worse in upper lobes
Panacinar (panlobular): lower lobes more affected, observed in people with alpha-1-antitrypsin deficiency (protein deficiency)
What parts of the respiratory system are affected in emphysema?
Respiratory bronchioles
Alveolar ducts
Alveolar sacs
What are the clinical features of empysema?
Severe dyspnea Dry nonproductive cough "skin and bones" All energy is used to breath Absent (very decreased) breath sounds heard during auscultation of chest Expiratory phase increased
What is pathophysiology of chronic bronchitis?
Chronic productive cough for 3 months or year for >2 consecutive years
Proliferation of submucosal glands and goblet cells
Insidious: smokers cough, morning cough, continual cough (recurrent “pneumonia”)
What do the lungs do in response to irritants?
Contraction of bronchial smooth muscle
Denuded cilia
Increased secretions
Swelling of mucosa
What are clinical features of CB?
Chronic, productive cough: generally clear mucous unless infection
Overweight
Blue-ish color to lips and nails: peripheral edema in LE’s d/t right side heart failure)
Rhonchi and wheezes heard during auscultation
Expiratory phase increased
Abnormal PFT and CXR
What parts of the respiratory system is involved with CB?
Lobar bronchi, segmental bronchi, subsegmental bronchi
What is asthma?
Inflammatory disease causing SOA and DOE, wheezing, coughing
Bronchospasm and inflammation caused by hypersensitivity to extrinsic and intrinsic stimuli (pollen, grass, cold air, exercise, stress, etc)
Structural changes of airway with vast amount of thickening of airways
What happens to lung function with asthma and how do you treat it?
Results in air trapping increasing RV, increasing CO2, and decreasing O2.
Reduction of FEV1 and peak flow
Treatment: trigger awareness, inhaled agents (bronchodilators, anti-inflammatories, prophylactic agents)
What is EIB?
Caused by increased air flow and drying of airways.
Can experience without history of diagnosed asthma
Up to 30% of Olympic athletes have it.
Prevent with proper warm up and pharmacological therapy
What is cor pulmonale?
Right ventricular hypertrophy secondary to abnormalities of lung structure and function-
Developing pulmonary disease results in increasing hypoxemia.
Vasoconstriction causes pulmonary hypertension (makes right heart work harder which leads to peripheral edema)
What is CF?
Inherited chronic disease that affects lungs and digestive system.
Defective gene and its protein product cause body to produce unusually thick, sticky mucus that: clogs lungs and leads to infections, obstructs pancreas and stops natural enzymes from helping body break down and absorb food
What is life span of CF?
mid 40s
90% die from pulmonary complications: hypercarbia, hypoxia, cor pulmonale
What are symptoms of CF?
Persistent coughing, frequent lung infections, wheezing or shortness of breath, very salty tasting skin, poor growth/weight gain, frequent greasy bulky stools or difficulty with bowel movements
What is CF pathology?
Cystic fibrosis transmembrane conductance regulator (CFTR protein): dysregulation of this protein leads to failure of airways to clear mucus
Lung function progresses from obstruction to addition of a restrictive component
What are treatments for CF?
Inhaled meds: bronchodilators, mucolytics, antibiotics Exercise Nutrition Lung transplant Drug therapies
What are the drug therapies for CF?
Kalydeco: oral pill taken twice a day for kids >6 with G551D mutation, helps improve lung function, lowers sweat chloride levels, helps patients gain weight, allows cell to produce protein that enables movement of chloride through cell membrane
Orkambi: delta 508 drug, used in kids >12, helps correct misfolded CFTR protein, treats root cause of CF instead of treating symtpoms
What are signs and symptoms of COPDers?
SOA, DOE for all Hypoxia for emphysema Hypercarbia for CB Dry cough for emphysema Productive cough for CB Fatigue Weight loss Anorexia Cough Syncope Peripheral edema Depression Anxiety
What is our job as PTs to help with COPD?
Evaluate exercise endurance, muscle strength, flexibility, and body comp
Assess and reassese exercise prescription
Goals for increasing flex, strength, endurance
Educate energy conservation
Body mechanics to reduce O2 requirement
Breathing techniques such as pursed lip and diaphragmatic (decreases RR, VE)
Observe for dyspnea
Oxygen sat levels
Focus on ADLs
In COPD who should get oxygen support?
Empysema patients can benefit from low flow oxygen
DO NOT give CB patients oxygen because their drive to breathe is gone completely
What are differences between obstructive and restrictive lung diseases?
Obstructive: trouble getting air out, pursed lip helps prevent air trapping, decreased flow rates and hypercapnia, radiographically identified by hyperinflation
Restrictive: trouble getting air in, hypoxia, reduced lung volumes with normal flow rates, radiographically identified by diffuse bilateral persistent interstitial densities
T/F: with restrictive lung diseases the patient course is typically chronic and diffuse firbrosis is the ultimate pathologic process in most conditions
True
What is pulmonary fibrosis?
