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Kin 187 > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Two types of pulmonary disease

A

Obstructive

Restrictive

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2
Q

Obstructive disease is when

Examples

A

The air has trouble flowing out of the lungs due to RESISTANCE

Airway obstruction

Due to excessive contraction of the smooth muscle

e.g. Asthma, Bronchiectasis, COPD

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3
Q

Restrictive disease is when

Examples

A

The chest muscles cant expand enough which creates problems with air flow

e.g. pulmonary fibrosis, chest wall disease

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4
Q

Chronic obstructive pulmonary disease (COPD) is

A

Preventable and Treatable disease

Has some significant extrapulmonary effects which are characterised by an airflow limitation that is not fully reversible

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5
Q

Progressive disease involves

A

Emphysema

Chronic brochitis

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6
Q

Emphysema is due to

A

Breakdown/collaspe of lung tissue/alveoli

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7
Q

Chronic brochitis is due to

A

Excessive mucus blocks airway

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8
Q

Dynamic measures of spirometry are

A

Force vital capacity (FVC)

Forced expiratory volume 1 sec (FEV 1.0)

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9
Q

When do you know if airway is obstructed

A

FEV1.0/FVC <70%

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10
Q

Characteristics of COPD involve

A

Increased airway resistance

Reduced lung elastic recoil

Increased work of breathing

Ventilatory muscle weakness/fatigue

Ventilatory inefficiency

Ventilatory failure

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11
Q

What 3 things are affected by exercise intolerance due to respiratory disease

A

Altered breathing mechanics

Impaired gas exchange

Skeletal muscle dysfunction

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12
Q

What is the overall outcome of exercise intolerance due to respiratory disease

A

Decrease external work capacity

Decrease external work endurance

Decrease ability to support physical activity

Decrease quality of life

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13
Q

What are the treatments options for COPD (increasing in severity)

A

Self management education and smoking cessation

Bronchodilators

Inhaled corticosteroids

Pulmonary rehabilitation

Oxygen given

Surgery

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14
Q

What is the typical exercise response in COPD

A

Hyperinflation (air trapping)

Weaken diaphragm contraction

High CO2
Low O2 in blood

Abnormal Cardiac function

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15
Q

Exercise testing for COPD (aerobic)

A

Ramping cycle protocol

Treadmill

1-2 METs/stage

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16
Q

Exercise testing for COPD (endurance)

A

6 min walk

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17
Q

Exercise testing for COPD (strength)

A

Isokinetic or isotonic

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18
Q

Exercise testing for COPD (flexibility)

A

Sit and reach

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19
Q

Exercise testing for COPD (neuromuscular)

A

Gait analysis

Balance

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20
Q

Exercise testing for COPD (functional)

A

Sit to stand

Stair climbing

Lifting

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21
Q

What are the special considerations for exercise testing in COPD

A

Pulmonary function test required

Determine arterial blood gases or arterial oxyhemoglobin saturation > 90%

Perceptions of dyspnea

Modifications of traditional protocols

Not appropriate to use VO2 peak based on age predicted HRmax

6 min walk test for assessing functional exercise capacity with more severe disease

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22
Q

What is the FITT recommendation for aerobic for COPD patients

A

3-5 days/wk

Light (30-40%) improves symptoms and quality of life
Vigorous (60-80%) shows physiologic improvements (more encouraged)

Intermittent exercise/ interval training = A few mins then rest

Walking or cycling

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23
Q

What is the FITT recommendation for resistance for COPD patients

A

Follow same FITT principle for healthy adults

Greater dyspnea means its more beneficial to work on muscles of shoulder girdle

Inspiratory muscle training

24
Q

What are the benefits from exercise in COPD

A

Majority of research supports exercise as a supplementary treatment in individuals with COPD

Main beneficial effect involves adaptations in the musculoskeletal and cardiovascular systems which reduce stress on the pulmonary system during exercise

25
Q

Adaptations in the musculoskeletal and cardiovascular systems that reduce stress on the pulmonary system consist of

A

Cardiovascular reconditioning

Reduced ventilatory requirement

Reduced hyperinflation

Desensitisation to dyspnea

Increased muscle strength, flexibility and body composition

Better balance

26
Q

Chronic restrictive pulmonary disease have a range of heterogeneous disorders that contribute to…

A

Low lung function and reduced thoracic compliance:

Reducing tidal volume
Increasing work of respiratory muscles
Less efficient ventilation

27
Q

CRPD instrinsic to the parenchyma of the lung involves

A

Pulmonary fibrosis

As the disease progresses, the normal lung tissue is gradually replaced by scar tissue

28
Q

What is pulmonary fibrosis

A

Scarring of the lung

29
Q

CRPD extrinsic to the parenchyma of the lung involves

A

Disease restricting lower thoracic/abdominal volume

Obesity?
Kyphoscoliosis?
Neuromuscular disease?
Trauma?

