Pulmonary Flashcards
Two types of pulmonary disease
Obstructive
Restrictive
Obstructive disease is when
Examples
The air has trouble flowing out of the lungs due to RESISTANCE
Airway obstruction
Due to excessive contraction of the smooth muscle
e.g. Asthma, Bronchiectasis, COPD
Restrictive disease is when
Examples
The chest muscles cant expand enough which creates problems with air flow
e.g. pulmonary fibrosis, chest wall disease
Chronic obstructive pulmonary disease (COPD) is
Preventable and Treatable disease
Has some significant extrapulmonary effects which are characterised by an airflow limitation that is not fully reversible
Progressive disease involves
Emphysema
Chronic brochitis
Emphysema is due to
Breakdown/collaspe of lung tissue/alveoli
Chronic brochitis is due to
Excessive mucus blocks airway
Dynamic measures of spirometry are
Force vital capacity (FVC)
Forced expiratory volume 1 sec (FEV 1.0)
When do you know if airway is obstructed
FEV1.0/FVC <70%
Characteristics of COPD involve
Increased airway resistance
Reduced lung elastic recoil
Increased work of breathing
Ventilatory muscle weakness/fatigue
Ventilatory inefficiency
Ventilatory failure
What 3 things are affected by exercise intolerance due to respiratory disease
Altered breathing mechanics
Impaired gas exchange
Skeletal muscle dysfunction
What is the overall outcome of exercise intolerance due to respiratory disease
Decrease external work capacity
Decrease external work endurance
Decrease ability to support physical activity
Decrease quality of life
What are the treatments options for COPD (increasing in severity)
Self management education and smoking cessation
Bronchodilators
Inhaled corticosteroids
Pulmonary rehabilitation
Oxygen given
Surgery
What is the typical exercise response in COPD
Hyperinflation (air trapping)
Weaken diaphragm contraction
High CO2
Low O2 in blood
Abnormal Cardiac function
Exercise testing for COPD (aerobic)
Ramping cycle protocol
Treadmill
1-2 METs/stage
Exercise testing for COPD (endurance)
6 min walk
Exercise testing for COPD (strength)
Isokinetic or isotonic
Exercise testing for COPD (flexibility)
Sit and reach
Exercise testing for COPD (neuromuscular)
Gait analysis
Balance
Exercise testing for COPD (functional)
Sit to stand
Stair climbing
Lifting
What are the special considerations for exercise testing in COPD
Pulmonary function test required
Determine arterial blood gases or arterial oxyhemoglobin saturation > 90%
Perceptions of dyspnea
Modifications of traditional protocols
Not appropriate to use VO2 peak based on age predicted HRmax
6 min walk test for assessing functional exercise capacity with more severe disease
What is the FITT recommendation for aerobic for COPD patients
3-5 days/wk
Light (30-40%) improves symptoms and quality of life
Vigorous (60-80%) shows physiologic improvements (more encouraged)
Intermittent exercise/ interval training = A few mins then rest
Walking or cycling
What is the FITT recommendation for resistance for COPD patients
Follow same FITT principle for healthy adults
Greater dyspnea means its more beneficial to work on muscles of shoulder girdle
Inspiratory muscle training
What are the benefits from exercise in COPD
Majority of research supports exercise as a supplementary treatment in individuals with COPD
Main beneficial effect involves adaptations in the musculoskeletal and cardiovascular systems which reduce stress on the pulmonary system during exercise
Adaptations in the musculoskeletal and cardiovascular systems that reduce stress on the pulmonary system consist of
Cardiovascular reconditioning
Reduced ventilatory requirement
Reduced hyperinflation
Desensitisation to dyspnea
Increased muscle strength, flexibility and body composition
Better balance
Chronic restrictive pulmonary disease have a range of heterogeneous disorders that contribute to…
Low lung function and reduced thoracic compliance:
Reducing tidal volume
Increasing work of respiratory muscles
Less efficient ventilation
CRPD instrinsic to the parenchyma of the lung involves
Pulmonary fibrosis
As the disease progresses, the normal lung tissue is gradually replaced by scar tissue
What is pulmonary fibrosis
Scarring of the lung
CRPD extrinsic to the parenchyma of the lung involves
Disease restricting lower thoracic/abdominal volume
Obesity?
