Pulmonary/Cardiac Care In Athletes Flashcards
Pulmonary Terminology
TLC (Total Lung Capacity)
VC (Vital Capacity) = Maximum amount of lungs you can use with expiration and inspiration
RV (Residual Volume) = What is left in your lungs no matter how hard you blow out
IC (Inspiratory Capacity) = VT + IRV
IRV (Inspiratory Reserve Volume) = From top of VT to maximum inspiration
ERV (Expiratory Reserve Volume) = From bottom of VT to RV
VT (Tidal Volume) = Inspiration/expiration at rest
FEV1 = Forced expiratory volume in one second
FVC = Volume of forced VC
Obstructive Pattern Equation
FEV1/FVC
Decreased ratio is obstructive pattern and results in decreased flow rates
Restrictive vs Obstructive Lung Diseases
Obstructive lung diseases include conditions that make it hard to exhale all the air in the lungs. People with restrictive lung disease have difficulty fully expanding their lungs with air.
Exercise Induced Bronchospasm
Triggered by inhalation of large volumes of air that is cooler and dryer than the air within the lungs. Leads to water loss/moisture on surface of airways and then the body releases inflammatory mediators and causes bronchospasm.
Asthma
Reversible airflow obstruction. Inflammatory disease resulting in hyper-responsiveness of airways in response to allergens, exercise, cold, medications, infections.
Diagnosing EIB
Coughing, wheezing, SOB, chest tightness, feeling out of shape. Occurs within 5-30 minutes into an exercise bout (not usually right away) and is very predictable. Clinically you can have them on TM for 6-8 minutes at HR goal of 85% of theoretical max. Positive if FEV1 drops by 10-15% or more (compared to rest). Measure this at 5 minute intervals for 30 minutes. If the athlete takes this without a TUE (therapeutic use exemption) and they get drug tested it could lead to suspension.
Treating EIB
Have them warm up 10-15 minutes prior to practice/usual warm up. May give them refractory period where they don’t need meds. Beta2 agonists are the hallmark of treatment and inhaled (given 10-15 minutes prior). They are short acting and medication names end in “buterol”. They cause smooth muscles in the lungs to relax.
Side effects of beta2 agonists
Tachycardia, throat irritation, tremors, nervousness, and headache
Other medications for EIA
Mast cell stabilizers (chromalin), inhaled corticosteroids, long-acting beta agonists, leukotriene inhibitors, oral steroids. These can not be used as rescue medications and if an athlete hands you this it’s not going to help you during an attack.
NSAIDS and Aspirin
NSAID’s and Aspirin can be a trigger for EIB if their symptoms are getting worse or not responding to medication.
Steps for medication with asthma
- Short acting beta2 agonist
- Long acting beta2 agonist with inhaled corticosteroids
Vocal cord dysfunction
Inappropriate vocal cord motion (or lack of motion) that produces airway obstruction. Looks and sounds like asthma. Has similar triggers to asthma but also post-nasal drip, reflux (acid getting onto cords), but also anxiety.
Can differentiate because they will usually have Inspiratory wheezing, stridor (hard vibrating noise when breathing), and throat irritation.
Vocal cord dysfunction diagnosis
Formal pulmonary testing and laryngoscope that shows the cords right after exercise. Once they stop exercise it will often go back to normal very quickly…within several minutes (EIB can often take awhile). No wheezing in their lung fields with stethoscope but will whistle during inspiration and expiration.
Vocal cord dysfunction treatment
Reassure them, they won’t die from this. Speech therapy is very effective. Identify triggers and avoidance.
When does blow need to happened to cause Commotio cortis?
Just prior to T-wave peak (repolarization).
