Pulmonary Conditions Ch. 6, 7, 8

What disease has symptoms of shortness of breath (progresses from exercise to ADLs), coughing (mucus in the morning) and onset in midlife

Exam findings show I:E ratio of 1:4, diminished breath sounds, localized wheezing auscultated, barrel shaped chest (1:1), tripod posture, use of accessory muscles, pursed lip breathing

COPD

What medications are commonly used to treat COPD?

bronchodilators, ani-inflammatories, anibiotics

What are 3 characteristics of advanced COPD?

jugular vein distention, bilateral LE swelling, central cyanosis

how do we treat COPD?

pulmonary rehab, breathing retraining, exercise training, supplemental O2, thoracic stretches, postural re-education

What lifestyle modification are recommended to treat COPD?

Vaccines, stop smoking, avoid dust and chemicals

With COPD how does lung volume change?

larger residual volume (hyperinflated state)

What is the gold standard classification of COPD?

FEV1 <80 and FEV1/FVC <0.7

stage 1 = FEV1 <80, chronic cough with sputum

stage 2 = FEV1 50-80 chronic cough, sputum, dyspnea

stage 3 = FEV1 30-50 chronic cough, sputum, dyspnea

stage 4 = FEV1 <30 chronic cough, sputum, dyspnea, respiratory or right heart failure, weight loss

What common condition is a sign of underlying cardiac condition and has greater incidence in patients with CAD, cardiac dysthymias, HTN? what is the diagnostic criteria?

Obstructive sleep apnea (type of COPD)

>5 episodes/hr of 10s or more

What is chronic swelling and inflammation of bronchi caused from irritation of tracheobronchial tree?

Chronic Bronchitis (type of COPD)

What disease is characterized by increased hypoxemia and PaCO2 retention, increased pulmonary artery constriction and pressure and right ventricle strain, coughing up mucus and could appear blue in nail beds and lips

Chronic Bronchitis (type of COPD)

What medications are commonly used for chronic bronchitis?

IV fluid, antibiotics, bronchodilators, corticosteriods, digitalis, diuretics

What disease is characterized by mild bronchial wall thickening and cardiomegaly seen on X-ray?

Chronic Bronchitis

What is the best interventions for treating dyspnea in patients with COPD?

Exercise

What test is commonly used for qualification for a lung transplant?

6-minute walk-test

What disease is a lung condition with abnormal enlargement of airspaces and destruction of their walls

Emphysema

What disease is a type of emphysema characterized by edema, inflammation, destruction of respiratory bronchioles, and more common in men with chronic bronchitis?

Centrilobular Emphysema

What disease is a type of emphysema characterized by enlargement and eventual destruction of alveoli, decreased elasticity to alveoli and can cause collapse even with normal exhalation?

Panlobular Emphysema

What disease is characterized by Bullae, increased A/P chest diameter, thin structure, elevated shoulders, reduced breath sounds in many lung fields, cough, wheezing and shortness of breath?

Emphysema

How do we treat emphysema?

address deconditioning and muscle wasting

What is the ultimate cure for cystic fibrosis?

lung transplant

What disease is gene mutations that causes mucus stasis throughout the body (nasal, sinuses, pancreas, intestines)?

Cystic Fibrosis

What disease is characterized by persistent wet cough, lung infiltrates, frequent respiratory tract infections, salty-tasting skin, wheezing and/or shortness of breath, poor growth and slow weight gain despite diet, greasy bulky stool with difficult bowel movement.

Cystic Fibrosis

What age group is effected by cystic fibrosis and when is the lung transplant usually done? + what is PT goal?

young ages... delay the need for lung transplant until early teens (better outcomes)

What do we do for cystic fibrosis?

postural drainage with percussion, shaking and vibration, controlled breathing technique, exercise, inspiratory muscle training, thoracic stretching, postural re-ed

What disease is an inflammatory condition of the airways, increased response by smooth muscle in airway to certain stimuli and narrowing of airways?

Asthma

What disease is characterized by increased production of mucus, cough, wheezing, chest tightness, lungs hyper inflated, shortness of breath, reduced breath sounds, difficult and rapid breathing, airways narrowed?

Asthma

How do we treat Asthma?

- take bronchodilator 30min prior to exercise

- low-intensity warm-up with longer cool down

- secretion clearance techniques

- controlled breathing techniques

- exercise and strength training

- thoracic stretching

- postural re-ed

- encourage self management to become independent

What disease is localized abnormal dilation of medium sized bronchi as airway deformities to a segment of whole lobe?

Bronchiectasis

What are the 3 types of bronchiectasis?

