The document provides information on various pulmonary conditions including normal adult ABG values, COPD, asthma, bronchiectasis, primary ciliary dyskinesia, pulmonary tuberculosis, and their signs and symptoms, pathophysiology, predisposing factors, radiology findings, auscultation findings, potential complications, and management including medications, physiotherapy, exercise programs, and lifestyle changes. Conditions discussed include the structures affected, causes of inflammation and airway obstruction, and methods to reduce symptoms and exacerbations through airway clearance techniques and antibiotic treatment of infections.

1. CVR Conditions
Wiki/You tube: bronchoscopy/ABG
demo/CPAP/BIPAP/AUSCULTATION/Incentive
spirometry/IPPB Bird/Couch Assist/Chest Physical
Therapy/Suctioning Mobility & ICU/COPD Living/Cardiac or
pulmonary rehabilitation
Blackboard: Differences in Children

2. NORMAL VALUES - Adults
ABG’s Other
• Heart Rate 50-90
• pH 7.35-7.45
• RR 12-15 (30+ hyper)
• PaO2 10.7-13.3 kPa Av 11
• BP 120/80
• PaCO2 4.7-6.0 kPa Av 5.1
• Temp 37.2
• HCO3 – 22-26 mmol/l
• Hb Average 12-14
• Base Excess -2 - +2 • Wcc 4-11
• Sa02 > 95% • CRP < 10
If CO2 and pH go in opposite direction – • Urine 30-50mls p/h
Respiratory Problem
If PaCO2 RespACIDOSISIf PaC02 RespALKALOSIS
If HC03  Metabolic ACIDOSISIf HC03  Metabolic ALKALOSIS

3. COPD
• Bronchi and Alveoli Afffected
• Chronic inflammation - chronic bronchitis and
emphysema
• Bronchioles – destruction of
elastin/decilliation/increased numbers of
goblet cells - lining becomes irritated and
inflamed producing excess mucus that blocks
the airways.
• Alveoli – destruction of alveolar
septum, reduced transfer of O2 and
CO2, bullae, floppy airways prone to collapse
• Slow progressive disease
• THE EFFECTS OF COPD MEAN THAT LESS
OXYGEN PASSES INTO YOUR BLOOD . less gas
exchange area and reduced surface area for gas
exchange/reduced compliance of lungs?
Alveolar interdependence affected too

4. COPD
• Mechanical effects
• HYPERINFLATION
– Passive - Diaphragm is flat (due to increased size of lungs
pushing down on it)
– Dynamic- they develop hyperinflation during the dynamic
aspect of physical activity and, therefore, the problem gets
worse or develops with tasks.
– Costophrenic angle reduced
– So need use of accessory muscles – bent over/hunch over
to try and dome the diaphragm
• Other Effects:
• CorPulmonale (Enlargement of R ventricle in
response to increased resistance/High BP
• Stress incontinence
• Constipation
• Anxiety/Depression
• CAUSES
• Smoking is the major cause of COPD.
• Other factors can be occupation, gender (males
more likely), climate and childhood respiratory
conditions.
• Repeated infections

5. COPD – S&S
• -Using accessory muscles
• -Purse lip breathing (stops collapse of floppy airways)
• -Barrel chest
• -Ribs in at the bottom when breathing in (paradoxical
breathing)
• -Chronic dirty phlegm
• -Wheezing or a whistling sound when breathing
• -Feeling tired / Losing weight without trying
• Hypercapnia (Hich PaCo2 in advanced disease) use hypoxic
drive to trigger breathing

6. COPD- Complications/Treatment
TREATMENT
• Quit smoking – advice on smoking cessation
• Adopt a healthy lifestyle to prevent infections
Medications-
• Bronchodilators (inhaler) treat SOB
• corticosteroid pills prevent and treat COPD flare ups
• antibitotics treat infections that cause flare ups
• flu and pneumonia vaccines
• supplemental oxygen

