Pulmonary Disease and Impact on Exercise

Question 1

What is the function of the lungs?

Answer 1

Transport O2 into air sac’s (alveoli) and transport CO2 from the tissues to the atmosphere.

Question 2

Order of the respiratory tree from trachea to alveolar sacs:

Answer 2

CONDUCTING PORTION
trachea
primary bronchus
secondary bronchus
tertiary bronchus
bronchioles
terminal bronchioles

RESPIRATORY PORTION
respiratory bronchioles
alveolar ducts
alveolar sacs

Question 3

Ventilation equation

Answer 3

TV x RR = ventilation (L/min)

-both of these factors increase with activity

Question 4

As tidal volume increases, what happens to inspiratory reserve volume or expiratory reserve volume?

Answer 4

Inspiratory reserve volume:
-Goes down

Expiratory reserve volume:
-Goes down

Question 5

inspiratory reserve volume

Answer 5

The extra volume of air that can be inspired with maximal effort after reaching the end of a normal, quiet inspiration

Question 6

expiratory reserve volume

Answer 6

expiratory reserve volume (ERV) is the amount of air that can be forcefully exhaled after a normal resting exhalation.

Question 7

What is the fourth leading cause of death in the US?

Answer 7

COPD

Question 8

COPD - chronic bronchitis

Answer 8

-over production of mucus causes an occlusion of airways
-alveoli becomes damaged
-“blue bloaters” –> lack o2
-oxygen exchange is difficult

Question 9

COPD- emphysema

Answer 9

-destruction of the elastic fibers in the lungs
-inability of lungs to bounce back during expiration
-barrel chest
-“pink puffer”
-due mainly to chronic smoking

CAUSES:
-smoking
-hereditary alpha 1- antitrypsin deficiency –> destruction of elastic fibers surrounding the alveoli –> enlarged alveoli

Question 10

Symptoms of COPD

Answer 10

-SOB
-dyspnea on exertion
-orthopnea (better breathing in upright position)
-wheezing
-increased respiratory rate
-peripheral cyanosis
-digital clubbing: Digital clubbing, also known as finger clubbing, is a medical condition that causes the terminal phalanges of fingers or toes to bulge

-pursed lip breathing
-elbow changes
-malaise
-chronic cough
-barrel chest (emphysema) (can’t exhale the same as before)
-weight loss
-use of accessory muscles of respiration

-prolonged expiratory period (with grunting)

-decreased FEV1/FVC ratio

-can contribute to chronic anxiety and depression

Question 11

FEV1/FVC

Answer 11

ability to forcefully expel air as a proportion of total lung capacity

Question 12

What is an example of a differential pulmonary test?

Answer 12

pulmonary function tests (specifically identify deficits in lung function)

-FVC
-FEV1
-FEV1/FVC

Question 13

What can occur among ppl with COPD who exercise?

Answer 13

-impediment of lung emptying (more time required) –> obstructive lung disease

-increased breathing leading to hyperinflation and smaller tidal volumes

-impairment of gas exchange

Question 14

Normal FVC, FEV1 and FEV1/FVC Values with COPD vs Normal for person without COPD

Answer 14

**WITH COPD **

FVC - forced vital capacity: 80% of total lung capacity

FEV1 - or forced expiratory volume in one second- 80%

FEV1/FVC- 75%

WITHOUT COPD **
* Tidal Volume: 0.5L at rest
* Forced Vital Capacity (FVC): 3-5L
* Forced Expiratory Volume (FEV1): 2.5-4L
* FEV1/FVC: >80% in healthy adults**

Question 15

Mildly impaired FVC, FEV1 and FEV1/FVC Values

Answer 15

FVC - forced vital capacity: 60-79%

FEV1 - or forced expiratory volume in one second: 60-79%

FEV1/FVC: 60-74%

Postbronchodilator FEV1/FVC: <0.70, or >/= 80% of predicted

Question 16

Moderately Impaired FVC, FEV1 and FEV1/FVC Values (with COPD)

Answer 16

FVC - forced vital capacity: 51-59%

FEV1 - or forced expiratory volume in one second: 41-59%

FEV1/FVC- 41-59%

Postbronchodilator FEV1/FVC: <0.70 or 50-79% % of predicted

Question 17

Severely Impaired FVC, FEV1 and FEV1/FVC Values

Answer 17

FVC - forced vital capacity: 50 or less

FEV1 - or forced expiratory volume in one second: 40 or less

FEV1/FVC: 40 or less

Postbronchodilator FEV1/FVC: <0.70 or 30-49% of predicted

Question 18

Very severe COPD postbronchodilator

Answer 18

Postbronchodilator FEV1/FVC: <0.70 or <30% of predicted

Question 19

Effects of exercise training among ppl with COPD:

Answer 19

CV reconditioning

desensitization to dyspnea

improved ventilatory efficiency

increased muscle strength

improved flexibility

improved body comp

better balance

enhanced body image

Question 20

What are some examples of restrictive lung diseases?

Answer 20

characteristic of: diminished lung volume (difficult to inflate the lungs; affects the expandability of the lungs)

-Neuromuscular: DMD, ALS, Guillian Barre, spinal cord disorders
-chest wall disorders: kyphoscoliosis, ankylosing spondy., obesity, compression fractures
-pleural disorders: fibrosis, effusion

-neonatal respiratory distress syndrome
-ARDS
-malignancy
-pulmonary edema
-major lung resection
-radiation exposure
-infectious agents
-inhaled particles
-immunologic diseases
-drugs

Question 21

What are some pathologies that affect the pulmonary circulation?

Answer 21

-body position -> propping up the head and chest can help in some cases because fluid can back up into the alveoli

-stenosis or incompetence of heart valves

-CHF –> pulmonary congestion and edema

-pulmonary embolus

Question 22

Pulmonary fibrosis (interstitial lung disease)

Answer 22

These disorders lead to fibrosis, or scarring of the interstitium tissue.

Question 23

Supplemental oxygen and exercise:

Answer 23

If we don’t get people exercising, even when they’re oxygen saturation is low, they will not be able to improve their physical capacity—> okay for them to drop transiently

** concerned when the oxygen sat is below 88% throughout the day

** if they drop below this during exercise, likely okay transiently