Cylindrical - uniform dilation (most common)

Varicose - greater dilation than cylindrical and resembles varicose veins

Saccular - intermittent ballooning in airways

What disease is characterized by chronic mucus, short of breath, chronic productive cough, pleuritic chest pain, wheezing, fatigue, sinusitis, hemoptysis, increased chest wall size?

Bronchiectasis

Anything that causes death and distruction of pulmonary tissue can cause what type of COPD?

Bronchiectasis (dead pulmonary tissue puls on alive tissue causing dilation

How do we treat Bronchiectasis?

postural drainage techniques, assisted cough techniques, hydration, inspiratory muscle training, endurance exercise

What is the gold standard imaging technique for bronchiectosis?

CT

What disease causes irreversible fibrosis of pulmonary tissue? restrictive or obstructive?

diffuse interstitial pulmonary fibrosis

restrictive lung disease

What disease is characterized by pulmonary tissue damage by means of an irritant, inspiratory crackles, dullness in percussion, progressive shortness of breath, progressive cough, hemoptysis and chest pain?

Diffuse Interstitial Pulmonary Fibrosis

What disease has restrictive and obstructive symptoms; runny nose, fever, loss of appetite, coughing?

Bronchiolitis Obliterans

What disease is a restrictive lung disease that has acute respiratory illness with fever, night sweats, weight loss and dyspnea and is diagnosed by imaging into 3 different categories?

Pulmonary Infiltrates with Eosinophilia

What disease is an uncommon disease where the alveoli fill with proteinaceous material often times from an autoimmune reponse?

Pulmonary Alveolar Proteinosis

What disease is characterized by inspiratory crackles, dullness to percussion, progressive shortness of breath, weight loss, cough, hemoptysis and chest pain, cyanosis and finger clubbing?

Pulmonary Alveolar Proteinosis

What is a common medical treatment done for patients with pulmonary alveolar proteinosis?

whole lung lavage (lung filled with saline while manual percussion and vibration is applied to flush the lungs)

What disease is the growth of tiny granulomas in lungs from an unknown cause?

Sarcoidosis

What disease is characterized by bilateral hair adenopathy, skin and eye lesions, pulmonary infiltration, night sweats, joint pain, fatigue, cysts, cloudy vision?

Sarcoidosis

What disease is a systemic autoimmune disease that impacts joint and potentially other organs such as lungs and pleura with pulmonary complications more common in men while the disease is more common in women?

Rheumatoid Arthritis

What disease is characterized by pleuritic chest pain, shortness of breath, multi-joint pain

Rheumatoid Arthritis

What disease is a systemic collagen vascular disease with pulmonary involvement 50-90% of cases often times caused by infection or exposure?

Systemic Lupus Ertheymatosus (SLE)

What disease is characterized by restrictive pattern, shortness of breath on exertion, productive cough, potentially pleuritic chest pain, butterfly like rash on face?

Systemic Lupus Ertheymatosus

What disease is a thickening and fibrosis replacement of connective tissue throughout the body with collagen triggered by infection, stress or exposure to chemicals?

Progressive systematic Sclerosis (Scleroderma)

What disease is characterized by bibasilar crackles, wight loss, low grade fever, progressive cough, progressive shortness of breath, skin tightness, and Raynauds phenomenon?

Progressive systematic Sclerosis

What disease is a highly infectious bacterial disease from poorly managed sanitation systems?

Tuberculosis (TB)

What disease is characterized by mutli-system and multi-organ presentation, mucus, short of breath, chronic productive cough, pleuritic chest pain, wheezing?

Tuberculosis (TB)

What disease is uncontrolled cell division in the lungs and caused by lifestyle/environmental factors 50% of the time?

lung cancer

What disease is characterized as shortness of breath, chronic productive cough, pleuritic chest pain, wheezing, exhaustion, wight loss, mutlisystem and multiorgan impacts, and ussually is a precursor for COPD if they survive?

Lung cancer

What is pulmonary pneumonitis and fibrosis becuase of radiation treatment to thorax called?

Radiation Pneumonitis

What is a tumor around tracheobronchial tree causing swelling, fluid, mucus, obstructive and restrictive symptoms?

Broncheogenic Carcinoma

What disease is a partial or full collapse of the lung alveoli?

Atelectasis

What disease is characterized as increased work of breathing, structural changes in the lung, fever, post-operative pain, dyspnea?

Atelectasis

What is a Atelectasis lung collapse called?

pneumothorax

What is Atelectasis lung compression called?

Hydrothorax

What is Atelectasis lung obstruction called?

tumor

What disease has a bacterial and viral classification of infection that results in fluid in the lung?

Pneumonia

What disease is characterized by very high fever, pleuritic pain, dyspnea, tachypnea, chills, productive cough?

Bacterial Pneumonia

What disease is characterized by moderate fever, non-productive cough, myalgias, dyspnia and tachypnea?