7. COPD- Physio
• PHYSIOTHERAPY
• -Pulmonary rehabilitation therapy
• Postural/gravity assisted position
• -Exercise is very important to help stay
fitter for longer and improve
breathlessness
• -Diaphragmatic breathing
• -Active cycle of breathing
• -Controlled coughing to get rid of mucus
and prevent infections
• -Percussion techniques
• Long term O2
• EXACERBATION – clear secretions and
reduce WOB. Non – invasive ventilation
• BIPAP
• Bear in mind what their NORMAL o2 sat is
(some use low O2 sats to trigger breathing)
• MRC Dysponea scale

8. Primary CiliaryDyskinesia (PCD)
• Primary Sructures affected: Cilia
• Pathological process: uncoordinated
ciliary beat leads to excess secretions.
Inability to remove mucous
• Clinical S&S:Recurrent infections of
ears/sinuses and lungs. In children-
perpetual runny nose/glue ear/chest
infections
• Potential Problems: Increased mucous
• Radiology: N/A
• Auscultation: Crackles due to excess
mucous?
• Predisposing Factors/Causes: Inherited
condition
• Management: Not a progressive disorder.
Antibiotics and physio needed to delay onset of
bronchiectasis.
• Chest Physical Therapy to aid mucous removal
• Cough Assist?????

9. Bronchiectasis
• Primary Sructures affected: chronic
irreversible distortion/dilation of bronchi
• Pathological process: Chronic inflammation
damages elastic/muscular components of
airways. Warm environment of lungs +
excess mucus-infection-inflammation
obstruction viscous circle. Cilia are damaged.
Progressive destruction occurs. Advanced
disease= pulmonary heart disease
• Clinical S&S: Large quantities sputum.
Mucosal ulceration can cause haemoptysis.
Finger clubbing. Dyspnoea (SOB)
• Potential Problems: Fatigue. Loss appetite.
• Radiology: ??
• Auscultation: Secretions and collapsing
airways on expiration cause coarse wheezes
and crackles
• Predisposing Factors/Causes: severe
respiratory infection/foreign body inhalation/ • Management: Antibiotics for infections. Inhaled
CF/TB/smoke inhalation/primary steroids for inflammation and reduction of
ciliarydyskinesia sputum.
• Reduces mucus clearance by 15% - patients
need education in sputum clearance.
• Postural drainage in severe cases
• Hydration.ACB.Exercise Programme – lifelong
programme required!

10. Pulmonary Tuberculosis (TB)
• Primary Sructures affected: Lungs
• Pathological process: bacterial infection
from TB bacillus.
• Clinical S&S: Fever/Night
Sweats/Cough/Chest wall pain/Weight
Loss/Haemoptysis and SOB, fatigue
• Potential Problems: Tissue destruction and
necrosis are balanced by healing and
fibrosis.Affected tissue is replaced by
scarring and cavities filled with cheese-like
white necrotic material. During active
disease, some of these cavities are joined to
the air passages bronchi and this material
can be coughed up. It contains living bacteria
and can therefore pass on infection.
Treatment with appropriate antibiotics kills
bacteria and allows healing to take place.
Upon cure, affected areas are eventually
replaced by scar tissue.
• Radiology:
• Auscultation:
• Predisposing Factors/Causes: 1/3 of • Management: Antibiotics for up to 6 months –
population is infected with TB, which can very resilient
become active if the hosts defence
mechanisms are compromised due to poor • Devise exercise regimes within isolations rooms
living/drug dependency/HIV. Diabetes.Low • Air – filtered mask to be worn at all times!!
Weight

11. Asthma
• Asthma is a long-term condition
• Bronchioles are affected in asthma
• Chronic inflammatory with airway narrowing
and mucus plugging
• Pathological process:
• an asthma trigger stimulates excess
immunoglobulin E (IgE) in serum. This fixes to
Mast cells which then react to antigens and
release bronchorestrictor substances-
histamine
• the muscles around bronchioles tighten
airways become narrower and the lining of the
airways becomes inflamed and starts to swell.
• air flow can further be decreased by
inflammation or excess mucus secretion
• PERSISTENT INFLAMMATION leads to fibrosis
of airway walls and irreversibility
• Common triggers include house dust
mitesanimal fur, pollen, tobacco
smoke, exercise, cold air and chest infections.

