week 8 Flashcards
What are the purposes of pulmonary function tests?
to look for the presence of lung disease and diagnosis
to grade the severity of a respiratory disorder and show the progress or response to medical treatment
to monitor disease progression over time
to assess risk
to differentiate between different pathologies
to evaluate the response to treatment
What does spirometry tell us?
shows abnormalities in lung function, but is not disease specific
static lung volumes (how much air the lungs can hold)
dynamic lung volumes (how fast the volume of air can be moved and the flow of air through the airways
What are some indications for use of spirometry?
diagnostic
monitoring
disability
research
What are some contraindications for use of spirometry?
pneumothorax
haemoptysis of unknown origin
recent myocardial infarction or unstable angina
CVS instability
cerebral instability
recent surgery
recent chest infection
communication difficulties such as learning disabilities or confusio
if the patient is too unwell to perform forced expiration
describe the spirometry procedure
sit upright, wearing comfortable loose fitting clothes
after a relaxed breath out, take a maximal breath in
seal your lips around the mouthpiece and blow out as fast and completely as possible
What does an acceptable spirogram demonstrate?
quick and forceful exhalation
no coughing
smooth lines on graph
minimum exhalation time of 6 seconds with no change in volume in last second
What is total lung capacity?
The amount of gas the lungs contain after a maximal inspiratory effort when a person breathes in fully
What does capacity refer to?
The combination of 2 or more volumes within the total lung capacity
What is tidal volume?
The volume of air normally inhaled or exhaled with each breath during resting, quiet breathing
What is expiratory reserve volume?
Volume of air that can be exhaled with a maximal effort after a normal resting expiratory breath
What is residual volume?
volume of air remaining in the lung after a maximal effort expiration
What is inspiratory reserve volume?
the extra volume of air that can be inhaled with maximal effort after a normal resting inspiratory breath
What is inspiratory capacity?
Volume of air that can be inhaled with a maximal effort from a resting (tidal) end expiratory level
What is the equation for inspiratory capacity?
IC = TV + IRV
What is functional residual volume?
Volume of gas remaining in the lungs at the end of a normal tidal exhalation
What is the equation for functional residual capacity?
FRC =ERV + RV
What is vital capacity?
Volume from maximal inspiration to maximal expiration
What is the equation for vital capacity?
VC = IRV + TV + ERV
For a cough to be effective what does vital capacity need to be greater than?
1 litre
Name some factors that influence airway resistance
types of airflow
lung volume
elastic recoil
bronchial smooth muscle tone
airway obstructions
What is forced vital capacity?
the volume expired forcefully (following a maximal inspiration), until residual volume is reached
What is forced expiratory volume in one second?
the volume of air a subject can exhale in the first second of a maximal breath out, following a maximal inspiration
What is FEV1 approximately 3/4 of?
FVC
What does the FEV1/FVC ratio look at?
it looks at the amount expelled within the first second compared with the overall volume achieved
How is FVC converted into a percentage?
results are compared with the predicted value for a patient of the same age, sex, height and ethnic origin and then converted to a percentage
What is considered a normal result for forced vital capacity?
the result is considered normal if the score is 80% or more of the predicted value
Name some causes of reduced FVC
decreased expansion
decreased inspiratory muscle strength
obesity
decreased expiratory muscle strength
increased airway resistance
What FEV1, FVC and FEV1/FVC ratio would a normal person have?
FEV1= >80%
FVC = >80%
FEV1/FVC ratio= >70%
What FEV1, FVC and FEV1/FVC ratio would a patient with an obstructive pathology have?
FEV1=<80%
FVC = normal or low
FEV1/FVC ratio = <70%
What FEV1 and FVC would someone with a restrictive pathology have?
FEV1 = < 80%
FVC = <80%
What grade of airflow obstruction would someone, who has been identified to have an obstructive condition ,with FEV1 of 80% or more of the predicted value have?
Mild
If you have mild COPD, your spirometry test results can be normal after you take medication
What grade of airflow obstruction would someone, who has been identified to have an obstructive condition, with a FEV1 between 50-79% of the predicted value after medication have?
moderate
What grade of airflow obstruction would someone, who has been identified to have an obstructive condition, with a FEV1 between 30-49% of the predicted value after medication have?
severe
What are the characteristics of an obstructive pathology?
limitation of airflow due to partial or complete obstruction
What are the characteristics of a restrictive pathology?
reduced expansion of lung parenchyma accompanied by decreased total lung capacity
Give some examples of obstructive pathologies
emphysema
chronic bronchitis
bronchiectasis
asthma
Give some examples of restrictive pathologies
interstitial lung disease
idiopathic pulmonary fibrosis
pneumoconiosis
sarcoidosis
chest wall neuromuscular disease
What is the TLC of an obstructive disease?
normal
What is the TLC of a restrictive pathology?
decreased
What population groups does shortness of breath on exertion effect?
heart failure
COPD
interstitial lung disease
What is heart failure?
it is when the pumping ability of the heart has reduced and cant keep up with the workload
What happens in heart failure?
blood and oxygen may not be circulated around the body as efficiently
How can heart failure be managed?
with medications and lifestyle adaptations
How does hear try to make up for heart failure?
enlarging
developing more muscle mass
pumping faster
How does the body try to compensate for heart failure?
Blood vessels narrow to keep blood pressure up
the body diverts blood away from less important tissues and organs
What are some symptoms of heart failure?
shortness of breath
persistent coughing or wheezing - producing white or pink blood tinged mucus
build up of excess fluid in body tissues (oedema) - swelling in the feet, ankles, legs or abdomen or weight gain
tiredness and fatigue
lack of appetite/nausea
confusion and impaired thinking
increased HR/palpitations
What conditions does interstitial lung disease include?
idiopathic pulmonary fibrosis
sarcoidosis
What happens with interstitial lung disease??
involves fibrosing, scarring and thickening of the lung tissue
‘stiff lungs’
loss of elasticity and expansion in lung tissues
What is the prognosis for interstitial lung disease?
Poor prognosis and limited effective medications available to slow prognosis
What are the benefits of pulmonary rehabilitation?
improved exercise capacity
improved health-related quality of life
reduces perceived intensity of breathlessness
reduced hospitalisations and length of stay
reduced anxiety and depression associated with COPD
increased survival
Why should you do exercise?
increases exercise tolerance
improves muscle strength
reduces breathlessness and fatigue
benefits on quality of life
What is the exclusion criteria for pulmonary rehabilitation?
unstable angina
unstable diabetes
acute LVF
uncontrolled BP
uncontrolled arrhythmias
history of Mi or cardiac surgery in 6 weeks leading up to start of PR
mobility limited by musculoskeletal or neurological condition
cognitive problems
compliance issues
aortic aneurysm
What is the structure of exercise in pulmonary rehabilitation?
warm up
aerobic training programme
cool down
approx 1 hour session
What topics are included in the education component of pulmonary rehabilitation?
disease and education
healthy eating and supplementation
managing breathlessness
medications
energy conservation
exercise
chest clearance
palliative care/end of life discussion
