Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EXS 450 > Respiratory Diseases > Flashcards

Respiratory Diseases Flashcards

1
Q

Most common respiratory diseases

A

COPD

Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Respiratory disease stats

A

1 billion people have a chronic respiratory condition and more than 4 million die prematurely/year from respiratory disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Leading cause of death in children

A

Pneumonia

Upper respiratory tract infection (RSV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

COPD stats

A

Affects up to 200 million people

4th leading cause of death worldwide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Asthma stats

A

Affects up to 300 million people worldwide

More than 250,000 deaths are attributed to asthma worldwide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lung cancer stats

A

Most common cause of death from cancer worldwide

Incidence and mortality rate are approximately 50 and 42 per 100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

COPD epidemiology

A

3rd leading cause of death in the US

Persistent respiratory symptoms and airflow limitations due to airway/alveolar abnormalities caused by exposure to toxic particles and gases

A direct relationship between severity and management cost

Chronic bronchitis

Emphysema

Evolves from a complex interaction between genetics and the environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

COPD epidemiology: risk factors

A

Tobacco smoke, environmental or occupational exposures to inorganic/organic dust, chemical fumes, pollution, age, gender, lung growth, and development, etc.

Tobacco and marijuana is directly related to prevalence is the most common risk factors

Up to 50% of smokers don’t have COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

COPD pathophysiology

A

An exaggerated inflammatory response due to chronic exposure to noxious gases and particles (similar to an autoimmune disease)

Overproduction of mucus from hypertrophied submucosal glands and enlarged goblet cells cause a cough

Dyspnea

Lung hyperinflation affects cardiovascular function

Ventilation and perfusion of the lung is compromised

Skeletal muscle dysfunction is the most common extrapulmonary manifestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Asthma epidemiology

A

Heterogeneous disease

24 million people have asthma, including more than 5 million under the age of 14

Higher prevalence among non-Hispanic Blacks (9.9%) than among Caucasians (7.6%) or Hispanics (6.7%) with the highest prevalence in Puerto Ricans (16.5%)

1.5 times greater for females than males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Asthma characterized by

A

Chronic airway inflammation

An exaggerated inflammatory response following exposure of the airway to triggering stimuli such as dust or pollen, viral infection, or airway drying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Asthma defined by

A

History of respiratory symptoms such as a wheeze, SOB, chest tightness, and cough that vary over time and intensity, together with variable expiratory airflow limitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Asthma: airway becomes

A

Hyperresponsive, narrow, and may undergo extensive airway remodeling over time causing irreversible airway obstruction or development of COPD-asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Asthma process

A

Chronic inflammatory response results in airway remodeling

Microbial antigens can attach to toll-like receptors expressed by epithelial cells that initiate intracellular signaling cascades resulting in the production of various cytokines and chemokines

Dendritic cells in the airway epithelium serve as gatekeepers of the immune response

Controls whether the antigen is tolerated or an immune response results

Eosinophils are involved in many aspects of asthmatic inflammation and their role may vary with endotype

Mast cells are key effector cells in the allergic immune response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Asthma pathophysiology

A

Acute asthma attack, contraction of airway smooth muscle, and swelling of the airway epithelium
-Cause airway narrowing that obstructs the airflow, making it more difficult to ventilate the lungs

Chronic asthma is linked to significant airway remodeling over time
-Characterized by epithelial sloughing, mucous gland and smooth muscle hyperplasia, basement membrane thickening, and airway edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Exercise-induced asthma and bronchospasm

A

Exercise-induced asthma (EIA) and exercise-induced bronchoconstriction (EIB) are terms often used interchangeably to describe wheezing or difficulty breathing during or after exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Exercise-induced asthma

A

Bronchoconstriction during exercise because exercise is one of many possible triggers of their existing asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Exercise-induced bronchospasm

A

Exercising at a high intensity or in a cold environment is the trigger for an inflammatory response that induces airway constriction and difficulty breathing

19
Q

Exercise testing in respiratory conditions

A

Severe respiratory disease leads to lung function being the clear limiting factor to exercise capacity

Mild to moderate respiratory disease leads to exercise capacity being limited by skeletal muscle dysfunction caused by poor oxygenation over time, poor physical conditioning, and/or other diseases

20
Q

ABSOLUTE contraindications to cardiopulmonary exercise testing once the test starts

A

Patient requests to stop

Drop in systolic BP of > 10mm Hg when
accompanied by other evidence of ischemia

Moderately severe angina

Increased nervous system symptoms

Signs of poor perfusion

Technical difficulties (will the results be valuable?)

