Pulmonary Conditions Flashcards
Describe the BODE index.
A 4-point scale identifying 4 areas that indicate the severity of COPD:
B MI - Identifies O2 uptake deficits and is a typical comorbidity of COPD.
O bstruction - within the airway, measured by FEV1% and scaled on the GOLD staging of COPD.
D yspnea scale - determines shortness of breath, indicating QoL and ADL impairment.
E xercise tolerance - measured using the 6MWT to review functional capacity. It has a strong correlation with mortality and morbidity.
What are the GOLD guidelines for diagnosis and staging of COPD?
0 - 4 scale:
0 - Not troubled by breathlessness.
1 - (mild breathlessness - >80% predicted FEV1): SOB when hurrying or up slight hills.
2 - (moderate breathlessness - 50-79% predicted FEV1): Slower walk than average (of pop), on level ground due to breathlessness, OR has to stop for breath at normal pace.
3 - (severe breathlessness - 30-49% predicted FEV1): Stops for breath after ~100m or a few minutes on level ground.
4 - (very severe breathlessness -
List the Primary and Secondary aims of COPD management.
P - reduce breathlessness, increase exercise capacity, improve QOL.
S - Prevent/treat exacerbation, slow disease progression, prolong survival.
List 3 risk factors for and signs of COPD.
Risk factors:
smoking; occupational; environmental; allergy/asthma; poor nutrition; genetics.
Signs:
Bronchitis (airway inflammation); peribronchiolar fibrosis; irreversible airway obstruction; wheezing/ chronic cough; hypoxia; lactic acidosis.
What are the norms for measures of lung function when healthy, obstructive, and restrictive? FVC, FEV1, and FEV1%/FVC.
*Note with obstruction (asthma) all values are reduced, while restrictive lung function (fibrosis) reduces only FVC and FEV1.
Function Healthy Obstructive Restrictive
FVC 5L 3.1L 3.1L
FEV1 4L 1.3L 2.8L
FEV1%/FVC 89% 42% 90%
It is recommended that smokers older than 45yrs, or those who experience dyspnea, a chronic cough, wheezing or excessive mucous production undergo a Spirometry test to determine any restrictive or obstructive pulmonary abnormalities.
T/F?
True - Spirometry provides measures of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), A ratio of the above two, and peak expiratory flow (PEF).
Name two characteristics each of an obstructive and a restrictive pulmonary disorder.
O - difficulty exhaling, narrowing airway inside the lungs, exhale slower than normal, breath rate increased.
R - lungs cannot fully expand, possible chest stiffness, weak diaphragm, damaged nerves innervating lung action.
There are 8 pulmonary conditions in which exercise is supported as rehabilitative. List 3 and their description.
COPD - Irreversible airflow limitation due to bronchitis and emphysema.
Bronchitis - inflammation of the bronchi causing a chronic productive cough lasting 3 months at a time.
Emphysema - permanent enlargement and destruction of terminal bronchiole walls.
Asthma - Airway obstruction due to inflammation and bronchospasms.
Cystic Fibrosis - Genetic; excessive, thick muscous production obstructing airway and causing chronic respiratory infection.
Bronchiectasis - Abnormal chronic enlargement of airways with impaired mucous clearance.
Pulmonary Fibrosis - Scarring and thickening of the parenchyma (function tissue - alveoli, ducts and bronchioles) of the lungs.
Lung Cancer.
What are the FITTP principles for Asthma - which may be translated to other pulmonary conditions (sign and symptom dependent).
F - 2-3 days per week
I - 60% VO2peak; 80% walking speed determined by 6MWT, or RPE 11-13
T - 20-30min/day
T - aerobic: large muscle group activities such as walking, running, swimming.
resistance - major muscle groups 2-3/week 2-4 sets of 8-15reps
P - if well tolerated progress to 70%VO2peak, up to 40 minutes duration and up to 5 days per week.
It is important to encourage healthy behaviours and self-administered measurement systems to keep the person from deteriorating. How might this be done, list 3 methods.
Encourage smoking cessation
Educate on proper medication use and exercise habits
Monitor signs/symptoms, sleep pattern, breath at rest, mucous production, exercise habit with a diary.
Seek medical advice when unwell
Avoid triggers (certain smells, allergens in the air, etc)
The goal of exercise training/rehabilitation is…
To retrain effective breathing patterns
To implement adequate endurance, strength and flexibility for upper and lower body
To train ventilatroy muscles (intercostals, diaphragm, SCM, scalenes, etc)
To conserve energy
Patient education, exercise training, self-management, psychosocial intervention, and support are integral in for proper client-centered treatment.
T/F?
True
