Obstructive Pulmonary Disorders Flashcards
What is COPD? What is impaired?
- A group of disease characterized by chronic inflammation causing restricted airways and obstructed airflow to and from the lungs making exhalation hard
- deterioration of small airways
(bronchioles and alveoli are impaired)
_____ and ______ of the lung occurs in COPD which makes getting air ___ of the lungs difficult
air trapping and hyperinflation of the lung occurs in COPD which makes getting air out of the lungs difficult
what are the different COPD disorders?
- Chronic bronchitis, asthma, and emphysema, cystic fibrosis
what are ways in which airflow can be obstructed in COPD?
-retaining secretions
- inflammation of mucosal lining
- bronchial constriction
- weakening of support structures
describe mechanisms of air trapping in COPD
- mucus plugs and narrowed airways cause air trapping and hyperinflation on expiration.
- during inspiration, the airways are pulled open, allowing gas to flow past the the obstruction.
- during expiration, decreased elastic recoil of the bronchial walls result in collapse of the airways and prevents normal expiratory airflow.
In COPD, there is ___ perfusion at the capillary membrane resulting in ____. Progression of COPD contributes to decreased ____ in arterial blood. _____ progresses to _____ which is increased CO2 in arterial blood. This can contribute to ______.
In COPD, there is mismatches perfusion at the capillary membrane resulting in hypoxemia. Progression of COPD contributes to decreased O2 in arterial blood. Hypoxemia progresses to hypercapnia which is increased CO2 in arterial blood. This can contribute to pulmonary HTN.
How does COPD affect…
- elastic recoil
- alveolar spaces
- compliance of lung tissue
- mucus secretion
- thorax position
- loss of elastic recoil causing airways to collapse (already narrowed by inflammation and excess secretions closes airways prematurely causing air trapping)
- wall between alveoli are destroyed and dilation of alveolar spaces
- increased compliance of lung tissue
- mucus secretion increased which clogs airways
- hyperinflation prevents the thorax from returning to its normal resting position
what are risk factors for COPD
- occupational exposure
- exposure to air pollution
-age - cigarette smoking
- childhood respiratory conditions
- genetics
what is the COPD clinical presentation?
- dyspnea is the most common symptom that is often with exertional activities, tends to worsen over time and becomes apparent with lower level ADLs
- chronic cough
- barrel chest
- wheezing
- reduced or absent breath sounds
- retain CO2
what are common symptoms of COPD
- constant coughing
- SOB with everyday activities
- inability to breath easily or take a deep breath
- excess mucus production
- wheezing
Advanced COPD: - pursed lip breathing
- cyanosis
- digital clubbing
What is pulmonary function testing (PFT)? What volumes are monitored? What is it used for?
- spirometry tracings that measure time- volume relationships in the lung
- two forced expiratory volumes monitored are forced expiratory volume in 1 second and forced vital capacity (FEV 1/ FVC)
- used to quantify degrees of airway obstruction, document baseline, and progression of disease
how does COPD present with PFT?
- in COPD, there is delayed and incomplete emptying of the lung during exhalation
- decreased FEV1 and FEV1/FVC diagnoses COPD
what is the gold standard for COPD diagnosis?
spirometry
GOLD stages for COPD: Grade 1
- This is the mild stage with mild symptoms. Some patients have SOB.
- Severity of airflow obstruction is > or equal to 80% of normal predicted FEV1
- patient may require short acting bronchodilator
GOLD stages for COPD: Grade 2
- This is the moderate stage where patients start to seek help because of SOB.
- Severity of airflow obstruction is 50-80% of normal predicted FEV1
- patient may require long acting bronchodilator and rehab
GOLD stages for COPD: Grade 3
- This is the severe stage where COPD symptoms worsen and flareups become more frequent.
- Severity of airflow obstruction is 30-50% of normal predicted FEV1
- patient may require inhaled corticosteroid
GOLD stages for COPD: Grade 4
- This is the very severe stage where the disease has progressed and lung function has deteriorated.
- Severity of airflow obstruction is <30% of normal predicted FEV1.
- patient may need of O2 for respiratory failure or surgical intervention
How does COPD affect lung volumes?
- vital capacity (VC) is decreased
- residual volume (RV) and functional residual capacity (FRC) are increased
- total lung capacity (TLC) is increased
- RV/TLC ratio is increased
How does BODE index compare to FEV1
- in a 2008 study it was found that BODE was a better predictor than FEV1 alone for exacerbation of COPD
Describe the scores of the BODE index
BODE estimated the 4-year survival chance for COPD patients
- score 0-2 points is associated with 80% chance of survival
- score of 3-4 points is associated with 67% survival
- score of 5-6 points is associated 57% survival
- score of 7-10 points is associated with 18% survival
what are the avenues of medical management for COPD
- smoking cessation
- mucolytics, bronchodilators, steroids
- influenza vaccine
- pneumonia vaccine
- treatment of sleep disorders
- pulmonary rehabilitation
- surgery
what is emphysema? what are the causes? what is a common symptom?
