Pulmonary Disease and Impact on Exercise Flashcards
What is the function of the lungs?
Transport O2 into air sac’s (alveoli) and transport CO2 from the tissues to the atmosphere.
Order of the respiratory tree from trachea to alveolar sacs:
CONDUCTING PORTION
trachea
primary bronchus
secondary bronchus
tertiary bronchus
bronchioles
terminal bronchioles
RESPIRATORY PORTION
respiratory bronchioles
alveolar ducts
alveolar sacs
Ventilation equation
TV x RR = ventilation (L/min)
-both of these factors increase with activity
As tidal volume increases, what happens to inspiratory reserve volume or expiratory reserve volume?
Inspiratory reserve volume:
-Goes down
Expiratory reserve volume:
-Goes down
inspiratory reserve volume
The extra volume of air that can be inspired with maximal effort after reaching the end of a normal, quiet inspiration
expiratory reserve volume
expiratory reserve volume (ERV) is the amount of air that can be forcefully exhaled after a normal resting exhalation.
What is the fourth leading cause of death in the US?
COPD
COPD - chronic bronchitis
-over production of mucus causes an occlusion of airways
-alveoli becomes damaged
-“blue bloaters” –> lack o2
-oxygen exchange is difficult
COPD- emphysema
-destruction of the elastic fibers in the lungs
-inability of lungs to bounce back during expiration
-barrel chest
-“pink puffer”
-due mainly to chronic smoking
CAUSES:
-smoking
-hereditary alpha 1- antitrypsin deficiency –> destruction of elastic fibers surrounding the alveoli –> enlarged alveoli
Symptoms of COPD
-SOB
-dyspnea on exertion
-orthopnea (better breathing in upright position)
-wheezing
-increased respiratory rate
-peripheral cyanosis
-digital clubbing: Digital clubbing, also known as finger clubbing, is a medical condition that causes the terminal phalanges of fingers or toes to bulge
-pursed lip breathing
-elbow changes
-malaise
-chronic cough
-barrel chest (emphysema) (can’t exhale the same as before)
-weight loss
-use of accessory muscles of respiration
-prolonged expiratory period (with grunting)
-decreased FEV1/FVC ratio
-can contribute to chronic anxiety and depression
FEV1/FVC
ability to forcefully expel air as a proportion of total lung capacity
What is an example of a differential pulmonary test?
pulmonary function tests (specifically identify deficits in lung function)
-FVC
-FEV1
-FEV1/FVC
What can occur among ppl with COPD who exercise?
-impediment of lung emptying (more time required) –> obstructive lung disease
-increased breathing leading to hyperinflation and smaller tidal volumes
-impairment of gas exchange
Normal FVC, FEV1 and FEV1/FVC Values with COPD vs Normal for person without COPD
**WITH COPD **
FVC - forced vital capacity: 80% of total lung capacity
FEV1 - or forced expiratory volume in one second- 80%
FEV1/FVC- 75%
WITHOUT COPD **
* Tidal Volume: 0.5L at rest
* Forced Vital Capacity (FVC): 3-5L
* Forced Expiratory Volume (FEV1): 2.5-4L
* FEV1/FVC: >80% in healthy adults**
Mildly impaired FVC, FEV1 and FEV1/FVC Values
FVC - forced vital capacity: 60-79%
FEV1 - or forced expiratory volume in one second: 60-79%
FEV1/FVC: 60-74%
Postbronchodilator FEV1/FVC: <0.70, or >/= 80% of predicted
Moderately Impaired FVC, FEV1 and FEV1/FVC Values (with COPD)
FVC - forced vital capacity: 51-59%
FEV1 - or forced expiratory volume in one second: 41-59%
FEV1/FVC- 41-59%
Postbronchodilator FEV1/FVC: <0.70 or 50-79% % of predicted
Severely Impaired FVC, FEV1 and FEV1/FVC Values
FVC - forced vital capacity: 50 or less
FEV1 - or forced expiratory volume in one second: 40 or less
FEV1/FVC: 40 or less
Postbronchodilator FEV1/FVC: <0.70 or 30-49% of predicted
Very severe COPD postbronchodilator
Postbronchodilator FEV1/FVC: <0.70 or <30% of predicted
Effects of exercise training among ppl with COPD:
CV reconditioning
desensitization to dyspnea
improved ventilatory efficiency
increased muscle strength
improved flexibility
improved body comp
better balance
enhanced body image
What are some examples of restrictive lung diseases?
characteristic of: diminished lung volume (difficult to inflate the lungs; affects the expandability of the lungs)
-Neuromuscular: DMD, ALS, Guillian Barre, spinal cord disorders
-chest wall disorders: kyphoscoliosis, ankylosing spondy., obesity, compression fractures
-pleural disorders: fibrosis, effusion
-neonatal respiratory distress syndrome
-ARDS
-malignancy
-pulmonary edema
-major lung resection
-radiation exposure
-infectious agents
-inhaled particles
-immunologic diseases
-drugs
What are some pathologies that affect the pulmonary circulation?
-body position -> propping up the head and chest can help in some cases because fluid can back up into the alveoli
-stenosis or incompetence of heart valves
-CHF –> pulmonary congestion and edema
-pulmonary embolus
Pulmonary fibrosis (interstitial lung disease)
These disorders lead to fibrosis, or scarring of the interstitium tissue.
Supplemental oxygen and exercise:
If we don’t get people exercising, even when they’re oxygen saturation is low, they will not be able to improve their physical capacity—> okay for them to drop transiently
** concerned when the oxygen sat is below 88% throughout the day
** if they drop below this during exercise, likely okay transiently