Obstructive Pulmonary Disease (OPD) Flashcards
What is obstructive pulmonary disease (OPD)?
Any disease of the airway the produces restriction to expiratory airflow, resulting in delayed and incomplete emptying of the lungs during exhalation- difficulty getting air OUT
What 4 things relates to obstructive pulmonary disease?
- retained secretions
- inflammation of the mucosa lining the airway walls
- bronchial constriction due to increased tone or spasm of bronchial smooth mm
- weakening of support structure of airway walls
What are the 2 main causes of obstructive pulmonary disease?
- Inhalation factors: cigarette smoke or other chemicals/air pollutants
- Genetics
What would an x-ray look like for someone with OPD?
-lung hyperinflation
-elevation of shoulder girdle
-horizontal ribs
-barrel-chested
-low and flat diaphragm
What happens to gas exchange in someone with OPD?
Oxygenation levels decrease and carbon dioxide vary depending on specific stage and disease
T/F exhalation becomes active in those with OPD
True- exhalation becomes forced due to the inability of a passive exhale b/c of the flattened diaphragm and during inspiration the accessory muscles have to be recruited
what is used to measure if a patient is getting a complete emptying of their lungs during exhale?
Spirometer: measures how fast and how much air you can blow out of your lungs
-FEV1: forced expiratory volume
-FVC: forced vital capacity
a normal FEV1/FVC= >75% (how much of the air that can be forcefully expired can be expired in 1 second)
**the ratio decreases as the severity of the disease increases
T/F those with OPD show smaller than normal total lung capacities and residual volumes
False- they have larger amounts due to the air trapping and hyperinflation
What is the purpose of pulmonary function tests?
To provide information regarding the volume of air the lungs contain after different levels of inhalation or exhalation
What are the disease specific obstructive lung conditions?
-COPD: chronic bronchitis and/or emphysema
-asthma
-cystic fibrosis
-bronchiectasis
T/F COPD is a preventable and treatable disease
True- however it is the 3rd leading cause of death in the world
What is emphysema?
A form of COPD where there is permanent enlargement of the bronchioles and destructive changes in the alveoli- results in loss of recoil of lungs, collapsing of airways during exhalation and chronic airflow obstruction
What is the major cause of emphysema?
Cigarette smoking
S/S of emphysema
-dyspnea
-little/no sputum production
-thin w/ elevated shoulders
-increased chest diameter
-wheezing
-breathes with accessory muscles and pursed lips
-leans forward on knees (dyspnea relief)
-rapid and shallow respirations
-absent cough
What is the most common symptom associated with emphysema?
Dyspnea
How is chronic bronchitis diagnosed?
a chronic cough on most days for a minimum of 3 months/year for >2 consecutive years
What causes chronic bronchitis?
long-term irritation of the tracheobronchial tree:
-cigarette smoke
-environmental pollutants
-occupational irritants
S/S of chronic bronchitis
-chronic cough
-increased sputum production (excess mucus)
-dyspnea on exertion
-frequent respiratory infections
-cyanosis
-excessive body fluids
What are the “sayings” for emphysema vs bronchitis?
- Emphysema: pink puffer
- Chronic bronchitis: blue bloater
What are the systemic effects of COPD?
-cardiovascular disease: most significant non-respiratory contributor to death
-skeletal muscle dysfunction
-OP
-lung cancer
-depression
-respiratory infections and failure
Random COPD S/S
-clubbing fingers
-cyanosis
-auscultation of lungs will show a prolonged expiratory phase (>4 seconds)
-breath sounds are diminished
-jugular vein distension
-ankle/lower leg swelling when CHF is present
What is the gold standard for diagnosing COPD and monitoring its progression?
Pulmonary function tests
-decreases in FEV1 and FEV1/FVC values
-spirometry is the best objective measure of airflow limitations
How to diagnosis COPD?
-pulmonary function tests
-X-ray
-CT
-Sputum culture (looking for infection)
-CBC and check blood gases
T/F if a patient’s spirometer measure is abnormal, the test is repeated again after using a bronchodilator- those with asthma will then have normal results and those with COPD will only see a partial improvement
True
What is the BODE index used for? && what does it stand for?
To predict the survival of those with COPD
-B: body mass
-O: obstruction
-D: dyspnea
E: exercise
What does end stage COPD result in?
R sided heart failure (cor pulmonale)
Goals of COPD management
-relieve symptoms
-prevent disease progression
-improve exercise tolerance
-reduce mortality
Which medications are used for COPD management?
-bronchodilators
-anti-inflammatories: glucocorticoids or corticosteroids
-antibiotics
What is cystic fibrosis?
A multisystem disorder that effects every organ system that has epithelial surfaces
**most predominant are the lungs and pancreas
How does cystic fibrosis affect the pulmonary system?
causes chronic obstruction and inflammation, thick mucus, and recurrent bacterial infections- results in failure of airways to clear mucus normally
How does cystic fibrosis affect the pancreas?
it develops exocrine pancreatic insufficiency which then effects GI function and growth and development
How is cystic fibrosis diagnosed?
-newborn screen (CFTR mutation screen)
-sweat test: elevated chloride levels (>60 mEq/liter)
What are the management goals of cystic fibrosis?
-control lung infections
-promote mucus clearance
-improve nutrition status
Implications for PT for those with cystic fibrosis, or those with asthma
-secretion clearance
-controlled breathing
-exercise and strength training
-inspiratory muscle training
-thoracic stretching
-postural eduction
What is asthma?
Airway resistance caused by constriction of the bronchial smooth muscle cells and mucus production within the airway- chronic inflammatory disorder of airway
What are the causes of asthma?
-viral or allergen exposures
-exercise
-inhalation of cold air
Symptoms of asthma
-wheezing
-chest tightness
-SOB
What are the special types of asthma?
-seasonal
-exercise-induced
-asthmatic bronchitis
T/F 50% of those who have childhood asthma continue to have symptoms into adulthood
True
What is bronchiectasis?
Dilation of the bronchials- it is irreversible with chronic inflammation and infection
What can cause bronchiectasis?
-bronchial wall injury or structural weakness
-traction from adjacent lung fibrosis
-bronchial lumen obstruction
Symptoms of bronchiectasis
-cough with sputum production
-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
Diagnostic tests for bronchiectasis
-CT scans PFTs
-blood work (blood gases abnormal)
-sputum testing (H. Influenzae and P. aeruginosa)
-evaluation of GERD
Goals of management for bronchiectasis
to reduce the number of exacerbations and improve quality of life
Which OPD has the poorest prognosis?
CF and bronchiectasis both have the poorest
What is the most common drug class used to treat respiratory disorders?
bronchodilators- work by relaxing the smooth muscle within the bronchi and brinchioles to open the airway and make it easier to breath
what are the 2 types of bronchodilators?
- short-acting: work quickly after you take them so you feel relief from symptoms quickly
- long-acting: have long lasting effects and should not be used for quick relief (dilates airway for up to 12 hours)
what are the common side effects of bronchodilators?
-increased HR
-HA
-anxiety
-tremor
T/F the timing of bronchodilators doesn’t matter
False- they should be administered prior to therapy session to allow for optimal respiratory function
What is the goal of supplemental oxygen?
To increase oxygen saturation- but too much supplemental oxygen can be dangerous for patients with COPD
-O2 levels may rise with the use of less oxygen as opposed to increasing the oxygen
**>88% of O2 sat is normal for the respiratory population