30
Q

Type 2 alveolar cells produce and secrete

A

Surfactant

31
Q

What does surfactant do

A

Reduce the alveolar surface tension to prevent collapse

32
Q

Exercise response to CRPD

A

Reduction in exercise tolerance and dyspnea

Impairment in exercise capacity is associated with declines in exertional arterial oxygen tension and oxyhemoglobin saturation

33
Q

The reduction in exercise tolerance and dyspnea from CRPD is due to

A

Inefficient ventilation with a high dead space

Mechanoreceptor stimulation

Heightened central respiratory drive

34
Q

What are the potential alteration to the exercise response in CRPD

A

Bronchodilators

Antihypertensive medications

Systemic corticosteroid treatment

Severe pulmonary arterial hypertension

35
Q

Bronchodilators effect on exercise response

A

May improve ventilatory response, ventilation-perfusion matching and exercise capacity

36
Q

Antihypertensive medication effect on exercise response involves

A

Beta blockers may blunt heart rate response during exercise

37
Q

Systemic corticosteroid treatment effect on exercise response involves

A

May increase blood pressure and induce muscle weakness

38
Q

Severe pulmonary arterial hypertension effect on exercise response involves

A

Increases risk of hypotension and arrhythmias upon exercise

39
Q

Completion of 6 min walk test with measurement of pulse rate and oxygen saturation can provide information on

A

Disability due to pulmonary dysfunction

Detect conexistent factors that aggravate disability

Monitor progression of impairment and response to therapy

40
Q

What is the consideration for exercise testing in CRPD

A

Worsening hypoxia should be monitored because it can contribute to chest pain and arrhythmias

Oxygen saturation should be >90%

Meter dosed inhalers should be evaluated for proper technique

Avoid extreme temp or humidity

41
Q

The main goals for exercise recommendations for CRPD patients involves

A

Learning efficient breathing techniques

Improving ergonomics during ADLs

42
Q

The initial period for exercise recommendations for CRPD patients involves

A

6 to 8 weeks

20 to 30 mintues

5 days/week

Of intense training to establish baseline

Session duration can be divided

43
Q

What improvements ***

A
44
Q

What are the benefits of exercise for CRPD

A

Exactly the same as COPD

45
Q

Intervention of Bronchodilators, its mechanism and effect

A

Increased peak ventilation

Less dynamic hyperinflation

Effect:
?

46
Q

Intervention of repeated functional exercise stimulus, its mechanism and effect

A

Increased movement efficiency

Decreased ventilation at iso-work

Effect:
Increase peak VO2
Increase Peak work rate
????

47
Q

Intervention of repeated high intensity exercise stimulus, its mechanism and effect

A

???

48
Q

Intervention of resistance training, its mechanism and effect

A

????

49
Q

Fick’s law of diffusion is (proportional and inversely proportional)

A

The rate of gas transfer is proportional to:
Tissue area
Diffusion coefficient of the gas
The difference in the partial pressure of the gas on two sides of the tissue

Inversely proportional to:
Thickness

50
Q

Ficks law equation

A

V gas = A/T x D x (P1 - P2)

51
Q

What is the partial pressure of O2 and CO2 in air

A

PO2 = 159 mmHg

PCO2 = 0.3 mmHg

52
Q

What is the partial pressure of O2 and CO2 in deoxygenated blood

A

PO2 = 40 mmHg

PCO2 = 46 mmHg

53
Q

What is the partial pressure of O2 and CO2 in expired gas

A

PO2 = 116 mmHg

PCO2 = 32 mmHg

54
Q

What is the partial pressure of O2 and CO2 in oxygenated blood

A

PO2 = 95 mmHg

PCO2 = 40 mmHg

55
Q

Oxyhemoglobin dissociation curve shows that at PO2 in arteries

A

Around 100 mmHg

% oxyhemoglobin saturation is around 100%

Oxygen content is around 20ml/100ml blood

56
Q

Oxyhemoglobin dissociation curve shows that at PO2 in veins

A

Around 40 mmHg

% oxyhemoglobin saturation is around 75%

Oxygen content is around 15ml/100ml blood

Kin 187 (21 decks)

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