Disease-Specific Obstructive Lung Conditions

what adult disease-Specific Obstructive Lung Condition is characterized by chronic airflow limitation?

A “combo disease” caused by a mixture of parenchymal alveolar disease (emphysema) & small-airway disease (obstructive bronchiolitis)

Clinical presentation & sxs can vary from individual to individual.

Emphysema is a condition of lung characterized by destruction of alveolar walls & enlargement of airspaces distal to terminal bronchioles.

COPD (1 of 5)

how many subtypes of emphysema are there?

3

what Disease-Specific Obstructive Lung Condition has presence of chronic productive cough for 3 months in each of 2 successive yrs?

Hypersecretion of mucus begins in large airways & progresses to smaller airways.

Leads to hypertrophy of submucosal glands

degree of small-airway involvement (bronchioles) determines degree of disability

bronchitis

excess body fluids, chronic cough, SoB, ↑ sputum, cyanosis are s/s of

chronic bronchitis

what are findings/sxs during physical exam of adult w/ obstructive lung conditions (COPD)?

coughing, dyspnea, SoB

Auscultation of lungs shows prolongs expiratory phase

pt may assume tripoding position

Chest x-ray changes noted late in disease progression

CT scans can help to detect presence of bullae

what is the medical mgmt of adult obstructive lung conditions (COPD)?

Pharmacotherapy, Smoking cessation

Influenza vaccine (yearly) & pneumococcal vaccine (1x) to help prevent respiratory infections

Tx of sleep disorders (sleep apnea)

Pulmonary rehab, breathing retraining, & exercise training to improve exercise tolerance & reduce dyspnea & fatigue

what are PT implications for COPD?

Secretion clearance techniques as indicated (assisted cough)

Controlled breathing techniques (pursed lips & paced breathing) at rest

Controlled breathing techniques & breathing retraining coordinated w/ position changes, ambulation, & stair climbing

Ambulation w/ RW, Thoracic stretching exercises

Instruction in use of recovery from SoB positions

Instruction in self-mgmt of disease (monitoring of weight, secretion color, dyspnea w/ activity)

Endurance exercise training, Strength & weight training

Optimal use of O2 w/ activity

Postural reeducation to avoid round-shouldered postures

what adult obstructive lung condition has dilation of bronchia, irreversible w/ chronic inflammation & infection?

Distortion of conducting airways, thickening, herniation, or dilation

Mechanisms: Bronchial wall injury/structural weakness, Traction from adjacent lung fibrosis, Bronchial lumen obstruction

Sxs: Cough w/ sputum production, hx of recurrent or chronic lung infections, Hemoptysis, Dyspnea & tiredness

bronchiectasis

What are key physical exam findings w/ bronchiectasis?

dx by presence of signet ring sign on HRCT

Classified into 3 types based on appearance of bronchial walls: cylindrical, varicose, & saccular

Blood work: blood gases become abnormal

Sputum testing: Haemophilus influenzae & Peudomonas aeruginosa are predominant organisms

The medical mgmt/goal for bronchiectasis involves reducing # of exacerbations & improve QoL. What does long-term maintenance therapy include?

use of nebulized meds & bronchodilators if indicated, secretion clearance techniques, ↑ hydration

Bronchiectasis: Implications for physical therapy tx

Secretion clearance

Controlled breathing techniques coordinated w/ activity

Inspiratory muscle training to improve strength & endurance of accessory muscles

Strength training, esp quad strength

Endurance exercise

What Pediatric Obstructive Lung Condition is a multisystem disorder in children & young adults that affects every organ system w/ epithelial surfaces?

Mucus stasis occurs in conducting airways of lung, nasal sinuses, sweat glands, small intestine, pancreas, & biliary system.

Most prominent sxs related to pulmonary, intestine, & pancreatic involvement.

Pulmonary system is affected by chronic airway obstruction & inflammation, thick tenacious mucus, & recurrent bacterial infections.

Cystic fibrosis

what is a form of male infertility where the sperm is produced but blocked from exiting the reproductive tract?

Obstructive azoospermia

Cystic fibrosis is a Pediatric Obstructive Lung Condition where intestine develops thick mucus that interferes w/ nutrient absorption & results in malnourishment & low weight. Pancreas develops exocrine pancreatic insufficiency.

Other affected organs: Upper airway (sinus infections), Male reproductive tract (obstructive azoospermia), Sweat glands (elevated sodium chloride levels in sweat)

Goals of med mgmt:

Controlling lung infection, Promoting mucus clearance, Improving nutritional status

Cystic fibrosis: goals for Physical Therapy

prevent lung infections & clear secretions

What uses controlled breathing to move mucus from smaller airways to central airways to be cleared

Autogenic drainage

What Pediatric Obstructive Lung Condition is a chronic inflammatory disorder of airways?

Involves abnormal accumulation of eosinophils, lymphocytes, mast cells, macrophages, dendritic cells, & myofibroblasts

Causes recurrent episodes of wheezing, dyspnea, chest tightness, & coughing. Episodes often associated w/ widespread but variable airflow obstruction

Key Physical Exam Findings: The reversibility of airway obstruction following use of bronchodilator meds is hallmark of this. Airway responsiveness occurs when airways demo excessive bronchoconstriction in response to inhalation of an irritating substance. Results of pulmonary function tests help classify severity

asthma

what are the 4 tx recommendations for asthma?

Use objective measures of pulmonary function to assess severity & monitor therapy effectiveness.

Identify & eliminate factors that worsen sxs, precipitate exacerbations, or promote ongoing airway inflammation.

Provide pharmacologic therapy to reverse bronchoconstriction & to reverse & prevent airway inflammation.

Create a therapeutic partnership b/t pt & care provider

what are PT implications w/ asthma?

PT should not begin unless appropriate med therapy has been initiated & good sx control.

Individuals w/ exercise-induced asthma may require use of bronchodilator meds 30 min before exercise.

Key interventions: Secretion clearance techniques (active cycle of breathing & gentle manual techniques, shaking, & vibration), Controlled breathing techniques, Exercise & strength training, Thoracic stretching exercises, Postural reeducation to avoid round-shouldered postures, Review & timing of meds