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Chronic Obstructive Pulmonary Disease

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Bronchiectasis could follow any disease that causes weakening of the immune system, chronic infection, mucous production, or a foreign body. – PowerPoint PPT presentation

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Title: Chronic Obstructive Pulmonary Disease


1
Chronic Obstructive Pulmonary Disease
  • By Sara-Louise Walsh, SPT

2
Objectives
  • After this in-service presentation
  • Viewers will be able to accurately describe how
    COPD damages the body when prompted.
  • Viewers will be able to correctly name 3 physical
    therapy interventions that help patients who have
    COPD when prompted.

3
What is COPD?
  • Progressive
  • Irreversible Lung Disease
  • Characterized by chronic bronchial outflow
    obstruction

4
What is COPD?
  • A category of lung diseases.
  • Includes
  • Emphysema
  • Chronic Bronchitis
  • Asthma
  • Bronchiectasis

5
Terminology
  • COPD often begins as emphysema or chronic
    bronchitis.
  • These two diseases are similar in progression.
  • If a patient is diagnosed with a lung disease
    after years of smoking it may be difficult to
    identify which disease the pt has.
  • A patient who has one disease is likely to have
    another disease under the category of COPD as
    well.

6
Common Pathology
  • Decreased ability of body to move air into and
    out of the lungs
  • Causes decreased oxygen intake and carbon dioxide
    output.
  • Body is unable to use oxygen to produce energy.

7
Trivia
  • Question
  • What is the most common cause of COPD?

8
Answer
  • Cigarette Smoking

9
Emphysema
  • Initial Lesion
  • Destruction of alveolar walls
  • Alveoli merge
  • Large air spaces form (bulla or bleb)
  • 90 caused by smoking

10
Results
  • Inflames lungs
  • Inhibit alpha-1 antitrypsin-
  • neutralize digestive enzymes produced by
    inflammatory cells
  • prevent over activity and digestion of normal
    tissue.

11
How Common is Emphysema?
  • Common
  • Present in half of all autopsy reports.
  • most had no symptoms

12
Visual of a Typical Emphysema Patient
  • Pink Puffer
  • Thin
  • Smoker
  • Short of breath
  • Barrel shaped chest
  • Breaths thru pursed lips
  • Causes pink cheeks
  • Wheezing
  • Coughing

13
Cont.
  • Over muscular neck muscles
  • Pt bends forward at the waste to ease breathing
  • Infection
  • Sputum production

14
Clinical Description of a Typical Emphysema
Patient
  • Short of breath first symptom
  • Dramatic wt loss
  • body sheds muscle the lungs can not support

15
Trivia
  • What might a typical emphysema patient look like?

16
Answer
  • Thin
  • Smoker
  • Short of breath
  • Barrel shaped chest
  • Breaths thru pursed lips
  • Wheezing
  • Coughing
  • Over muscular neck muscles
  • Pt bends forward at the waste to ease breathing
  • Infection
  • Sputum production

17
Chronic bronchitisDefinition
  • Chronic cough that produces sputum for 3
    consecutive months two years in a row.
  • Primary Cause cigarette smoking

18
Chronic BronchitisResults
  • Initial Lesion Bronchi
  • Smoke irritates bronchi and stimulates chronic
    inflammation and bronchial mucous secretion.

19
Chronic BronchitisConsequences
  • Simple chronic bronchitis
  • Productive cough
  • Do not have airway obstruction
  • Chronic asthmatic bronchitis
  • Some periods of asthma-like wheezing
  • Obstructive chronic bronchitis
  • Consistent wheezing and obstruction

20
Relationship Between Emphysema and Chronic
Bronchitis
  • Most patients with chronic bronchitis also have
    emphysema

21
Visual of a Typical Patient who has Chronic
Bronchitis
  • Blue Bloater
  • Hypoxic
  • Large Mid-section
  • No weight loss

22
Clinical Description
  • Airflow obstruction
  • Wheezing
  • Coughing
  • Sputum production
  • Infection
  • Acidotic

23
Note
  • Most patients visually fall somewhere between the
    pink puffer and blue bloater examples.

24
Trivia
  • Name two lung diseases a smoking patient is
    likely to have simultaneously.

25
Answer
Emphysema Chronic Bronchitis
26
Bronchiectasis
  • Marked permanent dilation of small bronchi
  • Destruction of smooth m and elastic supporting
    tissue of the airway
  • Both obstruction and infection are
    required-either may come first.

