Pulmonary Flashcards
Obstructive Disease
When the air has trouble flowing out of the lungs due to resistance
I/E airway is obstructed
due to excessive contraction of the smooth muscles
Examples of Obstructive Disease
Asthma, Bronchiectasis, COPD
Restrictive Disease
When the chest muscles can’t expand enough which creates problems with air flow
Examples of restrictive disease
pulmonary fibrosis, chest wall disease
COPD
chronic obstructive pulmonary disease
preventable and treatable with some significant extrapulmonary effects that are characterized by an airflow limitation
Progressive disease
COPD progression
Emphysema or chronic bronchitis
emphysema
walls of the alveoli break down leaving fewer, bigger air sacs with less surface area to allow exchange of O2 and CO2 b/w the lungs and the blood
chronic bronchitis
excessive mucus that blocks the airway. Bronchi are inflamed swollen and clogged
FEV1.0
85% of FVC
Airway obstruction (FEV1.0.FVC)
<70% FVC
COPD characteristics
increased airway resistance reduced lung elastic recoil increased work to breathe ventilatory muscle weakness/easy fatigue Ventilatory inefficiency Ventilatory failure Low FEV1 but normal FVC Increase TLC
CRPD characteristics
Low FEV1 or normal
Low FVC
Decrease TLC
Factors contrib. to exercsie intolerance in pulmonary disease
altered breathing mechanics, impaired gas exchange, skeletal muscle dysfunction
Altered Breathing Mechanics
TLC (^ in O, Decreased in O) Increased resistance in ins and exp. decreased lung compliance decreased IRV increased work in breathing decreased VE peak Decreased breathing reserve (>.85) Decreased tidal volume (restrictive >obstructive)
Impaired Gas exchange
Decreased cardiac output, O2 uptake kinetics, lactate threshold, HR peak, VA, PaO2
Increased VD, VD/Vtidal, PaCO2, pulmonary vascular resistance and mean PAD
Skeletal Muscle Dysfunction
Increased ROS and inflammation mediators, protein damage and degradation, muscle wasting, muscle weakness, fatigue
Decreased Type 1 muscle fibers, muscle capillary density, nutritive muscle blood flow, protein synthesis, caloric intake, protein malnutrition
Outcome of Exercise Intolerance
decreased external work capacity and external work endurance, decreased ability to support physical activity and ADLS
decreased quality
Treatment for COPD
- self management education and smoking cessation
- Brochodilators (B2 adrenergic agonist)
- Inhaled corticosteroids
- Pulmonary rehabilitation
- Oxygenn
- Surgery
COPD exercise response
Hyperinflation (air trapping)
weakened diaphragm contraction
High CO2, low O2 in the blood
abnormal cardiac function
Aerobic Exercise Testing COPD
ramping cycle protocol, treadmill, 1-2 METs/stage
Endurance Exercise Testing COPD
6 min walk
Strength Exercise Testing COPD
Isokinetic or isotonic
Flexibility Exercise Testing COPD
Sit and Reach
Neuromuscular Exercise Testing COPD
Gait Analysis
Balance
Functional Exercise Testing COPD
Sit to stand
stair climbing
lifting
Special Considerations for Exercise Testing COPD
- Pulmonary function test should be included
- Determine arterial blood gases or arterial oxyhemoglobin saturation (SaO2) >90%
- Borg CR10 scale for dyspnea
- use smaller increments, slower progression and base it on functional limitations and early onset of dyspnea
- Prediction of VO2peak based on age-predicted HRmax may not be appropriate
- The 6-min walk test for assessing functional exercise capacity in individuals with more severe pul. disease
Atmospheric Air Partial Pressure
PO2: 159 mmHG
PCO2: 0.3 mmHG
Deoxygenated Blood Partial Pressure
PO2: 40mmHG
PCO2: 46mmHG
Expired Gas Partial Pressure
PO2: 116 mmHG
PCO2: 32mmHG
Oxygenated Blood Partial Pressure
PO2: around 95-100 mmHG
PCO2: 40mmHG
Alveoli Partial Pressure
PO2: 105 mmHG
PCO2: 40 mmHG
Oxyhemoglobin Dissociation Curve
(Inverted Parabola, apex at top) At PO2 in arteries 100mmHg 100%oxyhemoglobin saturation oxygen content 20ml/100 ml blood At PO2 in Veins: 40 mmHg 75% oxyhemoglobin saturation 15 ml/100ml oxygen content in blood
FITT for COPD (aerobic)
3-5 days/wk
light to vigorous (30-40% peak work rate) to (60-80%) intermittent exercise or interval training
walking or cycling
FITT for COPD (Resistance and flexibility)
- Follow the same FITT for healthy individuals
- Because of greater dyspnea, more beneficial working on the muscles of the shoulder girdle
- Inspiratory muscle training is beneficial
Benefits of Exercise (COPD)
Occur mainly through adaptations in the musculoskeletal and cardiovascular systems that turn reduce stress on the pulmonary system during exercise
EX of benefits of exercise on COPD/CRPD
cardiovascular reconditioning
reduced ventilatory requirement, reduced hyperinflation
desensitization to dyspnea
increased muscle strength, improved flexibility, improved body comp
better balance, enhanced body image
