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Cardiopulmonary > Obstructive Disease > Flashcards

Obstructive Disease Flashcards

1
Q

What is an expiratory impairment?

A

Expiratory volumes increase

Inspiratory volumes decrease with diesease progression.

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2
Q

Obstructive Disease Causes…

A

Increased resistance to airflow

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3
Q

Signs and Symptoms of Obstructive Disease…

A

Tachypnea, dyspnea, decreased and/or adventitious breath sounds, chronic cough, and characteristic musculoskeletal changes.

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4
Q

What is the chain of events that lead to cor pulmonale?

A

Chronic alveoloar hypoxemia…..pulmonary vasoconstriction…..pulmonary hypertension

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5
Q

What are some common obstructive pathologies?

A 
Asthma
Chronic Bronchitis
Emphysema
COPD
Bronchiectasis
Cystic Fibrosis
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6
Q

What are some diagnostic assessments for obstructive disease?

A

Chest x-ray

Pulmonary Function Tests

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7
Q

Chest X-ray findings with obstructive disease…

A

Hyperinflation (flattened diaphragm)

Radiopacities (appear white) reveal regions with retained secretions

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8
Q

PFT findings with obstructive disease

A

Increased expiratory volumes
Decreased inspiratory volumes with worsening obstructive disease
Decreased FEV1/FVC ratio to (<75-80%)

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9
Q

What is Asthma?

A

Hyperirritability of the tracheobronchial tree

Results in bronchospasm, inflammation of the bronchioles, and excess mucous

Causes increased resistance to air flow.

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10
Q

What are the precipitating factors to Asthma?

A

Respiratory infection
Irritants
Allergens
Stress and /or exercise

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11
Q

Diagnostic Findings with Asthma

A

CXR consistent with hyperinflation with acute exacerbation; otherwise normal.

PFTs consistent with obstructive disease.

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12
Q

Hallmark Signs and Symptoms of Asthma

A
  • Wheezing or diminished / absent breath sounds
  • Hyper‐resonant with mediate percussion (air trapping)
  • Prolonged expiratory phase
  • Increased use of accessory muscles
  • Dyspnea
  • Cough (with or without sputum)
  • Cyanosis
  • Retractions
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13
Q

Medical Management of Asthma

A 
Pharmacologic
bronchodilators
corticosteroids
beta adrenergic agonists
anticholinergics
methylxanthines
leukotriene inhibitors

Pulmonary Toilet:
secretion clearance
supplemental O2

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14
Q

PT management of Asthma

A

Airway clearance
bronchospasm considerations, cough vs. huff

Breathing Exercises
pursed lip breathing and diaphragmatic

Activity/exercise
tolerance
ensure availability of rescue inhalers

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15
Q

Exercise benefits in patients with asthma.

A

Aerobic training at moderate to high intensity
• 20 minutes, 2 times/week, minimum of 4 weeks
• Contraindicated during acute exacerbation
• Include warm‐up to reduce risk of exercise induced
bronchospasm
• In the asthma population, exercise improves:
• Quality of life
• Cardiopulmonary fitness, but does not improve lung function
• In the asthma population, exercise reduces:
• Incidence of exacerbations
• Reports of dyspnea and anxiety during activity

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16
Q

Given a diagnosis of asthma, what
assessments must be performed to guide the
selection of the most optimal physical
therapy intervention(s)?

A

?

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17
Q

Chronic Bronchitis Characteristics

A

Leads to hypersecretion of bronchial mucous given hyperplasia of
mucous glands
• Creates irreversible lung damage given scarring of mucous membranes
• Results in dilation of alveoli

18
Q

Chronic Bronchitis Causes

A

Smoking
• Repeat airway infections
• Environmental and/or chemical irritants

19
Q

What is chronic bronchitis associated with?

A

Associated with recurrent productive cough for at least 3

consecutive months for 2 consecutive years

20
Q

Diagnostic findings with chronic bronchitis?

A

CXR consistent with mucous secretion; CXR not used diagnostically but
rather to rule out other pathologies
• PFTs consistent with obstructive disease
• FEV1 < 65% of predicted value
• FEV1 / FVC ratio < 70%
• ABGs consistent with hypoxemia and hypercapnia

21
Q

Hallmark Signs and Symptoms of Chronic Bronchitis

A
  • Cyanosis and barrel chest deformity (“blue bloater”)
  • SOB
  • DOE
  • Orthopnea and PND
  • Crackles and wheezes
  • Tachypnea
  • Chronic productive cough
  • Peripheral edema (if progressed to R‐sided heart failure)
22
Q

Medical Management of Chronic Bronchitis

A 
Pharmacological 
• Bronchodilators
• Corticosteroids
• Beta adrenergic agonists
• Anti‐cholinergics
• Cough suppressants
• Antibiotics in setting of
respiratory infection
• Vaccines to reduce risk of
influenza and pneumonia

Pulmonary Toilet
secretion clearance
supplemental oxygen as indicated

Smoking cessation

23
Q

Physical Therapy Management of Chronic Bronchitis

A

Airway clearance

Breathing exercises
pursed lip breathing and diaphragmatic

Activity / Exercise
tolerance
safety parameters.

24
Q

What is Hypoxic Drive?

