The trachea begins immediately below the larynx (voice box) and runs down the center of the front part of the neck and ends behind the upper part of the sternum.
FEV1 is the maximal amount of air you can forcefully exhale in one second. It is then converted to a percentage of normal. For example, your FEV1 may be 80% of predicted based on your height, weight, and race. FEV1 is a marker for the degree of obstruction with your asthma:FEV1 greater 80% of predicted= normal FEV1 60% to 79% of predicted = Mild obstruction FEV1 40% to 59% of predicted = Moderate obstruction FEV1 less than 40% of predicted = Severe obstruction
Other Tests A chest x ray or chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need oxygen therapy.
Shortness of Breath
during Exert i on
Present by : Heba althuwaini
Group no: 5
• What is breathlessness ?
• Shortness of breath during exercise
• What do the result of the physical examination pointed to?
• What do the abbreviation of the result of the pulmonary
function test stand for?
• What do the changes in static and dynamic lung volume
• What would explain the change in sao2?
• How can the man’s shortness of breath be explained?
• Which condition is the most probable cause?
• Why is expiration extended?
Case Signs & Symptoms
Looks pale, feels as his
temperature is raised.
Productive cough with
Shortness of breath
due to effort.
while sitting still.
• Is unpleasant sensation of uncomfortable, rapid or difficult
• The medical term is dyspnoea.
• It may come on suddenly (acute) or gradually over a period of time
• Dyspnea at rest indicate cardiac , pulmonary disease or other
cortex So the
not Shortness of breath ventilation to
normall during exercise
stimulat are air oxygenrich
e RC getting offand to
• Coughing : is the body's way of removing foreign material
or mucus from the lungs and upper airway passages or of
reacting to an irritated airway.
• Productive cough:
Is a cough that produces phlegm or mucus (sputum)
• Green sputum is indicative of a long-standing, possibly
The physical examination
What the result pointed to ?!
Rate of blood pressure
• Normal blood pressure = 120/80 mmHg
• 132/78 mmHg = prehypertension
• Normal resting heart rate for adult = 60-100 per minute
94 per min = Normal
• broad chest describes a rounded, bulging, almost barrel-like
appearance of the chest.
• It indicates a reduced pulmonary elastic recoil ( increase the
compliance) = sign of obstructive lung disease
• occurs as a result of long-term overinflation of the lungs.
•Because the lungs are overinflated with air,
the rib cage stays partially expanded, giving
the characteristic appearance of a barrel chest .
Position of Trachea
Normal position of trachea indicate there is no tracheal Deviation
• Wheezing is defined as a high-pitched whistling sound that
occurs with breathing.
• Wheezing can occur both with breathing in (inspiratory
wheezing) and with breathing out (expiratory wheezing.
• Wheezing indicates difficulty breathing, often caused by
constricted airway (excess mucus or inflammation).
• Extended expiration is a longer exhaling due to the increased
• It indicates an airway obstruction.
sound entire lung
This might be due to a reduction in the generation of sounds due to
poor transmission of sounds due to destruction of parenchyma.
increase in the rate of respiration
•A normal average resting respiratory rates by age are:
• Adults: 12-20 breaths per minute
•An increase in the rate of respiration )hyperventilation( is
called tachypnea in the medical term.
•Tachypnea is common in people who have emphysema, either
because they are not getting enough oxygen or they are trying to
"blow off" excess carbon dioxide .
•Tachypnea is commonly associated with dypsnea
• Oxygen saturation is a term referring to the concentration
of oxygen in the blood.
Normal arterial oxygen saturation = 95-100%.
Sao2= 91 %
What the result pointed to ?!
pulmonary function test
• forced vital capacity
Decreased FVC and
• Forced expiratory
volume in one second
Increased TCL, FRC
• The ratio of forced
expiratory volume in
one second to forced
• Total lung capacity
• functional residual
• residual volume
• the result show:
What do changes in static & dynamic lung
volumes indicate ?!
Functional Vital Capacity (IC).
Capacity (FVC). The of air
maximum volume Reserve
Inspiratory of air
that can be inspired from
that can be forcefully
end expiratory position. IC
expelledMaximum lungs of
= TV+IRVthe amountLung
following a maximal that can be
additional air Capacity (TLC). The
inspiration. VC = the end of a
inspired from volume of air contained
Tidal Volume (TV).
normal inspiration. lungs at the end
Expiratory Reserve amount of gas
of a maximal
Volume (ERV). inspired or expired
inspiration. TLC =
The maximum with each breath.
volume of additional Functional Residual
air that can be
Capacity (FRC). The
expired from the
volume of air remaining
The volume of air
end of a normal
in the lung at the end of
remaining in the
a normal expiration.
lung after a
FRC = RV+ERV
Static & Dynamic lung volumes
Static lung volumes :
Lung volumes that are not affected by the rate of air movement in
and out of the lungs
Dynamic lung volumes :
Lung volumes that depend upon the rate at which air flows out of the
lungs ( expressed in ml/min)
• In healthy lungs, dynamic and static volume are about equal
• “a consistent change in the level of compliance often indicates the
presence of a disease state.”
•Static lung volumes
All volumes and capacities except FVC and related volumes and
Indicates over expansion and failing to recoil like in obstructive
indicates collapse in the lung and failing to expand like in restrictive
• Dynamic lung volumes
•FVC , FEV 1 - FEV1/FVC
Obstructive Lung Disease
• Chronic obstructive pulmonary disease (COPD) refers to a
group of lung diseases that block airflow and make
In the patient with COPD, there will be obstruction of the
airways makes it especially difficult to expire,
Thus, causing entrapment of air in the alveoli and
This causes marked destruction of as much as 50 to 80%
of the alveolar wall.
change in the sao2
Therefore, the marked loss of alveolar greatly decrease the
diffusing capacity of the lung, which reduces the ability of the lung
to oxygenate the blood and remove carbon dioxide from the blood.
The most common irritant that causes
COPD is cigarette smoke.
Breathing in secondhand smoke
Chemical fumes or dust
• Productive cough
Shortness of breath, especially with physical activity
• Prolonged period of exhalation ( extended expiration)
Lung Function Tests:
The machine measures how much air you breathe out.
Spirometry is a painless study of air volume and flow
rate within the lungs.
• A chest x ray or chest CT scan.
• Pulse oximetry
• Measuring and monitoring a patient's O2 saturation.
•Quit Smoking and Avoid Lung Irritants
Quitting smoking is the most important step you can take to treat
Bronchodilators relax the muscles around your airways. This helps open
your airways and makes breathing easier.
If you have severe COPD and low levels of oxygen in your blood, oxygen
therapy can help you breathe better
Corticosteroid drugs inhaled as aerosol sprays may help relieve
shortness of breath.
Guyton and Hall Textbook of Medical Physiology