27
BronchiectasisCause
  • Usually secondary to something else
  • Immunodeficiency states-encourage infection
  • Chronic infection such as tuberculosis- damage
    bronchial walls
  • Retained bronchial foreign body-mucous retention
    and infection
  • Cystic fibrosis-prod thick mucous that obstructs
    bronchi

28
BronchiectasisResults
  • Obstruction can cause mucous retention-breeding
    ground for infection
  • Lower lobes typically involved, especially in
    airways that are close to vertical
  • Dilated flaccid, pus filled tube

29
BronchiectasisClinical Description of a Typical
Patient
  • Chronic Infection
  • Persistent Cough
  • Production of a large amount of yellow,
    fowl-smelling sputum.

30
Trivia
  • Name one component of the clinical description of
    a patient who has bronchiectasis.

31
Answer
  • Chronic Infection
  • Persistent Cough
  • Sputum Production

32
Results of COPD
  • Respiratory muscle fatigue
  • Cardiovascular deconditioning
  • Poor Posture
  • Rounded shoulders
  • Forward head
  • Anterior accessory muscles compensate for
    breathing.
  • Death from COPD is usually associated with a
    combination of hypoxia, acidosis, and right-sided
    heart failure.
  • Pneumonia is often the terminal event

33
Special Considerations
  • Bronchodilators may cause tachycardia or muscle
    weakness.
  • All pts with COPD are at risk for chronic hypoxia
    (low oxy)
  • Can lead to pulmonary vasospasm
  • Pulmonary hypertension
  • Right-sided heart failure

34
What kind of physical therapists see patients who
have COPD?
  • Hospital Setting
  • In-patient
  • Out-patient
  • Private Practice
  • Nursing Home
  • Home Care
  • Researchers

35
Specific Physical Therapy Goals
  • Improve Quality of Life Improve Ability to
    Breathe
  • Improve Breathing Pattern
  • Increase exercise tolerance
  • Improve Posture
  • Promote Relaxation of Accessory Muscles of
    Inspiration

36
Interventions Improve Breathing Pattern
  • Diaphragmatic Breathing
  • Pursed Lip Breathing
  • Encourage Cessation of Smoking Habits
  • 20 minutes after quitting heart rate and blood
    pressure drop
  • 12 hours after quitting carbon monoxide levels
    normalize
  • 2-3 months after quitting lung function improves
    and circulation increases
  • 1 year after quitting risk of coronary artery
    disease is cut in half

37
Interventions Increase Exercise Tolerance
  • Graded Endurance and Conditioning Exercises
  • Aerobic training
  • 30 minutes/day
  • 11-13 on RPE
  • Balance Training
  • Strength Training for Lower Extremities

38
Interventions Improve Posture
  • Strength training
  • Low resistance
  • High reps
  • 2-3 Days/Week
  • Flexibility training
  • Position for Relaxation

39
Trivia
  • Name three physical therapy interventions for
    patients who have COPD.

40
Answer
  • Improve Breathing Pattern
  • Increase Exercise Tolerance
  • Improve Posture

41
Interesting Research
  • One-legged exercise training
  • Use of supplemental oxygen

42
Works Cited
  • Como D. Mosbys Dictionary 8th edition. St.
    Louis, MO. Elselvier. 2009. 379.
  • McConnell, TH. The Nature of Disease.
    Baltimore, MD. Lippincott Williams Wilkins.
    2007. 332-335.
  • Gardenhire D. Adrenergic bronchodilators and side
    effects what do you look for? Journal for
    respiratory care and sleep medicine. 2008. March
  • Kisner C, Colby LA. Therapeutic Exercise. 5th
    edition Philadelphia, PA. Davis. 2007.
    864-877.
  • Dolmage TE, Goldstein RS. Effects of one-legged
    exercise training in patients with copd. Chest
    2008 133 (2) 370-376
  • Jolly EC, Di Boscio V, Aguirre L, Luna CM,
    Berensztein S, Gene RJ. Effect of supplemental
    oxygen during activity in patients with advanced
    COPD without severe resting hypoxemia. Chest.
    2001 120 (2) 437-443.
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