PS201 Week 6 Cue Cards - Chronic Lung Conditions and Oxygen Therapy

This set comprises Q&A flashcards covering obstructive vs restrictive diseases, COPD/ILD pathophysiology, clinical assessment tools, pulmonary rehabilitation, oxygen therapy, common patient attachments, and home/clinical management considerations to prepare for exams.

What is the broad categorisation of chronic respiratory diseases?

Chronic respiratory diseases (also called chronic lung conditions). The two major groups are obstructive lung diseases (airflow limitation, especially on exhalation) and restrictive lung diseases (restricted expansion of chest wall, airways, or alveoli).

What is the key difference between COPD and asthma regarding reversibility of airflow limitation?

COPD: airflow limitation is persistent and not fully reversible with medication.

Asthma: airflow limitation is variable and may be reversible with medication.

What is emphysema and how does it contribute to airflow obstruction?

Emphysema involves breakdown of alveolar walls leading to enlarged air spaces and loss of elastic recoil, contributing to airflow obstruction and gas trapping.

What is meant by gas trapping and dynamic hyperinflation in COPD?

Gas trapping occurs when airways close early during expiration, preventing complete lung emptying; dynamic hyperinflation happens during exercise as more air becomes trapped, increasing work of breathing.

What is a barrel chest and why does it occur in COPD?

Barrel chest refers to an increased anterior-posterior chest diameter due to lung hyperinflation, which flattens the diaphragm and increases breathing work.

Name two major risk factors for COPD beyond cigarette smoking.

Indoor and outdoor air pollution, occupational exposures, abnormal lung development, low birth weight, respiratory infections in childhood, and accelerated lung aging.

What spirometry finding supports a diagnosis of obstructive lung disease?

A reduced FEV1/FVC ratio, commonly <70%, with reference to lower limit of normal (LLN) considerations to avoid misdiagnosis.

What is an exacerbation in COPD and how is severity often determined?

An acute flare-up of symptoms requiring a change in treatment; severity is often categorized as mild, moderate, or severe based on required therapies.

What is the COPD Assessment Test (CAT) used for?

A self-reported tool measuring symptoms such as cough, phlegm, chest tightness, exercise tolerance, confidence, sleep, and energy.

What does breathlessness assessment in COPD include beyond intensity?

Domains include sensation severity, unpleasantness, quality, emotional distress, and functional impact on daily activities.

Why is pulmonary rehabilitation a cornerstone treatment in COPD?

It addresses breathlessness, improves exercise capacity, quality of life, and mood through structured exercise, education, and psychosocial support.

What is interstitial lung disease (ILD) and which ILD is most common?

ILD comprises fibrosis of the lung interstitium; idiopathic pulmonary fibrosis (IPF) is the most common ILD.

What are typical pathophysiological features of lung fibrosis in ILD/IPF?

Low lung compliance, reduced lung volumes, ventilation-perfusion mismatch, and hypoxemia with exercise; potential progression to pulmonary hypertension.

How does ILD-related pulmonary rehabilitation differ from COPD in training approach?

ILD often requires interval training due to breathlessness and may involve oxygen supplementation; benefits include reduced breathlessness and improved QoL similar to COPD.

What is the role of oxygen therapy in chronic lung diseases and why is it considered a medicine?

Oxygen therapy is prescribed to improve tissue oxygenation in hypoxemic patients and after surgery; it is managed like a medication with indications, dosing, and precautions.

Define FiO2, SpO2, and PaO2.

FiO2: fraction of inspired oxygen; SpO2: peripheral saturation of hemoglobin with oxygen; PaO2: arterial oxygen tension (partial pressure of oxygen in arterial blood).

Name common oxygen delivery devices from low to high concentration/flow.

Nasal cannula (1-4 L/min; ~24-36% FiO2); simple or non-rebreather masks; high-flow nasal cannula; non-invasive ventilation (NIV, e.g., CPAP); invasive mechanical ventilation.

What are typical SpO2 targets for COPD patients compared to general acute care?

In COPD with chronic respiratory failure, target SpO2 is often 88-92%. In acute medical conditions, targets are typically around 92-96%.

Why is arterial blood gas (ABG) analysis used, and what information does it provide?

ABG is the gold standard for arterial oxygenation and acid-base balance; it provides PaO2, PaCO2, SaO2, and ventilation status, often used when SpO2 is unreliable or desaturation persists.

What is an arterial line and what should clinicians guard against?

An arterial catheter inserted for real-time blood pressure monitoring and ABG sampling; clinicians must avoid dislodging or kinking the line and check chest imaging for placement after insertion.

What is a central venous catheter (CVC) used for and what are common risks?

A catheter inserted into central veins (IJ, subclavian, or femoral) to measure CVP and deliver drugs/nutrition; risks include pneumothorax, infection, and air embolism.

What are patient-controlled analgesia (PCA) and epidural analgesia, and what are their implications for physiotherapy?

