Pulmonary Conditions

examples of obstructive lung disease

• emphysema

• asthma

• chronic bronchitis

• bronchiectasis

restrictive lung disease examples

• autoimmune

• idiopathic

• work related

• drug related

examples of infectious lung diseases

• community acquired typical pneumonia

• community acquired atypical pneumonia

• nosocomial pneumonia

• aspiration pneumonia

• necrotizing pneumonia

• chronic pneumonia

• pneumonia in immunocompromised

examples of neoplastic lung disease

• non small cell lung carcinoma

• small cell lung carcinoma

COPD definition

• chronic, progressive airflow limitation

• not fully reversible

• persistent inflammation lead to abnormal airway repair and structural changes

• airway obstruction and expiratory flow limitation

risk factors of COPD

• cigarette smoking (primary cause)

• long term exposure to air pollution, dust and gases

• increasing age (typically presents at 55-60 years)

• male (the incidence is increasing in women)

• chronic respiratory infections

• genetic predisposition

pathogenesis of COPD

• air trapping leads to hyperinflation which leads to residual volume

• the decreased inspiratory capacity during activity leads to dypsnea

• decreased respiratory muscle efficiency leads to increased work of breathing and gas exchange abnormalities

clinical presentation of COPD

• dyspnea

• hypoxemia

• hypercapnia

• hyperventilation

• decreased breath sounds and increased expiratory phase

• chronic respiratory acidosis

• weight loss

• cyanosis and digital clubbing

• respiratory muscle weakness and fatigue

• venous thromboembolism in COPD

complications of COPD

• mismatched ventilation-perfusion and shunting of blood to areas of poor ventilation

• pulmonary hypertension

• cor pulmonale (right-sided heart failure)

• exacerbation due to infection

• COPD who are hypoxemic during sleep due to poor alveolar ventilation

medical examination for COPD

• chest xray

• ABG

• pulmonary function test results

examination for COPD

• pulmonary function tests

• lung volumes

• arterial blood gas measurements

gold standard for diagnosing COPD

spirometry

• decreased fev1 and fev1/fvc values

pulmonary function tests

• FEV1 decrease in COPD

• post bronchodilator FEV1 <80% of predicted with FEV1/FVC <0.7 confirms airflow limitation

lung volume examination with COPD

• increased in emphysema

• RV and FRC of the lungs also increased

Arterial Blood Gas Measurements with COPD

• decreased PaO2

• PaCO2 may initially be normal in mild COPD, but increase gradually in individuals

• may lead to respiratory failure

polycythemia

hematocrit >55% can develop in the presence of arterial hypoxemia to increase O2 carrying capacity

multiorgan-system disease

• exercise intolerance

  • skeletal muscle dysfunction contributes to weight loss

psychological impact of COPD

depression and/or anxiety

blood gas measurements with COPD

• decreased O2 levels (PaO2) characterize disease progression

• PaCO2 may be normal or decreased in mild COPD

• with bronchitis PaCO2 typically increases

• blood gas abnormalities worsen during acute exacerbations, sleep or exercise

physical examination for COPD

• auscultation

  • long expiratory phase

  • diminished breath sounds

  • occasional wheezing

• percussion

  • mediate percussion due to hyperinflation

• chest shape

  • barrel chested (when COPD is severe)

  • widening of xiphosternal angle

  • flattening of hemidiaphragms

• posture

  • forward-leaning (tripod)

  • use of accessory muscles

  • pursed lips

  • inspection of mucosal membranes + lips

chronic bronchitis definition

• inflammation that is accompanied by excessive mucus secretion

• obstructing bronchial tubes

• presence of a chronic productive cough for 3 months in each of two successive years

pathophysiology of chronic bronchitis

-hypersecretion in large airways

• initial without airway obstruction

• hyper secretion progresses to smaller airways

-thickening of the airway wall

-hypertrophy of submucosal glands

emphysema pathophysiology

• loss of pulmonary parenchyma

• dilation of terminal airways

• airway obstruction allows air to flow into the alveoli during inspiration but impedes the outflow of air during expiration

treatment of emphysema

• smoking cessation

• pharmacotherapy

intervention of COPD

• drugs

• supplemental oxygen

• surgical

• patient education

• ventilatory muscle training

• secretion removal technique

  • shaking/vibration/post drainage/suctioning

  • ACBT/flutter

• breathing exc/activity pacing

physical therapy treatment for all obstructive disorders

• secretion clearance techniques

• controlled breathing techniques at rest

• controlled breathing techniques coordinated with position changes, walking and climbing stairs

• ambulation with the use of a rolling walker

• instruction in the use of recovery from shortness of breath positions

• endurance exercise training

• strength and weight training

• thoracic stretching exercises

• postural reeducation to avoid round shouldered postures