Week 4 - Pulmonary Conditions

Question 1

restrictive pulmonary disease

Answer 1

does not allow for inhalation - often occurs in obese/overweight people

Question 2

obstructive pulmonary disease

Answer 2

interfere with exhalation - most common, symptoms include: coughing, wheezing, shortness of breath

Question 3

Tidal volume

Answer 3

basic resting inhalation + exhalation (10% lung volume)

Question 4

Inspiratory reserve volume

Answer 4

maximal inhalation

Question 5

expiratory reserve volume

Answer 5

maximal exhalation

Question 6

residual volume

Answer 6

total amount of air that remains in lungs after inhalation/exhalation

Question 7

vital capacity

Answer 7

functional range that which you can use air from your lungs (how much lung volume is actually utilised)

Question 8

Asthma

Answer 8

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

Question 9

Asthma diagnosis

Answer 9

measurement of peak flow rate (how quickly someone can expire air)
Can examine changes from medication (>20% improvement = asthma)

Question 10

COPD

Answer 10

increased number and size of mucus glands in airway (irreversible obstructive pulmonary condition)
Symptoms/signs –> problems with expiratory capacity)

Question 11

Emphysema

Answer 11

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

Question 12

Cystic Fibrosis

Answer 12

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)

Question 13

M/ment of Asthma

Answer 13

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

Question 14

Exercise Prescription (Asthma)

Answer 14

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

Question 15

M/ment of COPD

Answer 15

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.

Question 16

O2 saturation

Answer 16

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)

Question 17

typical resting value of O2 saturation

Answer 17

98% under normal resting conditions

Question 18

O2 haemoglobin curve

Answer 18

different levels of O2 offloading from haemoglobin in the blood

Question 19

M/ment of CF

Answer 19

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)

Question 20

Testing (contraints)

Answer 20

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

Question 21

Spirometry

Answer 21

measure of lung function
FEV1:FVC = 76% (healthy)

Question 22

Physical functions

Answer 22

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’)

Question 23

Prescription of exercise COPD

Answer 23

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

Question 24

Prescription of exercise CF

Answer 24

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

Question 25

Respiratory muscle training

Answer 25

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

Question 26

Diaphragm

Answer 26

primary muscle of inspiration

Question 27

Internal intercostal muscles

Answer 27

also contract + aim to inc lung volume

Question 28

Rectus Abdominus + external intercostal muscles

Answer 28

muscles used in expiration