Kyphoscoliosis?
Neuromuscular disease?
Trauma?
Type 2 alveolar cells produce and secrete
Surfactant
What does surfactant do
Reduce the alveolar surface tension to prevent collapse
Exercise response to CRPD
Reduction in exercise tolerance and dyspnea
Impairment in exercise capacity is associated with declines in exertional arterial oxygen tension and oxyhemoglobin saturation
The reduction in exercise tolerance and dyspnea from CRPD is due to
Inefficient ventilation with a high dead space
Mechanoreceptor stimulation
Heightened central respiratory drive
What are the potential alteration to the exercise response in CRPD
Bronchodilators
Antihypertensive medications
Systemic corticosteroid treatment
Severe pulmonary arterial hypertension
Bronchodilators effect on exercise response
May improve ventilatory response, ventilation-perfusion matching and exercise capacity
Antihypertensive medication effect on exercise response involves
Beta blockers may blunt heart rate response during exercise
Systemic corticosteroid treatment effect on exercise response involves
May increase blood pressure and induce muscle weakness
Severe pulmonary arterial hypertension effect on exercise response involves
Increases risk of hypotension and arrhythmias upon exercise
Completion of 6 min walk test with measurement of pulse rate and oxygen saturation can provide information on
Disability due to pulmonary dysfunction
Detect conexistent factors that aggravate disability
Monitor progression of impairment and response to therapy
What is the consideration for exercise testing in CRPD
Worsening hypoxia should be monitored because it can contribute to chest pain and arrhythmias
Oxygen saturation should be >90%
Meter dosed inhalers should be evaluated for proper technique
Avoid extreme temp or humidity
The main goals for exercise recommendations for CRPD patients involves
Learning efficient breathing techniques
Improving ergonomics during ADLs
The initial period for exercise recommendations for CRPD patients involves
6 to 8 weeks
20 to 30 mintues
5 days/week
Of intense training to establish baseline
Session duration can be divided
What improvements ***
What are the benefits of exercise for CRPD
Exactly the same as COPD
Intervention of Bronchodilators, its mechanism and effect
Increased peak ventilation
Less dynamic hyperinflation
Effect:
?
Intervention of repeated functional exercise stimulus, its mechanism and effect
Increased movement efficiency
Decreased ventilation at iso-work
Effect:
Increase peak VO2
Increase Peak work rate
????
Intervention of repeated high intensity exercise stimulus, its mechanism and effect
???
Intervention of resistance training, its mechanism and effect
????
Fick’s law of diffusion is (proportional and inversely proportional)
The rate of gas transfer is proportional to:
Tissue area
Diffusion coefficient of the gas
The difference in the partial pressure of the gas on two sides of the tissue
Inversely proportional to:
Thickness
Ficks law equation
V gas = A/T x D x (P1 - P2)
What is the partial pressure of O2 and CO2 in air
PO2 = 159 mmHg
PCO2 = 0.3 mmHg
What is the partial pressure of O2 and CO2 in deoxygenated blood
PO2 = 40 mmHg
PCO2 = 46 mmHg
What is the partial pressure of O2 and CO2 in expired gas
PO2 = 116 mmHg
PCO2 = 32 mmHg
What is the partial pressure of O2 and CO2 in oxygenated blood
PO2 = 95 mmHg
PCO2 = 40 mmHg
Oxyhemoglobin dissociation curve shows that at PO2 in arteries
Around 100 mmHg
% oxyhemoglobin saturation is around 100%
Oxygen content is around 20ml/100ml blood
Oxyhemoglobin dissociation curve shows that at PO2 in veins
Around 40 mmHg
% oxyhemoglobin saturation is around 75%
Oxygen content is around 15ml/100ml blood
