Pulmonary s11

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  • Pulmonary ventilation is breathing
  • Pulmonary s11

    1. 1. Pulmonary System and Exercise
    2. 2. <ul><li>Cough </li></ul><ul><li>Wheeze </li></ul><ul><li>Sputum </li></ul><ul><li>Shortness of Breath </li></ul><ul><li>History of exposure to smoking, pollution, etc </li></ul><ul><li>Spirometry impairment </li></ul>
    3. 3. INSPIRATION AND EXPIRATION
    4. 6. Pulmonary Diffusion
    5. 7. 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
    6. 8. <ul><li>Any disease or disorder where lung function is impaired. </li></ul><ul><li>Obstructive Lung Disease -- a narrowing or blockage of the airways  a decrease exhaled air flow </li></ul><ul><ul><li>- asthma, emphysema, and chronic bronchitis. </li></ul></ul><ul><li>Restrictive lung disease -- a loss of lung compliance / elasticity of the lungs themselves or problem expanding  decrease in the total lungs volume </li></ul><ul><ul><li>- Pneumonia, Cancer </li></ul></ul><ul><li>Vascular Defect – decrease ability lung tissue to move oxygen to blood </li></ul>
    7. 9. C hronic O bstructive P ulmonary D isease (COPD) Disease Cause Asthma Constriction airways Bronchitis secretion Excess mucus Emphysema Destruction of alveoli
    8. 10. Causes of COPD NOXIOUS AGENT (tobacco smoke, pollutants, occupational agent) Inflammation Airway inflammation Airway remodeling COPD Genetic factors Respiratory infection Other
    9. 11. Asthma <ul><li>Airway narrowing due to inflammation (bronchial hyperresponsiveness) </li></ul><ul><li> airflow obstruction “ bronchoconstriction” </li></ul>Less Constricted More constricted
    10. 12. Bronchitis <ul><li>Inflammation or thickened bronchial walls within the lungs due to secretion of fluids </li></ul><ul><ul><li>acute: infection </li></ul></ul><ul><ul><li>Chronic: +3 months to year </li></ul></ul>
    11. 13. EMPHYSEMA Loss of elasticity in the aveoli Associated with exposure to toxic chemicals & long-term exposure to tobacco smoke.
    12. 14. 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  
    13. 15. <ul><li>Reversible </li></ul><ul><ul><li>Accumulation of inflammatory cells, mucus, in bronchi </li></ul></ul><ul><ul><li>Smooth muscle contraction in airways </li></ul></ul><ul><ul><li>Increase functioning with dynamic hyperinflation during exercise </li></ul></ul><ul><li>Irreversible </li></ul><ul><ul><li>Fibrosis and narrowing of the airways </li></ul></ul><ul><ul><li>Loss of elastic recoil due to alveolar destruction </li></ul></ul><ul><ul><li>Destruction of alveolar support that maintains patency of small airways </li></ul></ul>
    14. 16. PULMONARY DISEASE <ul><li>Obstructive </li></ul><ul><ul><li> Flow </li></ul></ul><ul><li>Restrictive </li></ul><ul><ul><li> Volume </li></ul></ul>
    15. 17. PULMONARY FUNCTIONS
    16. 18. PULMONARY FUNCTIONS
    17. 19. 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
    18. 20. <ul><li>% of oxygen bound to hemoglobin </li></ul><ul><li>Measures for Hypoxia (decreased O2) </li></ul><ul><ul><li>Hypoxic – not enough supply of 02 </li></ul></ul><ul><ul><li>Anemic Hypoxia – not enough HGB </li></ul></ul>Diagnosis SaO2 Average 95-100% Normal 96 – 98 % Low <92% Dysfunction < 88 %--need supplemental O2
    19. 21. <ul><li>Men </li></ul><ul><li>VC = 0.1626*Height(inches) - 0.031*Age(years) - 5.335 
 </li></ul><ul><li>Women </li></ul><ul><li>VC = 0.1321*Height(inches) - 0.018*Age(years) - 4.360 </li></ul><ul><li>http://www.hopkinsmedicine.org/pftlab/predeqns.html </li></ul>
    20. 22. <ul><li>White males 15-79 years (Cherniack, 1972) </li></ul><ul><li>= (0.09107 * (height in inches)) - (0.0232 * (age in years)) - 1.50723 </li></ul><ul><li>White females 15-79 years (Cherniack, 1972) </li></ul><ul><li>= (0.06029 * (height in inches)) - (0.01936 * (age in years)) - 0.18693 </li></ul><ul><li>Black males 20-92 years years (Stinson, 1981) </li></ul><ul><li>= (0.096 * (height in inches)) - (0.021 * (age in years)) - 2.51  </li></ul><ul><li>Black females 20-92 years (Stinson, 1981) </li></ul><ul><li>= (0.062 * (height in inches)) - (0.017 * (age in years)) - 0.951 </li></ul><ul><li>http://www.medal.org/visitor/www%5CActive%5Cch8%5Cch8.01%5Cch8.01.01.aspx </li></ul>