- a condition of the lung characterized by destruction of the alveolar walls and enlargement of airspaces distal to the terminal bronchioles
- cigarette smoking is a major cause
- non-productive dry cough
what is chronic bronchitis? What can it lead to?
- the presence of chronic productive cough for 3 months in each of 2 successive years
- hypersecretion of mucus begins in large airways and progresses to smaller airways
- hypertrophy of submucosal glands
- can lead to the formation of misshapen or large alveolar sacs with reduced space for oxygen and CO2 exchange.
How does the clinical presentation/ appearance of an emphysema compare to chronic bronchitis
- emphysema: use of accessory muscles, pursed- lip breathing, minimal or absent cough, leaning forward to breathe, dyspnea on exertion
- chronic bronchitis: excess body fluids, chronic cough, SOB on exertion, increased sputum, cyanosis
How is thorax ROM, the diaphragm, and the muscles of ventilation affected in COPD?
- there is decreased excursion
- muscles of ventilation become stretched
- the diaphragm become unable to return to dome shape on exhalation and flattens over time –> leads to use of accessory muscles for breathing
what is asthma?
- chronic airway inflammation defined by history of respiratory symptoms such as wheezes, SOB, chest tightness, cough, with variable expiratory airflow limitation
what are asthma symptoms and characteristics?
- symptoms: wheezing, SOB, chest tightness, fatigue during exercise, poor athletics performance, avoids activity, coughing at night or early morning
- inflammatory response leading to narrowing of airways (bronchospasm), increased secretions, resistance to airflow and air trapping (hyperinflation), remodeling of airways overtime
what are risk factors for asthma?
- genetics
-sec - tobacco exposure
- infections
- allergens
- obesity
what is the clinical presentation of asthma via spirometry? what are the different classifications of asthma?
- decreased FEV1 and increased RV and FRC
- allergy asthma, occupational, and exercise induced
What is a peak flow meter? what are ranges?
- measures expiratory air flow in one fast blast and takes the best of 3 trials.
-Green: 80-100% of normal - Yellow: 50-80% of normal; indicating airways are narrowing and treatment is warranted
- Red: <50% of normal; indicating medical emergency
what are the asthma severity classifications?
- intermittent: <2x/wk, nighttime symptoms, exacerbation rare; <2x/mo that does NOT interfere with normal activities, normal spirometry (>80%)
- mild persistent: symptoms >2x/wk, nighttime symptoms 3-4x/month, attacks are severe and interfere with activity, normal spirometry
- moderate persistent: daily symptoms and nighttime symptoms 1x/wk, interferes with activity, abnormal spirometry >60% but <80%
-severe persistent: continuous day and night symptoms, activity severely limited, frequent exacerbations, abnormal spirometry >60%
How do asthma patients present during auscultation?
- wheezes with relaxed breathing or a forceful exhalation
- during exacerbations there are decreased breath sounds due to reduced airflow
What are common clinical presentations of patients with asthma?
- dyspnea on exertion
-bouts of coughing especially at night - accesory muscle use, pursed lip breathing
- forward leaning posture
aerobic exercise Rx for asthma
- aerobic exercise improves asthma control and lung function but not airway inflammation
- low volume HIIT improves asthma control
FITT recommendation for individuals with asthma
- aerobic: 3-5x/wk, mod intensity (40-59% HRR), 30-40min, large muscle groups, walking, running, cycling, swimming
- resistance: 2x/wk on non-consecutive days, 60-70% 1RM, 2-4sets, 8-12 reps
- flexibility: 2-3x/wk, stretch to point of tightness
what is cystic fibrosis?
- genetic inherited condition that can be life threatening as it is a multi system disease (respiratory, digestive, reporductive)
- abnormal protein affects the cells of the body producing mucus and sweat
- mucus becomes thickened and stuck resulting in reduced function or infection
what are cystic fibrosis symptoms and complications
-symptoms: persistent cough that can have green sputum, muscle pain
- complications: recurrent lung infections, malabsorption of nutrients in the GI tract, deficiencies in fat-soluble vitamins, pancreatic insufficiency, reduced bone density leading to osteoporosis, diabetes
what is the clinical presentation of cystic fibrosis?
failure to thrive due to GI and pancreas dysfunction, frequent pulmonary infection, chronic cough, abnormal breath sounds (crackles and wheezes), accessory muscle hypertrophy, pursed lip breathing, cyanosis, digital clubbing
what are the goals of PT for cystic fibrosis patients?
- prevent secondary complications, improve QOL by managing mucus secretions, maintaining or improving lung functions
what are signs and symptoms of acute pulmonary exacerbation?
- increased cough, sputum production, temperature, respiratory rate, WBC
- decreased FEV1, appetite, weight, activity level
what are common PT treatments for cystic fibrosis?
- secretion clearance techniques, controlled breathing techniques, exercise and strength training, thoracic stretching, postural re-ed, home management
Obstructive pulmonary disease
1. anatomy affected
2. breathing phase difficulty
3. pathophysiology
4. useful measurements
- airways
- expiration
- increased airway resistance
- flow rates