Sustained ventricular tachycardia

ECG with ST-segment elevation without a diagnostic Q wave

21
Q

RELATIVE contraindications to cardiopulmonary exercise testing once the test starts

A

Drop in systolic BP of > 10mmHg with no evidence of ischemia

ECG ST-segment or QRS changes such as ST depression

Arrhythmias other than sustained ventricular tachycardia

Fatigue, SOB, wheezing, leg cramps, claudication

Development of bundle branch block or conduction delay

Increased chest pain

Hypertensive response (Sys > 250; Dia > 115)

22
Q

Cardiopulmonary exercise testing: choosing a modality

A

Dictated by the modality of exercise best suited to the patient and by the availability of equipment

23
Q

Cardiopulmonary exercise testing: treadmill

A

Reflects ADL, higher peak oxygen consumption, and greater arterial oxygen desaturation
Difficult to accurately determine external work

24
Q

Cardiopulmonary exercise testing: cycle ergometer

A

Well-established energetic cost, safety related to balance/stability during measurement/stopping

25
Q

Cardiopulmonary exercise testing: incremental protocols

A

Intensity is gradually increased over time in steps, or at a constant rate

Last between 8-12 minutes (test duration of 5 minutes is sufficient for analysis in unconditioned patient)

A routine for estimating one-minute step workload increases needed to achieve a cycle ergometer test that is approximately 10 minutes long is available

Short stages, starting at 1.0 MPH and 0% grade

Treadmill-based protocols are also recommended

26
Q

Cardiopulmonary exercise testing: continuous or endurance work rate protocols

A

Warm up at a very low workload for 2-3 minutes then increase workload abruptly above critical power and the patient continues until fatigue or test is terminated

Constant load tests are superior to incremental tests

27
Q

Cardiopulmonary exercise testing: test components

A

Peak oxygen consumption rate

Ventilatory equivalents for oxygen and carbon dioxide (V̇E/V̇O2 and V̇E/V̇CO2)

Anaerobic threshold (extremely low)

Dead space to tidal volume ratio (VD/VT)

Respiratory exchange ratio (RER)

Alveolar minus arterial oxygen and carbon dioxide difference (P(A-a)O2) (how well we perfuse O2 and eliminate CO2)

Arterial minus end-tidal carbon dioxide difference (P(a-ET)CO2) (how well we eliminate CO2)

Oxygen saturation

Breathing and heart rate reserve

28
Q

Cardiopulmonary exercise testing: key findings

A

Lower than expected peak work rate and a v̇O2 peak that is below age-predicted norms

RER may exceed 1.0 at rest (a problem because they are always in an anaerobic state) or it may not increase above 1.0 during exercise because exercise is terminated prior to reaching the anaerobic threshold

Anaerobic threshold is usually at the lower end of normal but may be absent (due to the individual already being in the state of anaerobic)

Maximal voluntary ventilation is decreased

As exercise progresses, breathing reserve is typically exhausted

Cardiovascular response is mostly normal unless the cardiac or pulmonary vascular disease is also present

29
Q

Field testing options

A

6-minute walk test

Incremental shuttle walk test (ISWT)
-12 stage test to exhaustion

Endurance shuttle walk test
-Test at 85% of maximum sustainable walking speed until breathlessness or fatigue ensues (good for looking at the function of their daily living)

30
Q

Musculoskeletal testing

A

Static maximal isometric strength

Dynamic testing

31
Q

Musculoskeletal testing: dynamic testing

A

Strength over the ROM

1-RM is widely used; an alternative is an estimation of 1RM from 2RM to 10RM

Testing is generally contraindicated in those meeting the contraindication criteria for exercise testing in addition to those with musculoskeletal conditions or injuries that may be made worse by exerting maximal effort

