The Aging Pulmonary System Flashcards
An increase in production of CO2 from muscles lead to what in circulatory and pulmonary circulation
What about increase in uptake of O2
CO2 ->Peripheral Circulation dilation -> Increase SV -> Recruit Pulmonary System -> Increase in Tidal Volume
O2 ->Recruit -> Increase HR ->Dilate -> increase respiratory rate
Minute ventilation is calculated which 2 ways
Product of tidal volume and respiratory rate
Or
Sum of alveolar and dead space ventilation
What happens with VO2max with aging? Difference between men and women?
Declines about 1 ml/kg/min per year, faster in men, increases with age
Rate of decline in inactive men 2x of active individuals
Resting VO2 equivalent to 1 MET
What is 50 year old’s max? Activities example
80 year old?
3.5 ml/kg/min
At 50 about 10 times this so 35, equivalent of running 6mph, carrying 60 lb load up stairs
At 80 it’s about 21, walking uphill at 3.5 mph, pushing a lawn mower.
What stays consistent over time in the lungs in terms of morphology and physiology?
Elastin, lung cell populations (type I vs II)
Reduction in elastic recoil is offset by a stiffer chest wall, so TLC remains relatively stable.
How does vital capacity and residual volume change over time
Forced expiration volume
Even though TLC relatively constant,
VC decreases over time as RV increases
FEV1 decreases
What causes the gradual decrease in partial pressure difference between the alveolus and the systemic arterial blood
Pulmonary perfusion does not decrease with age but there is an increase in physiological dead space, which decreases alveolar ventilation. This causes an increased inequality in alveolar ventilation and perfusion, which leads to a gradual decrease in in arterial partial pressure,
COPD includes which 2 diseases
How are they structurally different?
How are they functionally the same
Emphysema and chronic bronchitis
Often difficult to distinguish the 2 and often occur at the same time
Emphysema: Enlargement of distal airspaces
CB: hypertrophy of mucous glands, small airway inflammation, bronchial smooth muscle hypertrophy.
Functionally they both limit expiratory flow
Stages of COPD, FEV1 values and FEV/FVC
FEV1/FVC stays <70 for every stage Stage I: Mild, FEV1 >/=80% predicted Stage II: Moderate: 50-80% Stage III: Severe: 30-50 Stage IV: Very severe: <30 or <50 plus chronic respiratory failure.
ldiopathic pulmonary fibrosis: Structural change, what happens to lung volumes, noise that can be heard
Thickening of the alveolar walls
Virtually all volumes decrease
Fine inspiratory crackles on inspiration
Clinically how does pulmonary edema present?
Orthopnea (dyspnea in supine) paroxysmal nocturnal dyspnea, frothy and pink if cough is productive, bilateral lobe crackles with auscultation
6 signs of medium sized PE
Pleuritic chest pain, dyspnea, tachypnea, tachycardia, hemoptysis, hypoxemia
Definition of cor pulmonale
R sided heart failure that developers due to pulmonary hypertension, which develops due to chronic hypoxemia, which leads to pulmonary vasoconstriction and increased arterial pressure, is common with most end stage lung disease, will develop peripheral edema and perhaps jugular venous distention
Top 2 reasons for hospitalization in adults over 65
1 acute CHF-causing pulmonary edema/congestion
2 pneumonia
Lung cancer most common cause of cancer related deaths in US
Chest auscultation reveals what in ppl with pneumonia:
Other signs of pneumonia: 6
Crackles or low pitched wheezes (rhonchi) diminished or bronchial lung sounds over th affected lobe
Tachypnea, tachycardia, fever, cough, malaise, pleuritic chest pain
Albuterol- how should PTs time this drug if short acting
Benefit begins about 10 minutes post-tx, peaks 1 hour, lasts about 4 hours
Metered dose inhaler vs nebula zero for albuterol
Higher HR and increased risk of vomiting with nebulizer
Glucocorticosteroids are used for treatment of which stages of COPD
Stable III and IV or during acute exacerbation of COPD or IPF
Inhaled glucocorticosteroid example and when used vs oral (prednisone/prednisolone)
Inhaled to prevent acute exacerbation, oral for acute exacerbations
What should the PT do with a patient who is on prednisone/isolone?