PCA: patient-activated analgesia with a rapid-onset dose, may depress respiration; Epidural: continuous pain relief with potential hypotension and reduced lower limb sensation; require careful mobilization planning and monitoring.

Why is timing important when treating patients on bronchodilators or with pain relief?

Coordinating physiotherapy with peak bronchodilator effect improves airway clearance; timing with analgesia can optimize participation and comfort during therapy.

What are common non-pharmacological and pharmacological management elements highlighted for COPD and ILD in pulmonary rehab guidelines?

Non-pharmacological: education, self-management, airway clearance strategies, pulmonary rehabilitation; Pharmacological: inhaled bronchodilators, anti-inflammatory therapies, and other disease-specific meds.

What are common complications and considerations for restrictive conditions like pleural effusion?

Pleural effusion causes restriction; recurrent pneumothorax can cause inflammation/fibrosis; neuromuscular conditions (e.g., GBS, dystrophies) and kyphoscoliosis can also cause restriction and require targeted physiotherapy.

What key biopsychosocial assessment principle should guide your COPD/ILD management?

Assess physical, psychological, and social factors; tailor an evidence-based, patient-centered pulmonary rehabilitation plan; consider comorbidities and quality of life.

Difference between obstructive and restrictive

• Obstructive: airflow limitation due to airway/airspace abnormalities, typically worse during expiration.

• Restrictive: reduced lung expansion capacity leading to smaller lung volumes; not primarily due to airway narrowing.

• Obstructive: reduced FEV1, reduced FEV1/FVC, hyperinflation signs; examples include COPD and asthma.

• Restrictive: reduced lung volumes with relatively preserved or high FEV1/FVC; examples include ILD/IPF, pleural diseases, neuromuscular restrictions.

Clinical manifestations of COPD

• Breathlessness (often progressive; worse with exercise).

• Sputum production varies; chronic cough and chest tightness common; fatigue.

• Exacerbations: flare-ups requiring treatment changes; can be mild, moderate, or severe.

• Quality of life reduction and exercise intolerance.

• Gender and ethnicity: COPD affects men and women; Indigenous Australians have higher risk (~2.5x compared with non-Indigenous).

What is pleural disease?

• Pleural effusion: abnormal pleural fluid accumulation that can restrict lung expansion.

• Restricted lung expansion and diaphragmatic movement can be improved or managed with physiotherapy and targeted rehab strategies.

• Recurrent pneumothorax can worsen restriction and promote inflammation.

Neuromuscular and thoracic cage restrictive conditions

• Neuromuscular diseases (e.g., Guillain–Barré syndrome, muscular dystrophies like Duchenne, spinal muscular atrophy) disrupt respiratory pump function.

• Thoracic cage deformities (e.g., kyphoscoliosis) contribute to restrictive physiology.

What are common methods for naso-oxygen delivery?

Nasal cannula/specs are used for low-flow oxygen, typically delivering 1-4\ L/min (approx. 24-36\%\ FiO2).

What is a pulse oximeter and what does it monitor?

A pulse oximeter is a non-invasive device that monitors peripheral oxygen saturation (SpO2), serving as a vital sign alongside HR, BP, and temperature.

What is an arterial line (A-line) and its primary uses?

An A-line is an invasive arterial catheter used for real-time arterial blood pressure monitoring and frequent arterial blood gas (ABG) sampling. It requires a flush system to maintain patency.

Name some parameters typically displayed on a bedside monitor.

Common parameters include Heart Rate (HR), arterial Blood Pressure (BP), Mean Arterial Pressure (MAP), Central Venous Pressure (CVP), Respiratory Rate, peripheral Oxygen Saturation (SpO2), and non-invasive BP.

What is a central venous catheter (CVC) and its main purposes?

A CVC is inserted into central veins (internal jugular, subclavian, or femoral) to measure CVP and deliver drugs, fluids, or nutrition. Chest X-ray confirmation is required post-insertion, and dislodgement should be avoided.

What are the common uses of intravenous (IV) therapy?

IV therapy is used for administering fluids and/or medications directly into a vein (e.g., dorsum of the hand, cubital fossa). Proper gel/catheter management is essential.

What is an indwelling urethral catheter (IDC) and its indications?

An IDC is used for urinary drainage due to urinary retention or for precise monitoring of urine output (normal output \approx 30\ ml/hour). It requires secure taping, and the bag should not be tipped during mobilisation.

What is a nasogastric tube (NGT) used for?

An NGT is used for enteral nutrition and/or aspiration of gastric contents. Its position must be confirmed by a chest X-ray before mobilisation, and dislodgement should be avoided.

How does Patient-Controlled Analgesia (PCA) work and what are its implications?

PCA is a patient-activated pump that delivers rapid-onset analgesia. It may cause drowsiness or reduce respiratory drive, often necessitating supplemental oxygen.

What is epidural analgesia and its effects on patients?

Epidural analgesia involves a continuous infusion via an epidural catheter, providing pain relief. It typically has less respiratory depression than systemic opioids, but can cause lower limb sensory/motor reduction, reduced gastric motility, and hypotension. Mobilisation requires caution and assessment of lower limb sensation and strength.

