Week 4 - Pulmonary Conditions Flashcards
restrictive pulmonary disease
does not allow for inhalation - often occurs in obese/overweight people
obstructive pulmonary disease
interfere with exhalation - most common, symptoms include: coughing, wheezing, shortness of breath
Tidal volume
basic resting inhalation + exhalation (10% lung volume)
Inspiratory reserve volume
maximal inhalation
expiratory reserve volume
maximal exhalation
residual volume
total amount of air that remains in lungs after inhalation/exhalation
vital capacity
functional range that which you can use air from your lungs (how much lung volume is actually utilised)
Asthma
inflammation of the airway
common causes: environmental triggers e.g dry air, pollen, pet hair or genetics
can be exercise induced or resting on set
it is a temporary respiratory disorder (time, removal of trigger and medication can reverse symptoms)
affects 10% of population
Asthma diagnosis
measurement of peak flow rate (how quickly someone can expire air)
Can examine changes from medication (>20% improvement = asthma)
COPD
increased number and size of mucus glands in airway (irreversible obstructive pulmonary condition)
Symptoms/signs –> problems with expiratory capacity)
Emphysema
advanced stage of COPD –> destruction of the bronchiole walls
Primary cause –> LT smoker, asbestos is another cause/trigger.
Treatment –> cessation in activity
Diagnosis –> spirometry (assessment of FEV1:FVC, <70% problem, 70-80% normal, 90% restrictive pulmonary disorder
Cystic Fibrosis
Genetic - most common life limiting disease in caucasians
Very early on set = LE 30s or 40s
Affects lungs, digestive enzymes and system
Inflamed mucosal lining of the airways + lungs (often leads to bacterial infection)
Symptoms: similar to asthma and COPD
However also enzymatic control problems –> compromise digestion (diet becomes a consideration)
M/ment of Asthma
Medication: bronchodilators e.g ventolin or Beta2 adrenoceptor agonists such as salbutamol
Preventer’s: corticosteroids (more chronic approach to suppressing mucosal inflammation), anti-inflammatory medication
Athletes need to be mindful (TUE - exemption) because salbutamol can potentially provide ergogenic benefits
Exercise Prescription (Asthma)
Can follow normal guidelines, however often medication is used to assist and continue exercise Frequency: 150 min/week
Intensity: moderate
Time: at least 30 min per day
Type: swimming is ideal (very moist and humid environment NOT DRY - also avoids pollutants + allergens) - also inherently works on the strength of respiratory muscles + respiratory pump (breath holding)
GOAL: inc functional capacity/dec ventilatory load + VO2 max, improve respiratory muscle strength, prevent medication adherence = inc QOL
M/ment of COPD
Medications: Epinephrine (vasodilator), Theophylline (sustained bronchodilation), muco-regulating drugs
Exercise: Not a cure but can rely on it as a method of maintaining functional capacity + maintaining O2 delivery to periphery.
O2 saturation
measures how much haemoglobin is currently bound to oxygen compared to how much haemoglobin remains unbound.
Altitude, changes in temperature or high intensity exercise cause O2 sats to drop (more rapid in COPD patients)
typical resting value of O2 saturation
98% under normal resting conditions
O2 haemoglobin curve
different levels of O2 offloading from haemoglobin in the blood
M/ment of CF
Medications: antibiotics, mucolytics, chest massage, bronchodilators, corticosteroids
Exercise: helps maintain QOL, functional capacity and main tolerance to daily tasks e.g walking up stairs
Dietary: require adequate protein due to atrophy, and adequate macronutrient supply (inc vitamin and mineral intake)
Testing (contraints)
Asthma –> reliever must be available, can use questionnaires.
CF + Late stage COPD –> need to be mindful of limitations + underlying cardiac RF, need to measure HR, RPE + sepcific BP measurements
Spirometry
measure of lung function
FEV1:FVC = 76% (healthy)
Physical functions
graded exercise tests - Bruce, Balke/Naughton protocols
- can look at Vemax relative to max voluntary ventilation (MVV)
- monitor O2 sats (do not want them to drop below 82% ‘test termination point’)
Prescription of exercise COPD
Exercise is NOT a cure but can inc QOL
- need to monitor O2 sats
Frequency: Regular (depends on severity of patient)
Intensity : highest tolerable (critical limit of O2 sat)
Time: 20 - 40 min
Type: aerobic whole body training/can include respiratory muscle training –> activate skeletal muscle tissue and drive O2 delivery, inc respiratory kinetics to get O2 around body
Prescription of exercise CF
Frequency: Regular 3-5 days/week
Intensity: RPE based, target HR below the point of O2 desaturation
Time: 30 mins
Type: combination of aerobic and high rep resistance training
Must monitor critical lower limit of O2 sats
GOAL: improve O2 kinetics at the periphery so the skeletal muscle can receive O2, inc ventilatory function + general physical function, improve diet and restore performance of ADL
Respiratory muscle training
Training RM –> inc aerobic power of diaphragm and accessory RM. –> has indirect effects on the brain and our sensations during exercise.
e.g dec hydrogen ion accumulation and ventilatory response = lower sensations of breathing (dec RPE = more comfortable during exercise)
dec lactate production and inc metabolite removal –> improves skeletal muscle performance
GOAL: improve strength of pump = whole body benefits e.g more rapid O2 circulation
Diaphragm
primary muscle of inspiration
Internal intercostal muscles
also contract + aim to inc lung volume
Rectus Abdominus + external intercostal muscles
muscles used in expiration
