Class Work sheet (pathologies) Flashcards
What is COPD
A progressive chronic obstructive pulmonary disease which is an umbrella term for emphysema and chronic bronchitis.
Usually >40yrs
Caused by smoking, dust or environmental factors which cause chronic inflammation
Physiotherapy problems with COPD
- Loss of lung volume
- Increased work of breathing (WOB)
- V/Q missmatch
- Reduced ex tolerance
- secretion retention
COPD
Why does INCREASED SPUTUM PRODUCTION occur
What symptoms does this cause and the PT problem
Why - The irritant (smoking/dust) stimulates the inflammatory response, causing goblet cells to hypertrophy and proliferate = hyper-secretion of mucus
Symptoms - Chronic cough, wet cough, coarse crackles on auscultation and a wheeze if airways blocked.
PT problem - Secretion retention
COPD
Why does STRUCTURAL DAMAGE TO CILIA occur
What symptoms does this cause and the PT problem
Why - Smoking/ irritant initially causes cilia to become paralysed, then cell death and damage occurs, reducing the cilia function and thickening the membrane meaning the cilia cannot beat the increased mucus out and towards the throat = damaged mucociliary escalator
Symptoms - Chronic wet cough, increased respiratory infections, green sputum, crackles and wheeze on auscultation from blocked airways
PT problem - Secretion retention
COPD
Why does the vicious cycle of infection occur
What symptoms does this cause and the PT problem
Why - the lungs become susceptible to repeated acute airway infections due to the abundance of rich mucus in the airways. Bacteria thrive off of the glycoproteins in the sputum.
These constant infections trigger the constant activation of the inflammatory response, causing worsening symptoms for the patient (eg: more sputum and then more infection) , this chronic inflammation of the airways/ bronchi = chronic bronchitis
Symptoms - Dependent on the acute infection ( lung scarring, lung fibrosis, pyrexia, wet cough, crackles/ wheeze)
PT problem - secretion retention and loss of lung volume
COPD
Why does hyperinflation of the lungs occur
What symptoms does this cause and the PT problem
why - Smoking damages the elastic fibres in the lungs so they cannot recoil back after inhalation. This causes the lungs to remain inflated and inhalation if difficult as the lungs are full of stale air = SOB
Emphysema = Alveolar distention creates Boullae and trapped air within the lungs increases FRC
Symptoms - Reduced chest movement, reduced expansion, atypical breathing pattern, increased RR, chest bases on auscultation, type 1/2 resp failure due to poor gas exchange and O2 intake, use of accessory muscles on inhale (scalene and sternocleidomastoid) and exhale (internal intercostals and abdominal muscles), malnutrition, reduced FEV1
PT problem - Increased WOB, V/Q mismatch, Loss of lung volume, decreased ex tolerance
COPD
Why does structural damage to the alveoli occur
What symptoms does this cause and the PT problem
why - Distention to the alveoli, the alveoli are constantly stretched in COPD (hyperinflation) so the alveolar walls become loose/ break down to form large sacs. Also, smoking damages the surfactant in the lung which usually nreduces surface tension to keep the alveoli open. When this is damaged they more likely to collapse
This reduces the surface area and amount of gas exchange
(emphysema)
Symptoms - Increased RR, type 1/2 resp failure, Low Sp02, Low PaO2 (altered ABGs) , hypoxia/ hypoxaemia, reduced breath sounds on auscultation, reduced baseline of SpO2
PT problem - V/Q mismatch, reduced ex tolerance,
ASTHMA
Why does the release of inflammatory mediators occur
What symptoms does this cause and the PT problem
why -
1) hyper reactive airways are exposed to an allergen which is picked up b y dentritic cells which process it and present the allergen to T-helper 2 cells
2) T-helper 2 cells in turn stimulate eosinophils and plasma cells which produce antibody immunoglobulin E (IgE)
3) IgE antibodies bind to mast cells and cause them to degrade and release chemical mediators: histamine, leukotrienes and cytokines = inflammatory cascade
4) This inflammatory response causes damage to the mucosa and gives us the asthma symptoms
Symptoms: Bronchoconstriction as the smooth muscle of the airways spasms and contracts =. wheezing and SOB, can be unable to complete sentences, type 1 resp failure
PT problem - Increased WOB, V/Q mismatch
What is Asthma
Causes
A chronic inflammatory condition which narrows the airways with inflammation and mucus.
Causes:
- genetics - hypersensitive (eczema)
- Hyper-responsiveness
- Nasal polyps
- dust/ smoke/ mould
- chest infections or URT infection
- pollen/ animal hair
- cold/ weather
- exercise
it is reversible however after chronic asthma, scarring and fibrosis can occur and cause permanent narrowing
during asthma the pt cannot fully exhale before their next breath causing CO2 to build up in the lungs as it’s trapped in the alveoli = severe causes type 2 resp failure
ASTHMA
why does the number of goblet cells increase
What symptoms does this cause and the PT problem
why - The body tries to repair itself and the airways being remodelling. Hyperplasia of Goblet cell in airway epithelium and hypertrophy of submucosal glands cause hyper secretion of mucus and increased blockages in airways.