CRPD
Chronic restrictive pulmonary disease range of herogeneous disorders with diverse pathological processes that contribute to low lung function and reduced thoracic compliance -Reduced tidal volume -Increased work of respiratory muscles -Less efficient ventilation DECREASED FVC and TLC
FRC=
ERV + IRV
CRPD capacities
decreased IRV, ERV, FRC, TLC, IC, VC, Vtidal
Pathophysiology of CRPD
Intrinsic to the parenchyma of the lung:
-pulmonary fibrosis
-as the disease progresses the normal lung tissue is replaced by scar tissue
Extrinsic to the parenchyma:
-Disease restricting lower thoracic/abdominal volume
-Obesity, kyphoscoliosis, neuromuscular disease, trauma
Pulmonary Fibrosis
seen in CRPD
scarring of the lung between alveoli greatly decreases gas exchange
Type 2 Alveolar Cells
Production and secretion of surfactant that reduces the alveolar surface tension to prevent collapse
Fick’s Law of Diffusion
The rate of gas transfer is proportional to the tissue area, the diffusion coefficient of the gas and the difference in the partial pressure of the gas on the two sides of the tissue and inversely proportional to the thickness V gas= A/T*D*(P1-P2) a =area t=thickness D=diffusion coefficient of gas and p1-p2=difference in partial pressure
Exercise response in CRPD
Reduction in exercise tolerance and dyspnea
-inefficient ventilation with a high dead space
-mechanorecpetor stimulation
-Heightened central respiratory drive
Impairment in exercise capacity is associated with declines in exertional arterial oxygen tension and oxyhemoglobin saturation
Bronchodilators (exercise)
may improve ventilatory response, ventilation-perfusion matching and exercise capacity
Antihypertensive medication (exercise)
B-blockers may blunt heart rate response during exercise
Systemic corticosteroid treatment (exercise)
May increase blood pressure and induce muscle weakness
Severe pulmonary arterial hypertension (exercise)
Increases risk of hypotension and arrhythmias upon exercise
Goals of Exercise Testing CRPD
Completion of a 6-min walk test with concurrent transcutaneous measurement of pulse rate and oxygen saturation can provide info on
- disability due to pulmonary dysfunction
- detect coexistent factors that aggravate disability
- monitor progression of impairment and response to therapy
Special Considerations for testing 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
Hypoxia
A lower-than-normal concentration of oxygen in arterial blood, as opposed to anoxia, a complete lack of blood oxygen. Hypoxia will occur with any interruption of normal respiration
Exercise Recommendation for CRPD Goals
Learning efficient breathing techniques
Improving ergonomics during ADLS
Exercise Recommendation for CRPD Initial Period
6 to 8 weeks, 20 to 30 min, 5 days.wk of intense training to establish baseline
Sessions can be divided
Exercise Recommendation for CRPD Improvement
Submax exercise endurance maximal oxygen uptake ventilatory endurance cardiovascular conditioning Peak exercise DLco as peak cardiac output increases (diffusing capacity for CO) Oxygen extraction Skeletal Muscle endurance Quality of life
Bronchodilator therapy
leads to increased peak ventilation and less dynamic hyperinflation
Repeated Functional exercise stimulus
leads to increased movement efficiency helps with increased peak VO2
Repeated High intensity exercise stimulus
Leads to increased cardiovascular function and increased skeletal muscle oxidative capacity which helps to increase VO2, peak work rate and functional exercise capacity
Strength Training
Leads to increases skeletal muscle strength to help with an increase in ability to perform physical activities
______ is a type of chronic obstructive pulmonary disease where excessive mucus blocks the airway.
Chronic Bronchitis
Criterion for diagnosis of COPD is FEV1/FVC ______.
<70%
One of the typical abnormal exercise responses in chronic obstructive pulmonary disease (COPD) patients is hyperinflation of the lung. T/F
True
________ has become popular (or general) for assessing functional exercise capacity in individuals with more severe pulmonary disease.
6 min walk test
Antihypertensive medication, such as beta blockers, may increase blood pressure and induce muscle weakness during exercise in patients with chronic restrictive pulmonary disease. T/F
False, corticosteroid medications do this
Bronchodilators may improve ventilatory response, ventilation-perfusion matching, and exercise capacity during exercise in CRPD patients. T/F
True
Arterial oxyhemoglobin saturation (SaO2) should be around 75% during exercise testing in patients with COPD because the normal oxyhemoglobin saturation in the artery is 75%.
False, (SaO2) should be 90%
Patients with COPD tend to have lower residual volume compared to patients with CRPD
False