12. Asthma – S& S
• Clinical S&S: :
• SOB
• Tightening of the chest
• Wheezing which can make a whistling sound when you breathe.
• Coughing
• Features of acute asthma:
• PaO2 ↓ RR >25 PaCO2 ↓ Pulse>110 BP↑
• DIAGNOSIS
• The spirometer takes two measurements: the volume of air you can breathe out in
one second (called the forced expiratory volume in one second or FEV1) and the
total amount of air you breathe out (called the forced vital capacity or FVC). This
can be done by the GP.
• Predisposing Factors/Causes: A family history, Prolonged exposure to tabacco
smoke as a child, Food allergy, Bronchiolitis as a child, Prem baby, Anxiety

13. Asthma - Management
Management: . Asthma can be well controlled in most
people most of the time.
• Inhalers
• Inhaling a drug is an effective way of taking an asthma
medicine as it goes straight to the lungs, with very little
ending up elsewhere in the body. The drug used is
Salbutomol – widens airways
• Steroids are also used but these can have side effects in
the long term.
• PHYSIOTHERAPY MANAGEMENT
• Breathing techniques can be used to help the patient to
relax and feel in control - simple gentle abdominal
breathing is used.
• Exercise can help if aerobic training is used.

14. Asthma

15. Cystic Fibrosis

16. Cystic Fibrosis
• Primary Structures affected:
• It is a chronic progressive obstructive disorder affecting
the exocrine glands. It is an inherited disease. Cystic
Fibrosis affects the internal organs, especially the lungs
and digestive system, by clogging them with thick sticky
mucus. This makes it hard to breathe and digest food.
• Pathological process: CF is caused by a mutation in the
gene for required to regulate the components of
sweat, digestive juices, and mucus.

17. Cystic Fibrosis- S&S
• Clinical S&S: Symptoms of CF can include a
troublesome cough, repeated chest
infections, prolonged diarrhoea and poor weight
gain. These symptoms are not unique to Cystic
Fibrosis – difficult diagnosis
• CF affects the pancreas, which makes it difficult for
people with CF to digest food. This can cause
malnutrition, which can lead to poor growth, physical
weakness and delayed puberty.

18. Cystic Fibrosis- Physio
• Predisposing Factors/Causes: Genetic
• Management:
• Chest physiotherapy is important
because helps to prevent the
thick, sticky lung secretions from
blocking the air tubes. This helps to
reduce infection and prevent lung
damage.
• ACTIVE CYCLE OF BREATHING
• POSITIVE EXPIRATORY PRESSURE
• OSCILLATING POSITIVE EXPIRATORY
PRESSURE e.g. acapella, flutter.
• Teach family how to do percussions
etc
• The patient needs to do exercise to
keep the lungs from deteriorating
and to improve physical strength and
bullk.
• Stretching exercises and being taught
correct posture can help.

19. Acute Renal Failure
• Primary Sructures affected: rapid loss of kidney function

20. Acute Renal Failure

21. Acute Renal Failure
• S&S: Puffy ankles as kidneys not removing proteins so BCOP goes
up – more fluid pushed into interstitial fluid space?? Also fluid
retention causes oedema
• Potential Problems: metabolic acidosis ( Kidneys retaining acid),
high potassium levels, uremia, changes in body fluid balance, and
effects to other organ systems.
• Management: hinges on identification and treatment of the
underlying cause. In addition to treatment of the underlying
disorder, management of AKI routinely includes the avoidance of
substances that are toxic to the kidneys, called nephrotoxins. These
include NSAIDs such as ibuprofen, iodinated contrasts such as those
used for CT scans, and others.Monitoring of renal function, by serial
serum creatinine measurements and monitoring of urine output, is
routinely performed. In the hospital, insertion of a urinary catheter
helps monitor urine output and relieves possible bladder outlet
obstruction, such as with an enlarged prostate.

