CH 12-13

COPD, Asthma, Cystic Fibrosis

The most common chronic obstructive lung diseases for which pulmonary rehabilitation is provided 

Patients with chronic restrictive lung diseases

Demonstrated improvement in functional abilities following pulmonary rehabilitation

Pulmonary Rehabilitation

Is of value for all patients in whom respiratory symptoms have resulted in a decreased functional capacity or a decreased quality of life

Air

Inspired through the nose or mouth through all the conducting airways until it reaches the distal respiratory unit

Respiratory Unit

Contains the respiratory bronchiole, alveolar ducts, alveolar sacs, and alveoli. 

Ventilation

The movement of air through the conducting airways

At full inspiration

The lungs contain their maximum amount of air

Total lung capacity (TLC)

Also called maximum amount of air in the lungs.

Divided into 4 separate volumes of air

• Tidal volume (TV)

• Inspiratory reserve volume (IRV)

• Expiratory reserve volume (ERV)

• Residual volume (RV)

TIER

4 Separate volumes of air

Capacities

Combinations of two or more of the lung volumes

Tidal volume

The amount of air inspired or expired during normal resting ventilation

Also shown as TV or V_t

As tidal volume of air enters the pulmonary system

it travels through the conducting Airways to reach the respiratory units

Tidal Volume

About 500mL/breath for a young healthy male of European descent and approximately 400mL/breath for a healthy female 

Asian and African American people

Have lower long volumes with a reduction of 6% to 7% and 12%, when compared to people of European descent. 

350mL of that 500mL total of the tidal breath

Amount of inspired air that reaches the distal respiratory unit and takes part in gas exchange

Anatomical Dead Space

Remaining 150mL of the inhaled tidal breath remains in the conducting airways and does not take part in gas exchange

Inspiratory reserve volume (IRV)

It is the volume of air that can be inspired when needed but is usually kept in reserve

Expiratory reserve volume (ERV)

The volume of air that can be exhaled in excess of tidal breathing

Lungs

Never completely emptied of air even after maximally exhaling the ERV.

Residual volume (RV)

The volume of air remaining within the lungs when ERV has been exhaled.

Capacity

The sum of two or more volumes

Inspiratory capacity (IC)

Tidal Volume + Inspiratory Reserve Volume - TV + IRV

Refers to the volume of air that can be inspired beginning from a tidal exhalation

Functional residual capacity (FRC)

The combination of Residual Volume and Expiratory Reserve Volume - RV and ERV

The volume of air that remains in the lungs at the end of a tidal exhalation. 

Vital capacity (VC)

The sum of Inspiratory Reserve Volume, Tidal Volume, and Expiratory Reserve Volume - IRV, TV, and ERV

It is all of the possible volume of air within the lungs that is under volitional control.

Forced vital capacity (FVC)

Common method of measuring vital capacity is to achieve maximal inspiration, then forcibly exhale as hard and fast as possible into a measuring device until the expiratory reserve volume has been exhausted. It is a forced expiratory maneuver

All volumes together equal total lung capacity

TV + IRV + ERV + RV = TLC