CVR - physio management of COPD

Question 1

What are the key problems for pts with stable COPD

Answer 1

Dyspnoea
Retained secretions
Reduced exercise capacity

Question 2

What physio management treatments are available for dyspnoea

Answer 2

• positioning
• breathing control
• pursed-lip breathing
• energy conservation and pacing
• fan therapy

Question 3

What physio management treatments are available for airway clearance?

Answer 3

• active cycle of breathing technique (ACBT)
• positive expiratory pressure (PEP) devices
• postural drainage
• manual techniques

Question 4

What physio management treatments are available for reduced exercise capacity?

Answer 4

• inspiratory muscle training
• tai chi
• pelvic floor muscle training
• pulmonary rehab

Question 5

What are the aims of physio in the management of dyspnoea in patients with COPD?

Answer 5

• reduce work of breathing (WOB)

- improve the quality of life

Question 6

How does positioning benefit patients with dyspnoea?

Answer 6

• encourages relaxation of upper chest and shoulders
• allows movement of lower chest and abdomen
• optimises length-tension relationship of the diaphragm
• overall reduces the work of breathing (WOB)

Question 7

How would you perform positioning for COPD patients with dyspnoea?

Answer 7

Lean forwards position
Abdominal contents raise the anterior part of the diaphragm
Facilitates its contraction during inspiration
‘Loading the diaphragm’

Question 8

Briefly describe how to perform breathing control and when it can be performed

Answer 8

Tidal breathing at the patients own rate and depth
Encouraging the use of the lower chest and diaphragm with upper chest and shoulder relaxation
Can be used at rest, or used to improve exercise capacity in breathless patients during activity

Question 9

How can pursed-lip breathing help pts with dyspnoea?

Answer 9

Aims to prevent airway closure on expiration and increase expiratory time
Generates a small positive pressure during expiration
May lead to decreased RR, increased TV and improved gaseous exchange

Question 10

Describe the ‘blow-as-you-go’ technique and why it is used

Answer 10

Breathe in before the effort and breath out during the effort
- as you lift a heavy object
Helps make tasks easier and can be combined with pursed-lip breathing

Question 11

Briefly describe paced breathing and how it is beneficial in day to day life

Answer 11

Pt paces steps with breathing
- inhalation on one step, exhalation on the next step
Useful during activities such as walking or climbing the stairs

Question 12

What are some methods that allow energy conservation and pacing?

Answer 12

• prioritise
• plan ahead
• pace activities
• sit during exercises (washing up)
• minimise above head activities
• adopt a good posture

Question 13

How can fan therapy benefit those with dyspnoea?

Answer 13

A cool draft of air may reduce sensation of dyspnoea
Can be combined with positioning and breathing techniques
Hold fan approx 15cm away from the face
Aim draft at the center of the face

Question 14

Describe the technique of pursed-lip breathing

Answer 14

• pt should be in a comfortable, well-supported position
• pt encouraged to relax upper chest, shoulders and arms
• inspire to normal tidal volume through the nose for approx 2 seconds
• during expiration, purse the lips and though blowing through a straw, and exhale for 4 seconds

** Inspiration:Expiration = 1:2**

Question 15

Describe how inspiratory muscle training can be performed

Answer 15

Training the inspiratory muscles by applying an inspiratory load via a device
Should be incorporated into exercise programme where respiratory weakness is a problem

Question 16

What is tai-chi and how is it beneficial to those with dyspnoea?

Answer 16

Combination of exercise and meditation and consists of slow movements and deep breathing
Low-intensity exercise with benefits of lung function and exercise capacity
Beneficial in improving balance and reducing falls
Estimated to work at 50-74% max HR

Question 17

How is the proximal clearance of mucus usually achieved?

Answer 17

• expiratory airflow of tidal breathing
• the action of the mucociliary escalator
• effective cough

Question 18

Describe the active cycle of breathing technique

Answer 18

Comprises a cycle of:

• breathing control
• thoracic expansion exercises (deep breathing)
• forced expiration technique (one or 2 huffs combined with breathing control)

Question 19

What are the aims of thoracic expansion exercises?

Answer 19

AKA deep breathing exercises

• get air behind retained secretions in order to aid removal using forced expiratory techniques
• re-inflate areas of lung collapse

Question 20

How do you perform thoracic expansion exercises?

Answer 20

Pt encouraged to take 3-4 deep breaths
3-second hold after inspiration and before expiration
Facilitated by therapists hands on the lateral aspect of the chest to promote proprioceptive input

Question 21

What are the aims of forced expiratory technique and what are the two types of huffs that can be performed?

Answer 21

Aims to mobilise retained secretions from the peripheral airways to the central airways to enable them to be expectorated

1. low lung volume huffs - will move the peripherally situated secretions (exhale actively with a sigh)
2. high lung volume huffs - when secretions have moved to larger, more proximal upper airways, a huff or cough from a high lung volume can be used to clear them (exhale forcefully, as though trying to steam up a mirror)

Question 22

Describe how the use of an equal pressure point can help mobilise secretions

Answer 22

During forced expiration, the pressure outside the airway remains relatively constant, whilst the pressure inside the airway decreases from the peripheral airways to the mouth, resulting in airway compression.
With a forced expiration, a wave of EPP’s move peripherally into smaller airways as the lung volume decreases and the pressure within the airway falls. This, together with the turbulent airflow created, facilitates the movement of secretions downstream towards the mouth.

Question 23

How is postural drainage achieved?

Answer 23

Place pt in specific positions that enable gravity to move mucus from peripheral airways to more central airways for expectoration
Drainage normally lasts 10 minutes

Question 24

Give some examples of manual techniques and the aim of them

Answer 24

• percussion
• vibs and shakes
  Aim to loosen secretion from the airway walls

Question 25

Briefly describe what percussion is

Answer 25

Consists of rhythmic clapping on the chest, creating an energy wave that is transmitted to the airways, loosening the secretions
Performed throughout the respiratory cycle

Question 26

Briefly describe what vibs and shakes are

Answer 26

Vibs are intermittent chest wall compressions consisting of fine oscillations. Performed on exhalation after a deep inhalation
Shakes are coarses movements where the chest wall is rhythmically compressed