22. Diabetes
• Primary Sructures
affected:
• Pathological process:
• Clinical S&S
• Potential Problems
• Radiology
• Auscultation
• Predisposing
Factors/Causes
• Management

23. Pulmonary Fibrosis/ idiopathic pulmonary fibrosis
Primary structures effected: In severe cases, symptoms can be
Lung tissue significantly worse and may include
Pathological progress: congestive heart failure, respiratory
failure, and strokes
is caused by repeated injury to small
areas of lung. Results in
inflammation of lungs causing
scarring and stiffness.
Clinical signs and symptoms:
Thickened lung tissues cause
decreased oxygen uptake from
blood, brain and other organs don’t
get enough oxygen.
SOB, clubbing of nails, shallow
breathing . Aching muscles and
joints, decreased exercise tolerance
Potential problems :decreased o2 to
the brain, chronic dry cough.

25. Radiograpy: Management:
• 10% of patients with IPF have normal • Allergen avoidance.
chest x-rays. X-ray usually reveals • At present for IPF, there is no treatment
shadows, mostly in the lower part of available which has been shown to
the lungs. In addition, lung size tends improve the condition.
to appear smaller than normal. • Counselling may be required in view of the
Auscultation: may present with poor prognosis.
crackles heard late in inspiration. • Supportive therapy may be helpful in the
form of oxygen therapy and physiotherapy
Predisposing factors/Causes: if bronchiectasisis present.
No common cause known, can be a • Patients should be encouraged to take
regular exercise to maintain their exercise
side effect of
tolerance.
medication, expositor to
• Patients should be encouraged to be
pollution, smoking, viral vaccinated against influenza and
infections. • Lung transplant is the only option which
improves long-term survival.3
• (patient.uk)

26. • The pulmonary fibrosis organisation suggests:
• Pulmonary rehabilitation :exercise training;
breathing exercises and retraining;
anxiety, stress and depression management;
and nutritional counseling, to name a few.

27. Pneumonia
Primary Sructures affected:
lung tissue
Pathological process:
• infection of one or both lungs which is usually caused by
bacteria, viruses, or fungi. contracted by breathing in small droplets that
contain the organisms that can cause pneumonia. Normally immune
system would suppress virus. if a person is in a weakened condition from
another illness, a severe pneumonia can develop.
• Alveoli fill with fluid
Clinical S&S:
• symptoms of cold, high fever, shaking, discolored sputum
production, sharp chest pain, skin color may change due to deoxygenating
Potential Problems:
• ifthe spongy tissue of the lungs that contain the air sacs is more
involved., oxygenation can be impaired, along with stiffening of the
lung, which results in SOB. if low immune response pneumonia may be life
threatening.

28. A)Normal chest, B) pneumonia
• Radiology:
• Auscultation: finecrackles,
sometimes pleural rub.
• Predisposing
Factors/Causes: very young,
very old, if immune system
is weakened by any
predisposing factors like
long term illness
• Management: oral or
intervenous fluids

29. • Antiviral/antibacterial drugs
• Oxygen if indicated
• In acute stage physio is limited to positioning to much Va/Q
and CPAP if hypoxemia persists despite 40% oxygen.
• Modified postural drainage - this allows gravity to drain
secretions from specific segments of the lungs
• IPPB Machine
• Shaking and vibes - to mobilize secretions
• Coughing and huffing exercises - to expectorate secretions
• Administer humidification - to mobilize secretions
• Breathing exercises - Localized and Diaphragmatic
• IPPB administration - to increase lung volumes
• Mobilization of the patient - done to increase air entry,
increase chest expansion, and to loosen secretions

30. Pneumothorax
Primary Sructures affected: pleural cavity
between lung and chest wall
Pathological process: may occur spontaneously
(primary) or in people with lung conditions
(secondary). If either pleural layer is ruptured
gas rushes into the pleural space either from
inside the lung or from outside. the tear
often occurs at the site of a tiny 'bullae' on
the edge of a lung
• Clinical S&S:
• The typical symptom is a sharp, stabbing pain
on one side of the chest which suddenly
develops.
• The pain is usually made worse by breathing
in (inspiration).
• Pt may become breathless. As a rule, the
larger the pneumothorax, the more
breathless .
• Pt may have other symptoms if an injury or a
lung disease is the cause. For example, cough
or fever.