Devastating and progressive disease: lung tissue becomes thickened, stiff, and scarred.
Causes range from autoimmune diseases to occupation exposures, or idopathic
Seen in people over age 65
Men account for 70% of patients
Survival is 2-3 years after diagnosis
What are the 5 types of pulmonary fibrosis?
Sarcoidosis lupus Rheumatoid disease Scleroderma IPF
What is sarcoidosis?
Systemic granulomatous disease of unknown etiology
Most common in blacks, 20-30, F>M
Chest Xray will show: fibrosis, alveolitis, scarring, honeycombing
What are signs and symptoms of sarcoidosis? Treatment?
Specific organ dysfunction (cough and dyspnea) Generalized weakness Fatigue Weight loss Malaise Fever
Corticosteroids and immunosuppressive drugs
What is lupus?
Systemic autoimmune disease with varied clinical manifestations.
Most common in women of child bearing age.
Chronic, with remission and exacerbations
70% of cases involve lungs and progress to pulm fib
Treatment: corticosteroids, prevention and treatment of pulmonary S&S
What is a rheumatoid restrictive lung disease?
Systemic disease with pleuro-pulmonary manifestations.
Unknown cause
F>M, but men have more pulmonary involvement
Treat signs and symptoms
What is scleroderma?
Primarily involves blood vessels and connective tissues resulting in fibrosis of organs.
F>M
Autoimmune problem so no satisfactory treatment
Progressive, with poor prognosis
Death due to pulmonary involvement
What is IPF?
Chronic lung disease of unknown cause Chronic, slow, progressive dyspnea Chronic inflammation and fibrosis Middle age, M>F Treatment: no known effective treatment, use corticosteroids and immunosuppressive drugs, supportive and treat signs and symptoms 50% live 5 more years at time of dx
What are environmental lung disease?
pathologic condition of respiratory tract that result directly from inhalation of gas or particulate matter in the air
What are the 4 categories of pulmonary pathogens?
Infectious agents
Organic dusts
Inorganic dusts: pneumoconiosis
Gases
What are the different causes of pneumoconiosis?
Disease caused by inhalation of inorganic dust
Silicosis: from silica
Asbestosis: from silicates
CWP: carbon
Diagnosis based on exposure history, duration, intensity
No effective treatment
Treat signs and symptoms
What are types of irritant gases and what are consequences if inhaled?
gases: ammonia, sulfur dioxide, chlorine, nitrogen dioxide, ozone, phosgene
May cause hyperemia, edema, epithelial injury, mucosal sloughing, coughing, dyspnea, cyanosis
Management is supportive and symptomatic
If significant exposure: pulmonary fibrosis by result
What are disease of spine and chest wall?
Kyphosis: posterior curve Scoliosis: lateral curve Kyphoscoliosis: post and lat Lordosis: sway back Pectus excavatum: funnel Pectus carinatum: pigeon
What are causes of spine and chest wall diseases? What are possible signs and symptoms?
Cause: congenital, traumatic, paralytic, infectious agents
F>M
children asymptomatic
adults 4/5th decade: CP embarrassment
Dyspnea, frequent pneumonia, respiratory insufficiency, hypoxia, hypercapnia, cardiac failure risks
What are possible diseases of the NM system that cause restrictive lung diseases?
Myastenia gravis
ALS
guillan barre
quadraplegia
What is MG?
Autoimmune disorder of neuromuscular junction
Descending muscular weakness and fatigue
May involve respiratory muscles
F>M
Tx= anticholinesterase drugs and steroids
Watch NIF and VC for changing condition
What is GB syndrome?
Acute from of inflammatory polyneuritis of unknown cause.
Effects peripheral nerves, ascending paralysis for 1-3 weeks, recovery in 2-4 weeks
Tx= plasmapheresis, immunoglobulin therapy
Watch NIC and VC from changing condition
How would quadriplegia affect the lungs?
C3-C5= diaphragm C5-C6= scalenes T1-T11= intercostals T8-T12= abdominals
What is pathophys of pneumonia?
Acute inflammatory process that effects the gas exchange units of the lung.
In response to inflammation, fluid and RBC pour into alveoli.
PMN’s also move into infected area to engulf and kill bacteria.
Macrophages appear to remove cellular debris
What is consolidation?
Alveoli become filled with fluid
What is onset, presentation, and complications for pneumonia?
onset: gradual or abrupt
Manifestations: general malaise, chills, fever, cough, chest pain, dyspnea
Complications: adjacent pleural lining may get involved and lead to pleural effusion
What is treatment and prognosis for pneumonia?
treatment: brought under control spontaneously or by antimicrobial therapy, resolution of inflammation and healing take place
Prognosis:
With no necrosis: resolution without sequelae is expected.
With destructive changes, fibrous scar tissue develops and there may be measurable loss of lung function
What is our role as PT for restrictive lung disease patients?
Difficult to exercise.
Endurance may be limited by chronic disease.
Supplemental O2 may improve exercise tolerance: no more than 6 lpm nasal cannula