32
Q

Musculoskeletal testing: static maximal isometric strength

A

Perform an MVC

Low risk

Measure force with a strain gauge, cable tensiometer, force platform, or force transducer

33
Q

Exercise training

A

Fundamental component of pulmonary rehab and the most effective method for reducing exercise intolerance

Each exercise prescription should be individualized

34
Q

Exercise training: purpose

A

To improve capacity to perform external work

35
Q

Aerobic exercise training: warmup

A

Long warm-up is important for these patients

5-10 minutes beginning at low intensity (< 40% of the V̇O2 reserve) and increasing to training intensity

Activities similar to those used in the conditioning phase

Mobility, ROM, and flexibility exercises should have purpose and thus need to be structured into the warm-up session appropriately

36
Q

Aerobic exercise training: cool down

A

Long cool down is important for these patients

5-10 minutes gradually decreasing whole-body aerobic exercise (< 40% of the V̇O2 reserve)

Help prevent venous pooling

May prevent bronchospasm

Static stretching and other flexibility exercises can be performed after the patient has sufficiently recovered from the conditioning exercises, but they should not be used as the primary cool-down activity

37
Q

Aerobic exercise training: conditioning phase (frequency)

A

3-5 d/wk (obese patients up to 7 d/wk)

Consider using multiple short bouts per day for those with lower fitness

1 session per week supervised by CEP

38
Q

Aerobic exercise training: conditioning phase (intensity)

A

Use of exertion scale may be helpful when exercise testing is not practical/possible; also dyspnea and breathlessness scales

Maintain oxygen saturation at ≥ 88%

Varying for patients with chronic respiratory disease
-Recommended aerobic training intensity for those with COPD ranges from 50% to 80% of the peak work rate and is likely suitable for patients with other chronic respiratory conditions

39
Q

Aerobic exercise training: conditioning phase (time)

A

Ideally 20-60 min during each training session

If deconditioned or moderate/severe disease may not be able to sustain interval training may be useful

40
Q

Aerobic exercise training: conditioning phase (type)

A

Commonly used: walking or cycling

Arm cycling to improve unsupported arm capacity but may produce dyspnea and distress due to fatigue of accessory muscle of inspiration

Be aware that cold may exacerbate symptoms

Both continuous and interval-training protocols improve exercise capacity and quality of life in patients with COPD
-Decisions should be guided by client preference, symptoms, and willingness to adhere to the program as well as by the therapeutic goals

41
Q

Resistance training

A

Consistently improves strength in COPD patients despite wide variation in training program characteristics

A higher-functioning patient would benefit from a combined program that could potentially improve strength and aerobic capacity to a greater degree than a unimodal program

Patients who are severely limited in their ability to undertake continuous or interval aerobic training may be better served initially by completing resistance training due to its lower demand for oxygen and lower dyspnea scores

Muscle dysfunction contributes to exercise intolerance, and it is a significant contributor to the severity of symptoms experienced by those with COPD

42
Q

Resistance training: considerations

A

8-10 whole-body exercises that involve all of the major muscle groups (i.e., arms, shoulders, chest, abdomen, back, and legs)

1-3 sets of 8 to 12 repetitions on 2-3 days each week

Usually, 2-3 min of recovery between sets; total time about 30-40 min

Various types of resistance elements: machine or free weights, elastic resistance bands, weighted grocery bags or other common items, or the patient’s own body mass

While inspiratory muscle training is effective, it should be considered an adjunct therapy to other forms of exercise training

Periodization of the program is recommended

43
Q

Flexibility training

A

Important given that impaired posture can affect ventilation and increase the work of breathing

No specific guidelines for pulmonary rehabilitation: apply general recommendations:
-Minimum 2-3 days/week, to the point of tightness, 10-30 seconds and 2-4 repetitions

44
Q

Asthma specific considerations

A

Medication use

Once symptoms are controlled, recommendations and guidelines are the same for individuals with asthma and healthy individuals

Start with a lower intensity progressing gradually

Avoid: scuba diving, swimming, exercise in cold, outdoor exercise

EXS 450 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions