Pulmonary Changes with Age Exam 3 Flashcards
Mechanical Changes: thoracic cage
Increased collagen leading to increased stiffness of costovertebral joints
loss of disc height leading to increase thoracic kyphosis and increased A-P diameter of the cage
Lung Parenchyma Changes with age
Decreased compliance in small airways
● More difficult to fill with air
⦿Increased size & production of mucous glands
⦿Decreased elastic recoil of lungs
● gas trapping…what is this similar to? COPD
Alevoli change with age
- decreased available surface area of gas exchange
- decreased diffusion capacity
decreased number of pulmonary capillaries
Change in respiratory muscle with age?
⦿Decreased size of Type I and II
⦿Decreased number of motor units
⦿Slowing at the neuromuscular junction
⦿Lose optimal L-T due to anatomical changes
- muscles must work harder to create negative pressure
Lung volume and capacities with age
⦿Decreased FVC ⦿Decreased FEV1 ⦿Increased RV
⦿No change in TLC
If you exercise with elders what changes will be seen with a greater ventilation:
- increased oxygen consumption
- decreased strength of respiratory muscle
- increased resistance to airflow
- changes in bony thorax
In elders who exercise less oxygen is available for myocardium and muscles during exercise leading to what?
● Decreased compliance of chest wall ● Decreased respiratory muscle strength ● Lungs are more compliant (air trapping) ● Increased small airway resistance ● Decreased ability to diffuse gasses ● Able to maintain respiration at rest
Normal inspiratory reserve volume
3100 ml
Normal tidal volume
500 ml
Normal expiratory reserve volume
1200 ml
Normal residual volume
1200 ml
Normal Inspiratory capacity
3600 ml
Normal residual capacity
2400 ml
Normal Vital capacity
4800 ml
Normal Total lung capacity
6000 ml
6 liters in men
5 liters in women
FEV1 ranges
● Little Obstruction FEV1 > 2 L
● Mild to Moderate FEV1 1-2L ● Severe FEV1 <1L
Gold Classification system gold 1:
mild
FEV 1 > 80% predicted
greater than or equal to 80
Gold Classification system gold 2:
Moderate
50 < FEV1 < 80% predicted
equal to 50
Gold Classification system gold 3:
Severe
30 < FEV1 < 50%
Equal to 50
Gold Classification system gold 4:
Very severe
FEV1 < 30%
Goals for medical assessment
Determine level of airflow limitation
Determine impact on health status
Determine risk of future events
Chronic obstructive pulmonary disease (COPD)
a common, preventable, and treatable disease, is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.
Goals of treating COPD
“Concomitant diseases are common; heart disease, muscle wasting, metabolic syndrome, anxiety, depression, lung cancer. These should be evaluated and treated as they have an independent correlation to hospitalizations and mortality.”
compared to usual care PR provides moderately large and clinically significant improvements in:
● Dyspnea ● Fatigue ● Emotional functioning ● Health-related QOL ● Exercise capacity
PR Goals:
⦿Modification of Risk Factors ⦿Increase strength ⦿Increase endurance ⦿Reduce economic burden of pulmonary disease ⦿Return to work ⦿Improve quality of life
Candidates of PR:
Dx of chronic, stable respiratory condition with symptoms that impair FUNCTION
Terminating exercise in PR
⦿ Breathlessness, fatigue, weakness beyond normal levels that doesn’t improve with rest or management with oxygen, medications, tripod positioning ⦿ Chest pain or tightness ⦿ Muscle pain that doesn’t improve ⦿ Feeling Dizzy or faint ⦿ Leg pain, weakness, cramping ⦿ Sweating more than usual with exercise
MMRC dyspnea scale grade 0
only get breathless with strenuous exercise
MMRC dyspnea scale grade 1
short of breath when hurrying on level ground or walking up a hill
MMRC dyspnea scale grade 2
walk slower than people of same age b/c of breathlessness or have to stop for breath when walking at my own pace
MMRC dyspnea scale grade 3
Stop for breath after walking 100 yards or a few minutes on level ground
MMRC dyspnea scale grade 4
too breathless to leave house or i am breathless when dressing
St. george is validated in:
COPD, bronchiectasis and sarcoidosis
Transtheoretical model: precontemplation
No intention to take action in next 6 months
Transtheoretical model: contemplation
Intention to take action in next 6 months
Transtheoretical model: preparation
Intention to take action in next 30d and has taken
behavioral steps to initiate change
Transtheoretical model: action
Behavior has changed for <6 months
Transtheoretical model: maintenance
Behavior has changed for > 6 months