    21. 23. Ventilation (L/min) VO 2 (ml/min kg) Max Max Ventilatory Adaptations to Graded Exercise Normal Pulmonary Impairment
    22. 24. THE VENTILATORY RESPONSE TO EXERCISE
    23. 25. <ul><li>COPD complications include: </li></ul><ul><ul><li>Weight loss </li></ul></ul><ul><ul><ul><li>fat free mass (FFM) </li></ul></ul></ul><ul><ul><li>Osteoporosis </li></ul></ul><ul><li>Further reduces exercise capacity, quality of life and survival </li></ul><ul><ul><li>Loss excess energy </li></ul></ul><ul><ul><li>Increased energy cost of breathing </li></ul></ul><ul><ul><li>Reduced tissue oxygen levels </li></ul></ul><ul><ul><li>Metabolic responses that enhance breakdown of body proteins </li></ul></ul>
    24. 26. <ul><li>Identify and eliminate sources of bronchopulmonary inflammation </li></ul><ul><ul><li>cigarette smoking, inhaled irritants </li></ul></ul><ul><li>Inhale or oral bronchodilators and corticosteroids </li></ul><ul><li>Establish individualized rehabilitation programs for stable patients </li></ul>
    25. 27. <ul><li>Rehabilitation programs generally similar to moderate physical and breathing exercises </li></ul><ul><ul><li>Respiratory muscle training may improve exercise performance </li></ul></ul><ul><li>Cardiovascular or selective respiratory muscle training </li></ul><ul><ul><li>May improve oxygen delivery and endurance performance at submaximal exercise </li></ul></ul><ul><li>Chronic home oxygen therapy </li></ul><ul><ul><li>for patients whose PaO 2 remains below 55 mmHg (the goal is to alleviate hypoxemia) </li></ul></ul>
    26. 28. <ul><li>Smoking </li></ul><ul><li>Exposure to pollution or other noxious agents </li></ul><ul><li>Genetics </li></ul><ul><li>Age </li></ul><ul><li>History of childhood respiratory infections </li></ul>
    27. 29. <ul><li>Pay special attention to environmental conditions </li></ul><ul><li>Follow GENERAL FIT recommended by ACSM </li></ul><ul><li>Walking most similar to daily living activities </li></ul><ul><li>Minimal goals for frequency is 3-5 d/wk— </li></ul><ul><ul><ul><li>reduced function more frequent exercise training </li></ul></ul></ul><ul><li>NO CONCENSUS AS TO THE OPTIMAL INTENSITY </li></ul><ul><ul><li>tolerated OR 50% of Max </li></ul></ul><ul><li>Start at few minutes…progress as able </li></ul><ul><li>Pulmonary effect the lungs as well as muscles </li></ul><ul><ul><li>Follow older adults guidelines </li></ul></ul><ul><ul><li>Shoulder girdle exercises </li></ul></ul>
    28. 30. <ul><li>Monitor for signs and symptoms </li></ul><ul><ul><li>Use dyspnea scale for 2-3 on 4 point scale </li></ul></ul><ul><li>May exhibit arterial desaturation w/ exercise </li></ul><ul><ul><li>May measure blood oxygenation </li></ul></ul><ul><ul><li>Oximetry </li></ul></ul><ul><li>May need O2 for patients with reduced PaO2 </li></ul>
    29. 31. <ul><li>Complete extensive pulmonary function tests prior </li></ul><ul><li>Only stable patients should exercise in a nonmedical setting </li></ul><ul><li>RXEX </li></ul><ul><ul><li>Suggested that patients exercise at 50% VO 2 peak </li></ul></ul><ul><ul><li>Emphasize progression over intensity </li></ul></ul><ul><li>To exercise Must be fully be symptom free from bronchitis </li></ul><ul><li>Have a bronchodilating inhaler with them at all times </li></ul><ul><li>Perform breathing exercises to help strengthen respiratory muscles </li></ul>
    30. 32. <ul><li>Avoid upper-body exercises initially because of the increased strain on the pulmonary system. </li></ul><ul><li>Some COPD individuals may require supplemental oxygen during exercise. Generally, supplemental oxygen is recommended for patients with a PaO 2 < 55 mmHg or SaO 2 < 88%, while breathing room air </li></ul><ul><li>COPD clients should not smoke </li></ul><ul><li>The type and dose of medications should be reviewed with the clients physician, based on the clients response to exercise </li></ul><ul><li>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 </li></ul>

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