Induction

Question 1

What is pursed lip breathing used for?

Answer 1

Relieving shortness of breath by slowing the breath rate.
Keeping the airways open longer, which decreases the work that goes into breathing.
Improving ventilation by moving old air (carbon dioxide) trapped in the lungs out and making room for new, fresh oxygen

Question 2

What is Dyspnoea?

And what is it often a symptom of?

Answer 2

When a person experiences shortness of breath.

COPD, asthma, bronchiectasis, chest infection, pneumonia, heart failure.

Question 3

What does COPD stand for?

Answer 3

Chronic obstructive pulmonary disease.

Question 4

What does Dyspnoea involve and what types are there?

Answer 4

Shortness of breath (SOB)
SOBOE (=SOB+on exertion)
Types; 
Orthopnoea :Breathlessness on lying down
Paroxysmal nocturnal dyspnoea (PND): Occurs after 1-2 hours of being supine. (Increased VR puts excess load on the (R) sd of heart

Question 5

What can breathlessness lead to?

Answer 5

Anxiety/depression -> Reduced exercise -> muscle wasting -> Disability.

Question 6

What does normal airway clearance rely on?

Answer 6

• Normal mucociliary clearance.

- Effective cough.

Question 7

How much mucus is it normal to produce each day (ml)?

Answer 7

100mls

Question 8

What is the Mucociliary layer?

Answer 8

It exists on the bronchial wall epithelium, and consists of a layer of cilia (sol layer) that sits on the epithelium wall, and a gel layer on the cilia.

Question 9

What is the function of the Mucociliary layer?

Answer 9

• The inferior sol layer approximates and enmeshes with cilia.
• Gel layer above, traps particles and micro-organisms which may be trapped.

The cilia present throughout the airways beat in a unified direction to move the gel layer to larger airways for coughing. (Up and out)

Question 10

What factors influence the rate of mucociliary clearance?

Answer 10

Increasers: Exercise
Inhibitors (slow it down): 
- Reduced clearance 
- increased quantity of sputum
- increased viscosity
- impaired cough 
- age
- being a smoker
- reduced during sleep
- hypoxia and hypercapnia
- social embarrassment.

Question 11

What is hypoxia?

Answer 11

Hypoxia is a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level.

Question 12

What is hypercapnia?

Answer 12

means abnormal increased CO2 levels in the blood.

Question 13

What can cause increased sputum production and or increased viscosity?

Answer 13

Dehydration - effects sol layer

Disease: bronchiectasis, cystic fibrosis (CF), primary ciliary dyskinesia (PCD), bronchitis, asthma, pneumonia.

Question 14

What are the causes of an impaired cough?

Answer 14

• Depression of CNS
• Damage to glossopharyngeal and vagal nn.
• Laryngectomy
• Reduced lung volumes/reduced expiratory airflow limitation.
• inspiratory or expiratory mm weakness
• Pain/fear

Question 15

What are the pathophysiological effects of Sputum retention?

Answer 15

• Predisposes to infection, stagnation/colonisation
• Increased airway resistance and work of breathing (WOB)
• May lead to small airway collapse (aka Atelectasis)
• Low levels of O2 in blood and tissues (hypoxia)
• Hypercapnia (increased levels of CO2)

Question 16

What are the clinical features of sputum retention?

Answer 16

• Thick mucopurulent sputum
• Increased quantity of sputum.
• Infection, fever/tachycardia
• Breathlessness
• Auscultation; reduced breath sounds, crackles, wheezes.
• CXR; atelectasis, consolidation
• Hypoxia; reduced PaO2, reduced SaO2

Question 17

What are the mechanisms of airflow limitation?

Answer 17

The airway in normal subjects is distended by alveolar attachments during expiration, allowing alveolar emptying and lung deflation. In COPD, these attachments are disrupted because of emphysema, thus contributing to airway closure during expiration, trapping gas in the alveoli and resulting in hyperinflation. Peripheral airways are also obstructed and distorted by airways inflammation and fibrosis (chronic obstructive bronchitis) and by occlusion of the airway lumen by mucus secretions, which may be trapped in the airways because of poor mucociliary clearance.

Question 18

What are the clinical features of airflow obstruction?

Answer 18

• Breathlessness
• Spirometry; Reduced FEV1
• Hyperinflation
• CXR; flattened diaphragm
• Chest wall shape; horizontal ribs

Question 19

What is FEV1?

Answer 19

FEV1 is the volume exhaled during the 1st second of a forced expiratory manoeuvre started from the level of total lung capacity.

Question 20

What is FVC?

Answer 20

FVC = the volume change of the lung btwn a full inspiration to total lung capacity and a maximal expiration to residual volume. The measurement is performed during forceful exhalation.

Question 21

Name types of impaired gas exchange, and what they involve?

Answer 21

- Hypoxia; Diffusion impairment,
V/Q mismatch,
Shunt
- Hypercapnia
Type 11 ventilatory failure
- Hypocapnia
- Chronic hyperventilation syndrome

Question 22

What can reduced lung volume lead to?

Answer 22

Leads to small airway collapse or atelectasis which may lead to ventilation/perfusion (V/Q) mismatch or shunt and therefore problems with gas exchange.

Question 23

What are the possible causes of Respiratory muscle dysfunction?

Answer 23

• Reduced drive; Pharmacological, neurological drive.
• Increased load; airflow obstruction, obesity.
• Reduced capacity; weakness, hyperinflation.

Question 24

What are the clinical features of respiratory muscle dysfunction?

Answer 24

• Breathlessness in supine or when submerged in water.

- Gas exchange impairment; ventilation failure if severe.

Question 25

What are the results of impaired exercise tolerance?

Answer 25

• Breathlessness
• Leg fatigue
• Anxiety