Test proximal LE muscles (due to potential myopathy) monitor for skin breakdown, limit sliding transfers, eliminate extreme thoracic flexion and or rotation due to osteoporosis
Tendinopathy/tendon rupture, especially the Achilles’ tendon, is associated with use of which drug, and especially if combined with which additional drug?
Fluoroquinolones, glucocorticosteroids
What should PT watch for in terms of adverse reactions of furosemide
First line of treatment for pulmonary edema, but can cause volume depletion (orthostatic hypotension) and electrolyte imbalance (potassium depletion, watch for fatigue, confusion, nausea, weakness, cardiac dysrhythmias.
The 6MWT predicts that for patients with COPD, a distance >______m predicts survival rate of _____ at 5 years, while a distance of
350m 75%
<250m 40%
Some though the initially proposed MCID of 54m or 180 feet too high for people with low functional abilities, what did they propose for people with COPD?
35m or 115 feet or 10% over baseline
Does ascites or pedal edema come first?
Pedal edema, abdominal swelling is last, dyspnea is first sign, due to R side heart failure from pulmonary disease or L side heart failure.
Wells criteria, 8 positive points, 1 negative point
1) Active cancer
2) Paralysis, paresis, or recent plater immobilization of the LE
3) Recently bedridden >3 days or major surgery within past 4 weeks
4) Tenderness along distribution of deep venous system
5) Entire LE swelling
6) Calf swelling by >3cm compared to asymptomatic LE
7) Pitting edema >asymptomatic LE
8) Collateral superficial veins (nonvaricose)
Alternative diagnosis that is as likely, subtract 2 points, this includes cellulitis, calf strain, post-op swelling
> /=3 points, probability of 75%
1-2 points, probability of 17%
What may be a better alternative to MMT for people with pulmonary disease
Sit-to-stand test, either number of reps in 10 seconds or number of seconds for 10 reps, or 60 second stst, may be more sensitive to change, is correlated with maximum gait speed and stair climbing ability, and may be motivating for the patient.
Medical Research Council Dyspnea Scale
1-5
1 No trouble except strenuous exertion
2 Short of breath when hurrying on the level or asking up slight hill
3 Walks slower than others on level surface or has to stop to catch breath after about a mile
4 Stops for breath after walking about 100 yard or after a few minutes on level ground
5 Too breathless to leave or house or breathless after dressing/undressing
What is the benefit of using the Borg CR10 scale for dyspnea?
Not linear in nature so can allow for more specificity in quantifying dyspnea beyond moderate severity. 1 unit is the MCID. 0 nothing at all .5 extremely weak 1 very weak 2 weak 3moderate 5 strong 7 very strong 10 extremely strong
Adventitious lung sounds can be classified into which 2 types? What does each indicate?
Continuous such as wheezes, during expiration, indicates some sort of airway obstruction such as bronchitis, bronchial constriction, bronchial tumor.
Discontinuous: crackles, typically occur with inspiration, Amy indicate atelectasis, pneumonia, PF, COPD, or pulmonary edema due to CHF.
Breathing techniques good for COPD and not recommended. Who is not appropriate for traditional chest therapy?
Pursed lip and positioning (forward leaning posture). Diaphragmatic breathing not beneficial for COPD.
Chest therapy not good evidence for use for people with pneumonia and chronic bronchitis, but can be good for people with a lot of secretions.
What did the Long-term Oxygen Treatment Trial from the National Heart, Lung, and Blood institute Find?
Long term oxygen treatment not beneficial in terms of outcomes like survival in people with moderate oxygen deficits (89-93 at rest, <90 upon exertion)
