Chronic Respiratory Conditions

Question 1

What are chronic respiratory conditions

Answer 1

Long lasting conditions that affect the airway

Question 2

What is COPD?

Answer 2

• Progressive lung diseases characterised by inflammation that intensifies as disease progresses
• Includes chronic bronchitis (excessive bronchial mucous secretions) and emphysema (destruction of alveoli and enlargement of airspaces)
• Decreased lung compliance, scarring and obstruction, impaired gas exchange

Question 3

Causes of COPD

Answer 3

• Active smoking or exposure to smoking
• Expoure to smoke from burning plant and animal foods
• Outdoor air pollution
• Fumes and dust in workplace
• Childhood respiratory infections

Question 4

COPD management

Answer 4

• Control risk factors eg. smoking (5A strategy)
• Health and education and promotion of self management
• PURSED LIP BREATHING:
• improves ventilation and releases trapped air, keeps airways open longer and reduces work of breathing
• Prolongs exhalation to slow RR
• Relieves SOB
• Creates general relaxation
• MOBILISING SECRETIONS
• Postural drainage - trendelenerg position
• Chest percussion - to loosen secretions
• Vibration - fine shaking pressure from hands to chest wall while pt is exhaling
• HYDRATION - adequate fluid intake to keep secretions moist

CLEARING AIRWAY
- Depends on pt coughing ability
- Promotes more effective breathing pattern (better air entry, better gas exchange)
- Deep breathing, controlled coughing, incentive spirometry (pt needs adequate pain relief)
- Forced exhalation (huffing)
- Suctioning (oropharyngeal, nasopharyngeal)

SUPPLEMENTAL O2
- End stage COPD
- Changes in hypoxic drive
- o2 dependence

NUTRITION
- Increased resting energy expenditure (REE) by 10-15% due to work of breathing
- High calorie, high protein, healthy diet
- Frequent snacking and small meals

Question 5

What is asthma?

Answer 5

• Chronic inflammatory condition of airways causing narrowing
• Airways in constant state of infalmmation, can be triggered to become more inflamed (asthma attack / flare up)
• Characterised by episodes of wheezing, breathlessness, chest tightness

Question 6

Asthma management

Answer 6

• Bronchodilators and corticosteroids / relievers and preventers, which may be delivered via MDI, dry powder inhaler, nebs
• Vaccinations to prevent viral infections
• PEFR - measures greatest flow velocity produced during forced respiration (after fully expanding lungs during inspiration)
• Asthma action plan - to help recognise deterioration, start treatment and reach medical attention
• Trigger avoidance (eg. b blockers, NSAIDS, aspirin, inhaled allergens, smoke, food additives and colourants, URTI, exercise and sport)

Question 7

What is sleep apnoea

Answer 7

• Cessation of breathing during sleep - decreased airflow through nose and mouth, causing intermittent dips in amount of o2 in blood
• Most common in obese individuals or those with large neck circumference

Question 8

Types of sleep apnoea

Answer 8

1. OBSTRUCTIVE (OSA)
   - Repetitive pauses in breathing during sleep due to obstruction / collapse of upper airway (throat), usually with decreased o2 sats and followed by awakening to breathe
2. CENTRAL
   - Loss of neuro inspiratory drive and as OSA (rare)
3. MIXED
   - Treatment same as obstructive

Question 9

Sleep apnoea management

Answer 9

Can be treated with devices that help open up airways such as a continuous positive airway pressure (CPAP) machine. A CPAP machine delivers air pressure through a mask placed over a person’s nose and/or mouth while they sleep

Question 10

What is cystic fibrosis

Answer 10

Hereditary disorder causing secretions to become thick, viscous and sticky

Question 11

Management of cystic fibrosis

Answer 11

• Physiotherapy to clear secretions
• Inhalations via nebs (mucolytics, bronchodilators, antibiotics, antiinflammatory)
• Na+ supplements to prevent dehydration
• High calorie, high salt, high fat diet
• Exercise to clear secretions
• Pancreatic enzyme deficiency prevents absorption and digestion of nutrients –> enzyme replacement

Question 12

What are the non-modifiable and modifiable risk factors of chronic respiratory conditions?

Answer 12

Non-modifiable
- Age
- Heredity
Modifiable
- Smoking
- Unhealthy diet
- Being inactive

Question 13

Education for respiratory patients

Answer 13

SELF- ASSESSMENT
identifying/avoiding triggers; using pulmonary function tests such as peak expiratory flow meters
MANAGING EXACERBATIONS
use of an asthma action plan; use of appropriate medications
MEDICATION MANAGEMENT
storage and use of inhalers; care and use of devices such as spacers/CPAP machine
NUTRITION
weight management and healthy diet choices
EXERCISE
maintaining appropriate level of physical activity
OTHER NON- PHARMACOLOGICAL TECHNIQUES
effective coughing and breathing techniques
SUPPORT
connecting to organisations such as Lung Foundation Australia, Asthma Australia, etc. which provide support programs for clients and families