Viral Pneumonia

What disease is when fluid builds up in the air sacs and the patient is unable to get enough air in so SpO2 drops and can also be caused my a number of different diseases?

Acute Respiratory Distress Syndrome (ARDS)

What disease is characterized by tachycardia, cyanotic, headache, increased anxiety, restlessness, dyspnea even at rest, breath pattern fast and labored?

Acute Respiratory Distress Syndrome (ARDS)

What disease is a fibrotic lung disease in response to inhaled silica resulting in pulmonary fibrosis, acellular nodules in upper lungs?

Silicosis

What disease occurs in response to inhaled asbestos causing an increased risk of cancer with smoking, bronchiectasis, and pleural cancer?

Asbestosis

What level of spinal cord injury would have an effect on inspiration?

C3-T12

What level of spinal cord injury would have an effect on expiration?

T1-L1

HOw does poliomyelitis and post-polio effect respiration?

respiratory muscles can weaken and lead to respiratory failure

What % of gullian barre patients develop respiratory failure?

10-20%

What % of myasthenia Gravis patients develop severe pulmonary symptoms?

10%

What is the classification for pulmonary hypertension?

mean pulmonary pressure >25 mm Hg at rest and greater than 30 mm Hg during exercise

What disease is characterized by auscultate S4, tricuspid or pulmonic valve regurgitation, dyspnea, increasing dyspnea on exertion, fatigue, an abnormal SpO2 decrease with increasing activity, changes in exercise tolerance associated with an increased need for supplemental O2, cough, dizziness, syncope or presyncope, chest pain or discomfort and edema?

Pulmonary hypertension

What is the gold standard to measure pulmonary pressure?

Right heart catheterization

What is the treatment for pulmonary Hypertension?

reduced salt intake, exercise, avoid exercise intensity that leads to severe breathlessness

What is the gold standard outcome measure for pulmonary hypertension?

6MWT

- <250-300m indicates high risk of morbidity/mortality and symptoms of syncope

Name a few group 1 pulmonary hypertensions.

idiopathic, familial, congenital

Name a few group 2 pulmonary hypertensions.

- left sided heart disease

- left sided valvular heart disease

Name a few group 3 pulmonary hypertensions.

- COPD

- interstitial lung disease

- chronic high altitude

Name a few group 4 pulmonary hypertensions.

- thromboembolic obstruction of proximal pulmonary arteries

- thromboembolic obstruction of distal pulmonary arteries

Name a few group 5 pulmonary hypertensions.

- Sarcoidosis

- Lymphangiomatosis

What is the goals when treating pulmonary hypertension?

- reduce afterload

- improve RV stroke volume and increase quantity of blood available for gas exchange and eventual CO

What is group 1 and 2 pulmonary hypertension treated with?

monotherapy

What is group 3 pulmonary hypertension treated with?

dual therapy

What is group 4 pulmonary hypertension treated with?

start with dual therapy than move to IV therapy

When treating pulmonary hypertension for endurance, what frequency, duration and intensity should endurance exercise be performed at?

frequency = 2-3x per week

duration = 10-25 minutes

intensity = 60-80% symptom free

When treating pulmonary hypertension for strength, what frequency, duration and intensity should strength exercise be performed at?

frequency = 1-2x per week

duration = 15-30 minutes

intensity = borg scale 4-5

When treating pulmonary hypertension for respiratory muscle training, what frequency and duration should respiratory muscle exercise be performed at?

frequency = 5-7x per week

duration = 10-15 minutes

When treating pulmonary hypertension for activities of daily living, what frequency, duration and intensity should ADL exercise be performed at?

frequency = daily

duration = whenever possible

intensity = low intensity

Using the 6 minute walk test what is the therapeutic goal for cardiac endurance training?

>440m to reduce risk to low

What tool measures the maximal inhalation followed by maximal exhalation, measuring volume of air and time? FEV1

Spirometry

Who is indicated for use of spirometry and what are significant values?

smokers

FEV1 >80% = normal

FEV1 50-80% = mildly abnormal

FEV1 30-50% = moderately abnormal

FEV1 <30% = moderate to severely abnormal

What is the formula for minute ventilation?

tidal volume x respiratory rate

What is the Inspiratory reserve volume?

max inspiration above normal inspiration

What is the tidal volume?

normal breath

What is expiratory reserve volume?

max expiration above normal expiration

What is residual volume?

remaining volume of gas after ERV

In Asthma, emphysema and COPD how does residual volume change?

increases

In lung cancer, MSK impairment and microatelectasis how does residual volume change?

reduces

What is total lung capacity? and what would happen to this with emphysema or restrictive lung disease?

amount of gas in the lung at the end of max inspiration

- emphysema = increased

- RLD = decreased