Symptoms - Chronic cough, wet cough, coarse crackles and wheeze on auscultation
PT problem - secretion retention, likely increased WOB, V/Q mismatch
ASTHMA
Why does the airway narrow/thicken and remodel itself
What symptoms does this cause and the PT problem
Why - Bronchospasm and bronchial wall oedema
Bronchospasm occurs as the inflammatory response causes the smooth muscle cells int he bronchioles to contract which narrows the airways
Bronchial wall oedema occurs becuase the inflammatory response increase capillary permeability to allow inflammatory cells into the area. Therefore fluid and immune cells leak from the bronchiole wall capillaries and accumulate in the bronchial tissue = narrowing/ obstruction
Chronic asthma = as the body tries to repair itself from repeated damage, the epithelial membrane thickens from epithelial grow and proliferate which thickens airways. Scarring and fibrosis occur in the airways, goblet cells undergo hyperplasia and secrete excess mucus which all narrow and obstruct the airways causing irreversible damage to the airways.
Symptoms - decline in lung function in general, SOB, fatigue, wheeze, resp failure and altered ABGs.
PT problem - Increased WOB, reduced ex tolerance, V/Q mismatch, secretion retention
BRONCHIECTASIS
Why is there increased sputum volume
What symptoms does this cause and the PT problem
why - Inflammatory damage to widen the bronchial walls stimulates proliferation of goblet cells, causing hypersecretion of mucus and exacerbating airway obstruction as it pools in the widened areas. The thickened mucus can also contribute to the formation of mucus plugs, which can further obstruct the airways and impair lung function.
the formation of extra thick mucus production to pool in the widened airways.
Symptoms - chronic productive wet cough, crackly, constantly brining up white phlegm, stress incontinence (leak urine from constant cough)
PT problem - secretion retention, V/Q mismatch, probably increased WOB
What is Bronchiectasis
Causes
widening of the airways
Bronchiectasis is an obstructive lung condition where the bronchi become abnormally widened due to an excessive inflammatory response or previous infection such as CF, TB, RA
Pts are less able to clear secretions.
leading to a build-up of excess mucus that can make the lungs more vulnerable to infection, resulting in airway blockage and further breakdown of the airway
overtime the bronchial tissue becomes fibrotic as elastic properties are lost so the bronchi are permanently widened/ damaged
Causes - 40% still unknown cause
- often from another respiratory disease/ infection
- pneumonia / CF
- Rheumatoid Arthrisits
- Chronic asthma
BRONCHIECTASIS
why permanent widening of the airways
What symptoms does this cause and the PT problem
why - The vicious cycle of infection from bacteria in the mucus or from other resp diseases ie CF, causes chronic inflammation and widening of the airways, results in a constant immune response and the release of inflammatory mediators such as neutrophils which over time cause tissue damage and fibrosis = permanent widening
elastin, mus§cle and cartilage breakdown by neutrophils
symptoms - SOB, snoring, finger clubbing, fatigue, anxiety, depression, continuous coughing of green sputum
PT problem - reduced ex tolerance, reduced lung volume
BRONCHIECTASIS
why is there reduced sputum clearance
What symptoms does this cause and the PT problem
Why - cilia become clogged with vast thick mucus and the become damaged. The walls membrane can also thicken and reduce movement of the cilia. This means the cilia cannot beat the mucus up and towards the throat.
mucociliary escalator becomes ineffective and the build up of mucus makes the airways prone to the vicious cycle of infection
Symptoms - chronic wet cough, increased resp infections, white or green sputum if infection , crackles, squeaks and pops on auscultation wheeze,
PT problem - secretion retention, V/Q mismatch, increased WOB, could have loss of lung volume
What is cystic fibrosis
causes
Cystic fibrosis is an inherited condition in which the mucous, salivary and sweat glads produce thick, sticky mucus which clogs up the organs.
Cause:
Both parents must have the defective CFTR gene on chromosome 7 which is responsible for the transport of salt and water in/out of cells.
CYSTIC FIBROSIS
why is there increased thickness of sputum
What symptoms does this cause and the PT problem
the CFTR gene responsible for salt and water transport is defective. Therefore the mucus produced is dehydrated, saltier and thicker.
symptoms - Chronic cough, wet cough, coarse crackles on auscultation, wheeze
PT problem - secretion retention, liekly increased WOB
CYSTIC FIBROSIS
why is the mucociliary transport impaired
What symptoms does this cause and the PT problem
why - The mucus is so thick and sticky the cilia are unable to move it and beat the mucus up and towards the throat.
Symptoms - Chronic cough, coarse crackles, wheeze, anxiety, fatigue, depression, SOBOE (on exertion)
PT problem - Secretion retention, likely increased WOB as well