31. Potential Problems:
breathlessness, collapsed lung
Radiology:
Auscultation: decreased or absent
breath sounds
Predisposing Factors/Causes: may
occur spontaneously in
healthy fit people(primary) or
in people with lung conditions
(secondary)
Management:
• small pneumothorax is left to
heal
• Larger pneumothorax can be
treated with a ‘Heimlich valve’
which allows air to escape but
not to re-enter.

32. • Chest drains may be used
• Physio is based on education in chest drain management
• Positioning: lying on good side often most comfortable and
best for VA/Q , lying of affected side my speed absorbition of
air.
• Precautions include avoidance of positive pressure
techniques.

33. Pleural Effusion
Primary Sructures affected:
Pleural space
Pathological process: excess
fluid in pleural cavity
caused by disturbed
osmotic or hydrostatic
pressure in plasma or
changes in membrane
permeability.
Clinical S&S: dull percussion
note, SOB, sometimes
chest pain

34. Potential Problems: those of
underlying illness, decrease
lung function
Radiology: ?fluide line tracking up
the pleura laterally?
Auscultation: decreassed breath
sounds, bronchial breathing
Predisposing Factors/Causes:
malignancy causes 25% of
pleural effusion other causes
are heart, kidney, or liver
failure, abdominal or cardiac
surgery, pneumonia or TB
Management:
On large effusions, drainage of
chest wall.
Smaller effusions may just left
under observation.

35. • Deep breathing exercises can not expand the
lungs under pressure of fluid.
• People with moderate unilateral effusion may
benefit from side-lying affected side upmost
as both ventilation and perfusion are greater
in lower lung.
• Large effusions are likely to show improved
PaC2 with effusion downwards to minimize
compression of unaffected lung.

36. Pulmonary Embolus
Primary Sructures affected: blood vessels in the
lung
Pathological process: blockage of an artery in the
lungs by fat, air, a blood clot
Clinical S&S:include unexplained shortness of
breath, problems breathing, chest
pain, coughing, or coughing up blood. An
arrhythmia (an irregular heartbeat) also may
indicate PE. In some cases, the only signs and
symptoms are related to deep vein
thrombosis (DVT). These include swelling of
the leg or along the vein in the leg, pain or
tenderness in the leg,
• Potential Problems: Severe breathlessness.
• Feeling faint, feeling unwell, or a collapse.
This is because a large blood clot interferes
with the heart and blood circulation, causing
the blood pressure to drop dramatically.
• Rarely, in extreme cases, a massive PE can
cause cardiac arrest, where the heart stops
pumping due to the clot. This can result in
death, even if resuscitation is attempted

37. Radiology:?
Auscultation: decrease in breath sounds
Predisposing Factors/Causes:
• most commonly deep vain thrombosis, blood clot breaks off and travels
to the lung.
• Other causes : Fatty material from the marrow of a broken bone (if a
large, long bone is broken - such as the femur (thigh bone).
• Foreign material from an impure injection. For example, with drug
misuse.
• A small piece of tumour (cancer) that has broken off from a larger tumour
in the body.
Management:
• Anticoagulant treatment.
• Oxygen given in the early stages to help with breathlessness and low
oxygen levels.
Hough ( p. 114, 2001) ‘..any active physiotherapy is considered risky until
anticoagulation therapy is established.’

