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KIN 187 Clinical Exercise Physiology > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Obstructive Disease

A

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

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2
Q

Examples of Obstructive Disease

A

Asthma, Bronchiectasis, COPD

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3
Q

Restrictive Disease

A

When the chest muscles can’t expand enough which creates problems with air flow

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4
Q

Examples of restrictive disease

A

pulmonary fibrosis, chest wall disease

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5
Q

COPD

A

chronic obstructive pulmonary disease
preventable and treatable with some significant extrapulmonary effects that are characterized by an airflow limitation
Progressive disease

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6
Q

COPD progression

A

Emphysema or chronic bronchitis

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7
Q

emphysema

A

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

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8
Q

chronic bronchitis

A

excessive mucus that blocks the airway. Bronchi are inflamed swollen and clogged

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9
Q

FEV1.0

A

85% of FVC

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10
Q

Airway obstruction (FEV1.0.FVC)

A

<70% FVC

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11
Q

COPD characteristics

A 
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
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12
Q

CRPD characteristics

A

Low FEV1 or normal
Low FVC
Decrease TLC

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13
Q

Factors contrib. to exercsie intolerance in pulmonary disease

A

altered breathing mechanics, impaired gas exchange, skeletal muscle dysfunction

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14
Q

Altered Breathing Mechanics

A 
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)
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15
Q

Impaired Gas exchange

A

Decreased cardiac output, O2 uptake kinetics, lactate threshold, HR peak, VA, PaO2
Increased VD, VD/Vtidal, PaCO2, pulmonary vascular resistance and mean PAD

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16
Q

Skeletal Muscle Dysfunction

A

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

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17
Q

Outcome of Exercise Intolerance

A

decreased external work capacity and external work endurance, decreased ability to support physical activity and ADLS
decreased quality

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18
Q

Treatment for COPD

A
  1. self management education and smoking cessation
  2. Brochodilators (B2 adrenergic agonist)
  3. Inhaled corticosteroids
  4. Pulmonary rehabilitation
  5. Oxygenn
  6. Surgery
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19
Q

COPD exercise response

A

Hyperinflation (air trapping)
weakened diaphragm contraction
High CO2, low O2 in the blood
abnormal cardiac function

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20
Q

Aerobic Exercise Testing COPD

A

ramping cycle protocol, treadmill, 1-2 METs/stage

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21
Q

Endurance Exercise Testing COPD

A

6 min walk

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22
Q

Strength Exercise Testing COPD

A

Isokinetic or isotonic

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23
Q

Flexibility Exercise Testing COPD

A

Sit and Reach

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24
Q

Neuromuscular Exercise Testing COPD

A

Gait Analysis

Balance

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25
Q

Functional Exercise Testing COPD

A

Sit to stand
stair climbing
lifting

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26
Q

Special Considerations for Exercise Testing COPD

A
  • 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
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27
Q

Atmospheric Air Partial Pressure

A

PO2: 159 mmHG
PCO2: 0.3 mmHG

28
Q

Deoxygenated Blood Partial Pressure

A

PO2: 40mmHG
PCO2: 46mmHG

29
Q

Expired Gas Partial Pressure

A

PO2: 116 mmHG
PCO2: 32mmHG

30
Q

Oxygenated Blood Partial Pressure

A

PO2: around 95-100 mmHG
PCO2: 40mmHG

31
Q

Alveoli Partial Pressure

A

PO2: 105 mmHG
PCO2: 40 mmHG

32
Q

Oxyhemoglobin Dissociation Curve

A 
(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
33
Q

FITT for COPD (aerobic)

A

3-5 days/wk
light to vigorous (30-40% peak work rate) to (60-80%) intermittent exercise or interval training
walking or cycling

34
Q

FITT for COPD (Resistance and flexibility)

A
  • 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
35
Q

Benefits of Exercise (COPD)

A

Occur mainly through adaptations in the musculoskeletal and cardiovascular systems that turn reduce stress on the pulmonary system during exercise

36
Q

EX of benefits of exercise on COPD/CRPD

A

cardiovascular reconditioning
reduced ventilatory requirement, reduced hyperinflation
desensitization to dyspnea
increased muscle strength, improved flexibility, improved body comp
better balance, enhanced body image

37
Q

CRPD

A 
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
38
Q

FRC=

A

ERV + IRV

39
Q

CRPD capacities

A

decreased IRV, ERV, FRC, TLC, IC, VC, Vtidal

40
Q

Pathophysiology of CRPD

A

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

41
Q

Pulmonary Fibrosis

A

seen in CRPD

scarring of the lung between alveoli greatly decreases gas exchange

42
Q

Type 2 Alveolar Cells

A

Production and secretion of surfactant that reduces the alveolar surface tension to prevent collapse

43
Q

Fick’s Law of Diffusion

A 
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
44
Q

Exercise response in CRPD

A

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

45
Q

Bronchodilators (exercise)

A

may improve ventilatory response, ventilation-perfusion matching and exercise capacity

46
Q

Antihypertensive medication (exercise)

A

B-blockers may blunt heart rate response during exercise

47
Q

Systemic corticosteroid treatment (exercise)

A

May increase blood pressure and induce muscle weakness

48
Q

Severe pulmonary arterial hypertension (exercise)

A

Increases risk of hypotension and arrhythmias upon exercise

49
Q

Goals of Exercise Testing CRPD

A

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
50
Q

Special Considerations for testing CRPD

A
  • 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
51
Q

Hypoxia

A

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

52
Q

Exercise Recommendation for CRPD Goals

A

Learning efficient breathing techniques

Improving ergonomics during ADLS

53
Q

Exercise Recommendation for CRPD Initial Period

A

6 to 8 weeks, 20 to 30 min, 5 days.wk of intense training to establish baseline
Sessions can be divided

54
Q

Exercise Recommendation for CRPD Improvement

A 
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
55
Q

Bronchodilator therapy

A

leads to increased peak ventilation and less dynamic hyperinflation

56
Q

Repeated Functional exercise stimulus

A

leads to increased movement efficiency helps with increased peak VO2

57
Q

Repeated High intensity exercise stimulus

A

Leads to increased cardiovascular function and increased skeletal muscle oxidative capacity which helps to increase VO2, peak work rate and functional exercise capacity

58
Q

Strength Training

A

Leads to increases skeletal muscle strength to help with an increase in ability to perform physical activities

59
Q

______ is a type of chronic obstructive pulmonary disease where excessive mucus blocks the airway.

A

Chronic Bronchitis

60
Q

Criterion for diagnosis of COPD is FEV1/FVC ______.

A

<70%

61
Q

One of the typical abnormal exercise responses in chronic obstructive pulmonary disease (COPD) patients is hyperinflation of the lung. T/F

A

True

62
Q

________ has become popular (or general) for assessing functional exercise capacity in individuals with more severe pulmonary disease.

A

6 min walk test

63
Q

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

A

False, corticosteroid medications do this

64
Q

Bronchodilators may improve ventilatory response, ventilation-perfusion matching, and exercise capacity during exercise in CRPD patients. T/F

A

True

65
Q

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%.

A

False, (SaO2) should be 90%

66
Q

Patients with COPD tend to have lower residual volume compared to patients with CRPD

A

False

KIN 187 Clinical Exercise Physiology (16 decks)

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