How should physiotherapists coordinate care with pain relief and bronchodilators?

Physiotherapists should time interventions (e.g., airway clearance) with the peak effect of bronchodilators or analgesics to optimize patient participation and reduce pain. Consider how analgesia affects breathing, coughing, and ability to engage in therapy, ensuring safety by recognizing potential respiratory depressant effects.

What are critical practical considerations for physiotherapists regarding patient attachments?

Physiotherapists must avoid tugging or dislodging lines/tubes, confirm their securement and position before movement, and coordinate with the care team when planning mobilisation or airway clearance. Knowledge of common medications and their interactions with physiotherapy is also crucial.

Why is oxygen considered a medicine?

Oxygen is considered a medicine because it has specific indications, dosing requirements, precautions, and potential side effects, requiring careful management like other medications.

What are key indications for oxygen therapy and the definition of hypoxemia?

Indications include acute respiratory failure, hypoxemia, increased metabolic demand (e.g., trauma, sepsis), and post-operative prophylaxis. Hypoxemia is defined as PaO2 < 80\ mmHg, often reflected by peripheral oxygen saturation (SpO2) below target ranges.

What critical precaution applies to oxygen therapy in COPD patients?

COPD patients with chronic respiratory failure may experience reduced respiratory drive due to a loss of hypoxic drive if given high-dose oxygen; therefore, careful titration and continuous monitoring are essential.

Describe the main oxygen delivery systems and their approximate FiO2 ranges.

1. Nasal Cannula: Low-flow (1-4\ L/min), approx. 24-36\%\ FiO2.
2. Simple Face Mask: 5-10\ L/min flow, higher FiO2; patient cannot eat/drink.
3. Non-Rebreathing Mask: Achieves up to 90\%\ FiO2 by preventing room air entry.
4. High-Flow Nasal Cannula (HFNC): Delivers heated/humidified gas up to 40\ L/min, near-ambient up to \approx 100\%\ FiO2; allows eating/drinking.
5. Non-Invasive Ventilation (NIV): Sealed mask (CPAP/BiPAP) for positive airway pressure.
6. Invasive Mechanical Ventilation: Endotracheal/tracheostomy tube with ventilator for full support.

What are typical SpO2 targets for general acute medical conditions versus COPD patients?

For general acute medical conditions, target SpO2 is typically 92-96\%. For COPD patients or those with chronic respiratory failure, the target is often lower (e.g., 88-92\%) to avoid hypercapnia risks, with individualised targets.

When is arterial blood gas (ABG) analysis used, and what information does it provide?

ABG is the gold standard for arterial oxygenation and acid-base balance. It provides PaO2, PaCO2, SaO2, and acid-base status. It's used when oximetry is unreliable, desaturation persists, or hypercapnia risk exists.

When should oxygen therapy be escalated or referred to a senior clinician?

Escalation or referral is warranted if there are high-flow requirements (>4-6\ L/min nasal flow or high FiO2 targets) or persistent desaturation despite supplemental oxygen. ABG analysis or invasive monitoring may then be considered.

What are common pitfalls and accuracy issues with pulse oximetry?

Accuracy can be affected by low perfusion, cold extremities, dark/pigmented skin, movement, nail polish (especially blue/black), carbon monoxide poisoning, severe anaemia, or very high PaO2. SpO2 reflects SaO2 non-invasively but does not provide direct acid-base information.

What is Breathing Control (BC) and its purpose?

Breathing Control (BC) is a relaxed, diaphragmatic breathing technique focused on gentle, low-effort abdominal breathing. Its purpose is to reduce the work of breathing, promote relaxation, help manage breathlessness, and conserve energy, especially during activities or periods of dyspnea.

What is Pursed Lip Breathing (PLB) and how does it help patients with chronic respiratory conditions?

Pursed Lip Breathing (PLB) is a technique where air is inhaled through the nose and exhaled slowly through pursed lips. This creates a slight resistance, which helps to keep airways open longer during exhalation, prevent premature airway collapse, reduce air trapping, and improve the efficiency of breathing. It is particularly beneficial for patients with obstructive lung diseases like COPD to manage breathlessness.

What is the Forced Expiratory Technique (FET) and when is it used?

The Forced Expiratory Technique (FET) involves one or two huffs (forced exhalations) from mid to low lung volume, followed by a period of relaxed Breathing Control (BC). It is used to move secretions from peripheral to central airways for expectoration, particularly in patients with excessive sputum production (e.g., Bronchiectasis, Cystic Fibrosis).

What is Thoracic Expansion Exercise (TEE) and its purpose?

Thoracic Expansion Exercise (TEE), or deep breathing exercises, involves slow, deep inspirations to maximal lung capacity, often held for a few seconds, followed by a relaxed exhalation. Its purpose is to increase lung volumes, improve ventilation, prevent atelectasis, and enhance chest wall mobility, particularly after surgery or in conditions causing shallow breathing.