38. CCF/LVF/RVF
• CCF • LVF • RVF
• Both left and right • Usually caused • Can be caused
heart failure with
congestions in by coronary by LVF or
pulmonary and heart disease – Chronic
systemic failing LV forces pulmonary
circulation up pressure in hypertension
• Pulmonary left atrim and caused by
Oedema pulmonary hypoxic
(extravascular
water in lungs) vasculature = conditions
caused by back pulmonary (pulmonary
pressure from oedema vasculature
failing Left side constrict if 02
• Pitting Oedema
reduced)

39. Smoking
• Primary Sructuresaffected:Lungs!
• Pathological process: inflammation/damage to
cilia/surfactant/Alveoli /Smooth muscle hypertrophy
• Increase in secretions but decreased ability of
mucocilliary escalator
• Alveolar gas exchange decreased/ V/Q Matching
• Fibrotic changes from ongoing inflammation
• Increase in IgE and IgM – markers of increased sensitivity
• Immune responses decreased – more infections
• LUNG CLOSING VOLUMES INCREASED – more airway
collapse will result
• Narrowing/Clogging of arteries/atherosclerosis/increase
cholesterol/stiffening arteries

40. Peripheral Vascular Disease
• Chain of events leading to • Risk factors:
amputation: • smoking- roughening
– Obstruction/resistance/sta means lipids stick more
sis of blood – CLOT easily
– Pain
• BP- stress on
– Skin Breakdown
vessels/perpetuates
– Infection atherosclerosis
– Amputation
• Diabetes-glucose causes
vessel damage/ Plasma
viscosity
increases/diabetic
neuropathy – can’t feel -
infections

41. Peripheral Vascular Disease
• Thrombus – occludes • Buerger’s disease –
vessel reducing blood vessels become
flow= ischaemia inflamed/ clots
• Vessel wall form/lumen
changes/blood flow obstructed/fibrous
stasis/changes in blood tissue forms
composition

42. Ischaemia
• Pain • INVESTIGATIONS
• Altered sensation – Dopler
• Loss of peripheral – Pulses
pulses
• Decreased muscular
strength
• Necrosis
• Intermittent
Claudication

43. Atherosclerosis
Primary Sructures affected: medium and large
arteries
Pathological process: become clogged up by
fatty substances, such as cholesterol. These
substances are called plaques or
atheromas.
Clinical S&S
• Atherosclerosis does not usually produce
any symptoms until your blood circulation
becomes restricted, or blocked, leading to
the onset of cardiovascular disease (CVD).
The type of CVD and its associated
symptoms will depend on where the
blockage occurs.

44. Atherosclerosis
Potential Problems:
• peripheral arterial disease: where the blood supply to your legs is blocked, causing
muscle pain (intermittent caludication?)
• coronary heart disease: where the main arteries that supply your heart (the
coronary arteries) become clogged up with plaques
• stroke: a very serious condition where the blood supply to your brain is interrupted
• heart attack: a very serious condition where the blood supply to your heart is
blocked
• Angina
• Aneurysm
Predisposing Factors/Causes:High fat diet/cholesterol/High Blood
Pressure/Smoking/Diabetes/no exercise/Alcohol/family history
Management: Medication for BP/cholesterol. Lifestyle changes/Diet/Smoking
cessation/Alcohol

45. Arteriosclerosis and atherosclerosis
Arteriosclerosis and atherosclerosis are two terms that are
sometimes used interchangeably. However, they are different.
Arteriosclerosis is a general term that describes any group of
diseases where there is a thickening, and a loss of elasticity, of
the walls of the arteries it is degenerative
Diabetes is a major factor leading to to it arteriosclerosis

46. Diaphragmatic Breathing
This deep breathing is marked
by expansion of the abdomen
rather than the chest when
breathing. It is generally
considered a healthier and
fuller way to ingest oxygen

47. ABGS
• Low 02 - -Hypoxemia (poor gas exchange)
• Co2 –
– High Hypercapnia (not breathing enough/poor gas
exchange – become acidotic)
– Low Hypocapnia (breathing too fast/a lot and blowing it
off)