COPD - chronic bronchitis, emphysema, asthmatic component Flashcards
Describe the pathology of Chronic Bronchitis.
- Daily expectoration of at least 3 months for 2 or more consecutive years.
- Risk factors: tobacco smoking, respiratory infections, comorbidities
Describe the pathophysiology of Chronic Bronchitis.
- Hypertrophy of mucosal glands –> increased mucous production in large bronchial airways –> excessive mucous form smaller plugs that can occlude in smaller airways.
- Reconstruction of airway - airway thickening occurs (increased bronchial smooth muscle), reduced lumen of airways, increased mucous production.
- Mucociliary clearance (MCC) impairment (due to cilial dysfunction) - increased mucous production (airway plugging), accumulation of inflammatory mucous exudates in airways leads to chronic inflammation (oedema of airway walls)
- Chronic inflammation with continual exposure to inhaled irritant (smoking)
What symptoms might this patient describe and why?
Shortness of breath (SOB): Airways that are partly blocked and narrowed by irritation (swelling and inflammation) + excess mucous make it hard for air to flow through them.
Cough + mucous: excessive mucous and MCC dysfunction
Ask me 2 questions, in the way you would ask a patient, to obtain more information about the symptom of XXX.
For SOB - Do you have any problems with your breathing? What makes you SOB?
For sputum - How’s your cough? What colour is your mucus? How much mucus do you produce?
What signs might this patient have and why?
Increased respiratory rate (RR): reduced partial pressure of oxygen (pO2) means body can respond with rapid breathing as a way to obtain oxygen → increased RR
Decreased breath size (tidal volume): Oxygen movement problem means the patient is not breathing at the correct depth and as deeply - reduced breath size
Pursed lip breathing: breathing like this attempts to reduce the amount of trapped air in the lungs so that there is more room to breathe.
Wheezing: bronchoconstriction - struggling to exhale out due to obstructed airways
Describe what you might hear if you auscultated this patient and why?
Wheeze - bronchoconstriction as lung airways are inflammed and narrowed.
Coarse crackles - mucus/sputum in the airways
Reduced breath sounds - reduced gas movement as airways are obstructed.
What are other findings from physiotherapy objective assessment?
OBSERVATION:
Increased respiratory rate:
- Impaired gas movement means there is reduced PaO2 -body responds with rapid breathing as a way to obtain oxygen
Decreased breath size (tidal volume):
- oxygen movement problem means patient is not breathing at correct depth and as deeply
PALPATION:
- Abnormal pattern of breathing:
- paradoxical breathing - abnormal indrawing, intercostal indrawing, lower rib indrawing.
- Accessory muscle use for breathing - to assist with breathing by expanding thoracic cavity as air.
What might be the findings on PFT and what do they mean?
Decreased FEV1% predicted - gas movement impairment
Decreased FEV1/FVC ratio (<80%) - obstructive order (less air will get out of lungs.
Decreased DLCO - decreased area of diffusion (bronchial obstruction)
What impairments might a patient with Chronic Bronchitis have? Why would they have it?
Reduced gas movement:
- Airway narrowing -> airway resistance -> obstruction to expiration
- Reduced oxygen movement
- Expiratory flow limitation reduces cough effectiveness.
Reduced secretion movement:
- Impaired MCC - increased mucus production and cilial dysfunction causes obstruction.
What signs/symptoms would support this impairment being present in Chronic Bronchitis?
Reduced gas movement:
- cough, SOB, wheezing
Reduced secretion. movement:
- ineffective cough - unable to clear mucus
Describe the pathology of Emphysema.
- Enlargement of the air spaces distal to the terminal bronchiole with the destruction of alveolar walls.
- Alveoli is damaged, alveolar walls create larger spaces instead of smaller ones –> gas movement impairment
Briefly describe the pathophysiology of emphysema.
- Excessive amounts of elastase released from neutrophils destroy the elastin of the alveolar walls.
- Damaged alveoli can’t support the bronchial tubes and airway collapse - gas trapping occurs –> causing obstructive airflow limitation and hyperinflation.
- Perforation of air spaces creates abnormal larger spaces instead of small distinct ones.
- Reduced number of alveolar –> reduced SA for gas exchange –> gas exchange impairment
What symptoms would a patient with emphysema have?
Severe dyspnea/SOB:
- gas exchange impairment as alveoli are damaged and makes it harder for oxygen to diffuse into the blood.
- too much extra air in their lungs (hyperinflation)
Exercise intolerance:
- SOB and difficulty with breathing
Chronic cough:
- hyperinflation –> ineffective cough
What signs would a patient with emphysema have?
- Barrel chest: hyperinflation with flattened diaphragm due to gas trapping
- Abnormal pattern of breathing: paradoxical breathing (chest goes in)
- Pursed lip breathing: attempts to reduce amount of air trapped in the lungs so there is more room to breath
- Nasal flaring: widens nasal opening to reduce airway resistance
- accessory muscles: increased work of breathing due to airway resistance
- Increased RR (body breathes more to compensate lack of oxygen) and decreased breath size (can’t breathe correct depth)
What might you hear if you auscultated a patient with emphysema?
Reduced breath sounds - decreased gas movement
