Download - Pulmonary s11
Pulmonary System and Exercise
Cough Wheeze Sputum Shortness of Breath History of exposure to smoking,
pollution, etc Spirometry impairment
INSPIRATION AND EXPIRATION
Pulmonary Diffusion
Respiration
INTERNAL Respiration — Gas exchange between the blood and tissues
Pulmonary diffusion — exchange of oxygen and carbon dioxide between the lungs and the blood
Pulmonary ventilation — inflow and outflow of air between the lugs and atmosphere
EXTERNAL Respiration
Any disease or disorder where lung function is impaired.
1. Obstructive Lung Disease -- a narrowing or blockage of the airways a decrease exhaled air flow- asthma, emphysema, and chronic bronchitis.
2. Restrictive lung disease -- a loss of lung compliance / elasticity of the lungs themselves or problem expanding decrease in the total lungs volume- Pneumonia, Cancer
3. Vascular Defect – decrease ability lung tissue to move oxygen to blood
Chronic Obstructive Pulmonary Disease (COPD)
Disease Cause
Asthma Constriction airways
Bronchitis secretion Excess mucus
Emphysema Destruction of alveoli
Causes of COPDCauses of COPDNOXIOUS AGENT
(tobacco smoke, pollutants, occupational agent)
Inflammation
Airway inflammation
Airway remodeling
COPD
Genetic factors
Respiratory infection
Other
Asthma• Airway narrowing due to inflammation (bronchial hyperresponsiveness) airflow obstruction “ bronchoconstriction”
Less Constricted More constricted
Bronchitis•Inflammation or thickened bronchial walls within the lungs due to secretion of fluids
•acute: infection•Chronic: +3 months to year
EMPHYSEMA
Loss of elasticity in the aveoli
Associated with exposure to toxic chemicals & long-term exposure to tobacco smoke.
RESTRICTIVE DISEASE
Disease Cause
Scoliosis Skeletal Origins
Pulmonary Edema Plural
Paralysis Neuromuscular
Pneumonia Alveolar blockage
Cancer or Fibrotic Lung Scarring or loss of tissue function
Reversible Accumulation of inflammatory cells, mucus,
in bronchi Smooth muscle contraction in airways Increase functioning with dynamic
hyperinflation during exercise Irreversible
Fibrosis and narrowing of the airways Loss of elastic recoil due to alveolar
destruction Destruction of alveolar support that maintains
patency of small airways
PULMONARY DISEASE
• Obstructive• Flow
• Restrictive• Volume
PULMONARY FUNCTIONS
PULMONARY FUNCTIONS
Diagnosis Restrictive Disease ( Vol)
Normal > 80% of predicted VC
Mild 60 to 75% of predicted VC
Moderate 50 to 60% of predicted VC
Severe < 50% of predicted VC
Diagnosis Obstructive Disease ( Flow)
Normal > 80% of predicted FEV1
Mild 60 to 70% of predicted FEV1
Moderate 40 to 59% of predicted FEV1
Severe < 40% of predicted FEV1
Diagnosis SaO2
Average 95-100%
Normal 96 – 98 %
Low <92%
Dysfunction < 88 %--need supplemental O2
% of oxygen bound to hemoglobin Measures for Hypoxia (decreased O2)
Hypoxic – not enough supply of 02 Anemic Hypoxia – not enough HGB
Men VC = 0.1626*Height(inches) - 0.031*Age(years) -
5.335
Women VC = 0.1321*Height(inches) - 0.018*Age(years) -
4.360
http://www.hopkinsmedicine.org/pftlab/predeqns.html
White males 15-79 years (Cherniack, 1972) = (0.09107 * (height in inches)) - (0.0232 * (age in years)) -
1.50723White females 15-79 years (Cherniack, 1972) = (0.06029 * (height in inches)) - (0.01936 * (age in years)) -
0.18693Black males 20-92 years years (Stinson, 1981) = (0.096 * (height in inches)) - (0.021 * (age in years)) - 2.51 Black females 20-92 years (Stinson, 1981) = (0.062 * (height in inches)) - (0.017 * (age in years)) - 0.951
http://www.medal.org/visitor/www%5CActive%5Cch8%5Cch8.01%5Cch8.01.01.aspx
Venti
lati
on (
L/m
in)
VO2 (ml/min kg) Max
Max
Ventilatory Adaptations to Graded Exercise
Normal
Pulmonary Impairment
THE VENTILATORY RESPONSE TO EXERCISE
COPD complications include: Weight loss
fat free mass (FFM) Osteoporosis
Further reduces exercise capacity, quality of life and survival Loss excess energy Increased energy cost of breathing Reduced tissue oxygen levels Metabolic responses that enhance
breakdown of body proteins
Identify and eliminate sources of bronchopulmonary inflammation cigarette smoking, inhaled irritants
Inhale or oral bronchodilators and corticosteroids
Establish individualized rehabilitation programs for stable patients
Rehabilitation programs generally similar to moderate physical and breathing exercises Respiratory muscle training may improve exercise
performance Cardiovascular or selective respiratory muscle
training May improve oxygen delivery and
endurance performance at submaximal exercise
Chronic home oxygen therapy for patients whose PaO2 remains below 55 mmHg (the
goal is to alleviate hypoxemia)
Smoking Exposure to pollution or other noxious
agents Genetics Age History of childhood respiratory
infections
Pay special attention to environmental conditions
Follow GENERAL FIT recommended by ACSM Walking most similar to daily living activities Minimal goals for frequency is 3-5 d/wk—
reduced function more frequent exercise training
NO CONCENSUS AS TO THE OPTIMAL INTENSITY tolerated OR 50% of Max
Start at few minutes…progress as able Pulmonary effect the lungs as well as muscles
Follow older adults guidelines Shoulder girdle exercises
Monitor for signs and symptoms Use dyspnea scale for 2-3 on 4 point scale
May exhibit arterial desaturation w/ exercise May measure blood oxygenation Oximetry
May need O2 for patients with reduced PaO2
Complete extensive pulmonary function tests prior
Only stable patients should exercise in a nonmedical setting
RXEX Suggested that patients exercise at 50% VO2 peak
Emphasize progression over intensity To exercise Must be fully be symptom free from
bronchitis Have a bronchodilating inhaler with them at all
times Perform breathing exercises to help strengthen
respiratory muscles
Avoid upper-body exercises initially because of the increased strain on the pulmonary system.
Some COPD individuals may require supplemental oxygen during exercise. Generally, supplemental oxygen is recommended for patients with a PaO2 < 55 mmHg or SaO2 < 88%, while breathing room air
COPD clients should not smoke The type and dose of medications should be reviewed with
the clients physician, based on the clients response to exercise
If a COPD clients exercise performance in a nonmedical supervised program worsens, they should be encouraged to participate in a pulmonary rehabilitation program, until signs and symptoms have improved