Resp Flashcards
Roles of respiratory system
warm, humidify air
Oxygenation
removal of CO2
pH regulation
dysfunctional breathing def
breathing disorder where breathign pattern is changes, causing dyspnoea and other symptoms AND that cant be explained by resp and cardiac disease.
hyperventilation syndrome
breathing in excess of metabolic demands, leads to hypocapnia = respiratory alkalosis
Normal breathing
nose, slow, low
1:2 insp:exp
passive exp
diaphragm
BPD fight or flight cycle
Perceived threat triggers SNS.
SNS prepares for action so increases depth/rate of breathing (hyperventilation).
hyperventilation = hypocapnia symptoms
hypocapnia symptoms = anxiety
anxiety stimulates SNS = more symptoms
symptoms = more hyperventilation = more anxiety
Hypocapnia 4 physiological effects
- decreased CO2= increased pH = alkalosis
- Haldane effect: alkalosis increases O2 afiinity of Hb = decreased O2 provision to cells
- electrolyte shift = smooth muscle constriction (lungs)
- vasoconstriction = decreased BF
Hypocapnia signs and symptoms - neuro
confusion, headaches, tinnitus, fait, decreased balance, dizziness, blurry vision, brain fog, epilespy..
Hypocapnia signs and symptoms - resp
SOB, sighing/yawning, tight chest, cough
Hypocapnia signs and symptoms - CV
HR increase, palpitation, arrhythmias, cold extremities, angina symptoms, ECG changes
Hypocapnia signs and symptoms - MSK
twitch, shiver, weakness, tetany, pain, hyperreflexio, increased muscle tension
Hypocapnia signs and symptoms - psych
anxiety, anger
Hypocapnia signs and symptoms - gut
cramps, bloating nausea
Hypocapnia signs and symptoms - other
poor sleep, decreased exercise tolerance, dry mouth, bladder hyperactivity
Subj assessment of BPD
medical Hx: asthma, allergies, anxiety/panic attack, sinusitis, cough, resp infection. MSK problems, anaemia, CV problems, meds.
social: support, family, home envrmt, lifestyle (diet, exercise), occupation (demands, type support, finance)
tests/investigations: blood test, lung function/spirometry, previous Rx
Obj assessment of BPD
posture
chest shape
breathing patten
accessory muscle palpation
nose/mouth breathing
nasal patency
hands - cold/clammy
speech
yawning/sighing/
cough
PEFR/max inspP/tidal spirometry
Nijmegen questionnaire (nymiguen)
score 0-4 for each symptom (never - very often).
>23 = +ve.
symptoms:
chest pain, tense, feeling, SOB, confusion …..
BPD Treatment (3)
- education: normal pattern, abnormal pattern, how it causes symptoms, potential triggers.
- awareness of own pattern
- retraining:
- start in comfy position, progress to sitting, w motion
- relaxation technique
- nose low slow, aim to activate diaphragm, 1:2 ratio, aim to hold post exp
- use biofeedback (own/pt hands, sandbag)
- can train diaphragm if weak
- refer if see other components(psychological)
Asthma - definition and main symptoms
chronic inflammatory disease of airways from hyper-reactivity to allergen.
wheezing, SOB, tight chest, coughing
Asthma - diagnosis
based on Rx response, signs&symptoms response, absence of alternate explanation
need to take careful clinical Hx and assess spirometry response after bronchodilator/ICS use
no reliable gold standard diagnosis.
Asthma risk factors
enrvrmt
occupation
family hx
other medical conditions
ethnicity - pacific ppl
sex
Asthma triggers
house dust mites
cigarette/wood smoke
animals
weather change
pollen
chemicals - perfume
animals
Aims of asthma Rx
control signs and symptoms, how they affect daily life.
prevent attacks/flare ups.
keep lungs healthy as long as possible.
Asthma management strategies (5) and barriers
- management plan -review yearly
- smoking cessation - whole household
- education - incl ppl surroundings
- review inhaler/spacer
- regular PEFR readings
barriers: cultural beliefs, family dynamic, cost, age
Asthma meds
reliever therapy (adults)
- long term Inhaled corticosteroid (ICS)/fast B agonist reliever (NOT SABA ALONE).
preventive therapy (adults)
- ICS
AIR therapy - anti-inflam reliever
Inhaler devices for Asthma - considerations, instructions
hand weakness, coordination issues, breath holding ability, adherence.
- hold inhaler up right and shake
- place inhaler in to spacer opening
- seal mouth tightly around mouth piece
- press inhaler once
- 6 slow breaths, maintaining spacer
- remove space and repeat for more doses
Asthma - Physio management (3)
- breathing retraining for dyspnoea/hyperventilation
- education on mamagement plan, inhaler/space use and benefit.
3 improvement of CV fitness
- increases lung function
- decreases airway inflam.
- increases QoL
- via walking, swimming, biking, gymnastic..
Managing an asthma attack
- sit person upright
- give them 4 doses with spacer(4 slow breaths)
- wait 4 mins
- no improvements = repeat 4 doses
- no improvements = AMBO
Asthma warning signs
usual symptoms worsen
decreased PEFR, increased dyspnoea, tight chest, wheeze
can develop fast and be life threatning
Obstructive Sleep Apnoea (OSA) - definition + pathophysiology
recurrent partial.complete obstruction of upper airways. it is the most common sleep disorder.
upper airway collapse, decreased muscle tone, increased intra-thoracic P, changes in neural reflexes.
OSA diagnosis (AHI)
any of:
- complete airflow obstruction> 10 secs
- airflow reduction for 50% for 10 secs
- airflow reduction 30% for 10 secs + O2 desaturation 3%
AHI: Apnea-hypopnea index = number of events/total sleep time.
OSA risk factors
large neck circumference - obesity
genetics - narrow airway, neuromsk disease, cranio-facial morphology
low PA
posture - protraction
old
men
OSA untreated effects
- hypertension risk
- increased mortality - stroke, CVD in sever OSA
- uncertain increased CV risk in moderate OSA
OSA associated conditions
atrial fibrillation
HTN
stroke
CVD
obesity
T2DM
OSA symptoms - daytime
- increased somnolence
- morning headache
- wakign unrefreshed
- poor concentration
- irritability
- impaire memory
OSA symptoms - nighttime
- rapid sleep onset
- snoring
- witnessed apnoea
- choking
- nocturia
OSA sleep questionaires (4)
- Epsworth sleep scale (ESS) - symptom frequency
- STOP -BANG - risk factor scale
- Functional outcome of sleep (FOSQ) - functional implications of OSA
- Pittsburg sleep quality index (PSQI) - functional
OSA management
- CPAP
- sleep posture
- surgery (UPPP)
- dentaal appliances
CPAP
for OSA
keeps Positive pressure in ins + exp
splints airways open
poor adherence, weight gain, no increased PA
benefits PA in OSA
- helps weight loss
- decreased apnea severity
- strengthens oropharyngeal muscles
- mitigates risk factors
- decreased fatigue
- increased QoL
upper airway strengthening
- oropharyngeal exercises
- wind instruments
- singing
Phsyio role in management of OSA
- education and awareness
- exercise prescription
- motivational interviewing
- behavioural change techniques
