Obstructive Lung Disease Flashcards
Obstructive Pulmonary Diseases
Diseases of airways, which produce obstruction of expiratory flow
Airflow obstruction can be related to:
Retained secretions
Inflammation of mucosal lining of airway walls
Bronchial constriction
Weakening of support structure
Signs of lung hyperinflation
Elevation of shoulder girdle
Horizontal ribs
Barrel-shaped thorax
Low, flattened diaphragms
Symptoms
Dyspnea on exertion (DOE), especially during functional activities
May have increased anxiety level
Secretion production and cough
COPD – Physical findings
Cough/sputum/hemoptysis Dyspnea – exertion Decrease breath sounds – more adventitious sounds Inc RR Wt loss Inc AP diameter of chest wall Cyanosis Clubbing Elevated shldr girdle posture Indications on chest xray
Changes with disease
Structural changes to the lung; musculoskeletal changes, psychological component
Lung changes first
Loss of recoil
Rib cage changes shape
As the disease progresses you get a forced expiration instead of passive
Inspiration is affected
Muscle compositions changes
Stage 1 COPD:
mild – FEV1 > 80% predicted, with or without chronic symptoms
Stage 2 COPD:
mod – 50% < FEV1 < 80%, SOB with exertion
Stage 3 COPD:
severe – 30% < FEV1 < 80%, SOB, dec exercise capacity
Stage 4 COPD:
very severe - FEV1 < 30%, dec QOL, life threatening
Chronic respiratory failure:
FEV1 < 50%
Gold standard for diagnosing COPD
spirometry
Lung volumes with COPD:
Larger than normal total lung capacity (TLC)
Larger residual volumes (RV)
Adult Obstructive Lung Conditions
COPD Emphysema Chronic Bronchitis Combination Bronchiectasis
Adult COPD
easily fatigued frequent respiratory infections use of accessory muscles to breath orthopneic cor pulmonale thin in appearance wheezing pursued lip breathing barrel chest dyspnea
Emphysema:
Condition of lung characterized by destruction of alveolar walls and enlargement of airspaces distal to terminal bronchioles
Chronic Bronchitis
Presence of chronic productive cough for 3 months in each of 2 successive years
Pink Puffers
emphysema no bronchitic component barrel chest dyspnea early hunched over hyperventilation adequate oxygenation weight loss
Blue Bloaters
chronic bronchitis bronchitic component cough, mucus no barrel chest dyspnea late no air hunger ventilation-OK cyanosis cor pulmonale obese
BODE index:
body mass, obstruction, dyspnea, exercise, score of 7 to 10 is associated with high mortality rate of 80% in 52 months
Combination COPD – PT Treatment
Secretion clearance Controlled breathing at rest and with activity Ambulation with rolling walker Education in use of recovery from SOB positions Endurance exercise training Strength training & wt training Thoracic stretching Postural reeducation
Bronchiectasis
Chronic congenital or acquired disease characterized by abnormal dilatation of the bronchi and excessive sputum production
Bronchiectasis - Symptoms
Cough with sputum production (small to large) quantities of mucopurulent secretions
Secretion layers—white frothy, mucoid inner, purulent bottom, composed of thick yellow-green plugs
Sputum greatest in morning
Recurrent, chronic, or recurring lung infections
Hemoptysis