A

Consequence of retained CO2

Chronic hypercapnia blunts sensitivity of central chemoreceptors
to detect changes in CO2
• Body fails to naturally increase respiratory rate to eliminate CO2 excess
• Drive to increase respiratory rate therefore stimulated by peripheral
chemoreceptor detection of hypoxemia
• Impact of supplemental oxygen administration in setting of
chronic hypercapnia
• May improve hypoxemia
• Without ongoing hypoxemia, body fails to increase respiratory
rate to address hypercapnia (negative feedback loop: peripheral
chemoreceptors detect sufficient oxygen and fail to stimulate
spontaneous increase in respiratory rate or depth)
• Often results in difficulty with supplemental oxygen weans
• Common for SpO2 goal to be ≥ 88%

25
Q

Emphysema Characteristics

A

Destruction of elastic fibers surrounding the alveoli given
deficiency of alpha 1‐antritrypsin
• Decreased number of alveoli
• Increased size of alveolar sac and ducts, thereby reducing elastic
recoil
• Overall reduced surface area for gas exchange

26
Q

Emphysema Causes

A

Genetic predisposition (hereditary alpha 1‐antitrypsin deficiency)
• Smoking
• Environmental (occupational) exposures

27
Q

Emphysema Diagnostic Findings

A
  • CXR consistent with hyperinflation (mucous not common)
  • PFTs consistent with decreased FEV1 and FEV1 / FVC ratio
  • ABGs consistent with slight hypoxemia
28
Q

Emphysema Hallmark Signs and Symptoms

A
  • “Normal” coloration (“pink puffer”)
  • Tachypnea
  • Increased WOB with pronounced accessory muscle use
  • SOB
  • Significant DOE
  • Thin (no barrel chest deformity)
  • Wheezes
  • Typically without a cough
29
Q

Emphysema Hallmark Signs and Symptoms

A
  • “Normal” coloration (“pink puffer”)
  • Tachypnea
  • Increased WOB with pronounced accessory muscle use
  • SOB
  • Significant DOE
  • Thin (no barrel chest deformity)
  • Wheezes
  • Typically without a cough
30
Q

Medical Management Emphysema

A 
Pharmacologic
• Bronchodilators
• Corticosteroids
• Beta adrenergic agonists
• Anti‐cholinergics
• Supplemental oxygen as
indicated
• Smoking cessation
• Lung volume reduction
surgery to reduce
hyperinflation
31
Q

PT Management Emphysema

A 
• Breathing exercises
• Primarily PLB and
diaphragmatic
• Activity / exercise
• Tolerance
• Determine parameters of
safety
32
Q

COPD Characteristics

A

Pathologic alveolar and airway changes resulting from
inflammatory responses to noxious particles or gases
• Partially reversible (treatable); preventable
• Typically reflects components of both chronic bronchitis,
emphysema, and asthma
• Most commonly a manifestation of chronic bronchitis
• Mucous production causes chronic and productive cough
• Additional findings consistent with right‐sided heart failure

33
Q

Pulmonary Rehab benefits with COPD

A

Improves:
quality of life
activity and max exercise tolerance due to improved skeletal muscle and heart function

34
Q

What does pulmonary rehab reduce in COPD patients?

A

Hospitalization frequency

Reports of dyspnea

35
Q

What does pulmonary rehab reduce in COPD patients?

A

Hospitalization frequency

Reports of dyspnea

36
Q

Bronchiectasis Characteristics

A

Results from a necrotizing infection that destroys the
muscular wall and elastic components of the bronchus
• Destroyed regions become fibrotic
• Changes predispose individual to repeat infections
• Results in irreversible dilation of the bronchi
• Dilated bronchi accumulate mucous (mucopurulent sputum)
• Mucous leads to bronchospasm
• Antibiotic management has lessened incidence in general
population
• Most typically seen in individuals with CF
• Airway clearance and exercise represent primary PT
interventions

37
Q

Cystic Fibrosis Characteristics

A

• Genetic, autosomal recessive trait
• Caucasian > non‐white
• Equal gender distribution
• Non‐curable, but now with expanded treatment options and
earlier detection
• Diagnosed by sweat test, genetic testing, and stool sample
• Impaired transport of chloride ion across membranes
leading to hypersecretion of abnormally thick mucous
• Creates mucous plugging and chronic respiratory infections
• Greatest impact on small conducting airways which causes air
trapping

38
Q

Diagnostic Findings with Cystic Fibrosis

A

CXR consistent with hyperinflation and secretion retention.

PFTs consistent with decreased VC, increased FRC, and decreased FEV1

39
Q

Cystic Fibrosis Hallmark Signs and Symptoms

A 
PULMONARY SEQUELAE
• Crackles and wheezes
• Tachypnea
• Chronic productive cough
• Hemoptysis may be present
during peak of respiratory
infection
• Increased WOB and DOE
• Increased use of accessory
musculature
• Increased respiratory rate
• Cyanosis
• Digital clubbing
• May progress to barrel chest
deformity
• Findings consistent with rightsided
heart failure
OTHER SYSTEM SEQUELAE
Underweight
• Salty skin and sweat
• Large, greasy, malodorous
stools
• Sterility in men
• Findings consistent with
chronic pancreatitis
40
Q

Medical Management of Cystic Fibrosis

A 
• Pharmacologic
• Aggressive antibiotics
during infections
• Bronchodilators
• Mucolytics
• Pulmonary toilet
• Secretion clearance
• Supplemental oxygen as
indicated
• Transplantation if
candidate
• Interdisciplinary
coordination
• RT, RD, MD, RN, PT
41
Q

PT Management Cystic Fibrosis

A 
PHYSICAL THERAPY
• Airway clearance
• Breathing exercises
• Primarily PLB and
diaphragmatic
• Activity / exercise
• Tolerance
• Posture education
42
Q

Exercise Benefits with Cystic Fibrosis

A

Exercise tolerance is an independent predictor of mortality
and morbidity
• In the CF population, exercise improves:
• Mucociliary transport
• Mobility of chest wall
• Activity tolerance
• Quality of life
• In the CF population, exercise reduces:
• Incidence of osteoporosis
• Decline in lung function
• Frequency of lung infections

Cardiopulmonary (9 decks)

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