Pulmonary Health Conditions

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Obstructive conditions

• Dec’d air flow out of lungs
• Narrowing of airway lumen
• They have room for good lung capacity, but it just wont occur
• Inc dead space
• Dec surface area for gas exchange

COPD

• Airflow limitation that is not reversible
• Usually progressive
• Typically combo of disorders:
  • Chronic bronchitis,
  • Emphysema
  • Small airway obstruction

Chronic bronchitis

• Cough and secretions for at least 3 months, 2 years in a row
• Narrowing of large and then small airways (inflammation of mucosa )
• Mucous glands hyperplasia
• Dec’d mucociliary function
  • May have infection, change in medication in hospital if already diagnosed

Emphysema

• Progressive destruction of alveolar walls and adjacent capillaries
• Decreased pulmonary elasticity (harder to breathe)
• Premature airway collapse (more at risk for lung collapse, not good gas exchange)

Asthma

• Immunologic response to allergens
• Characterized by:
  • Bronchial smooth muscle constriction
  • Mucus production (no infection)Bronchial mucosa inflammation and thickening
  • Status asthmaticus
    • Life threatening
    • Mechanical ventilation

Cystic Fibrosis

• Ultimately Lethal
• Autosomal-recessive trait

Pathophysiology

• Bronchial and bronchiolar walls become inflamed
• Gland cells hypertrophy—tenacious secretions
• Decreased mucociliary clearance
  • More mucus, very tenacious, very thick and almost brown ish!!!

Clinical Presentation

• Can be variable in presentation
• Life expectancy- ppl in 30s but we’ve gotten better w meds, so depends very variable on severity

Treatment

• Have them maintain their routine at home (ie percussion vest, then take med, etc)
• Try to help them maintain this routine
• Can do percussion with them – big help in PT

Bronchiectasis

• Permanent dilation of airways
• Destruction of elastic bronchiole walls
• Destruction of mucociliary cells
• Bronchial dilation
• Bronchial artery enlargement

Restrictive Lung Conditions

• Low lung volumes due to decreased lung compliance
• Increased work of breathing
• Treatment: chest wall stretching, expand, more mobility w lungs can be helpful

Atelectasis

Partial or total collapse of lung

• Inactivity
• Abdominal or thoracic incision pain (they don’t breathe deeply, can be at risk for collapsed lung)
• Compression of lung (accidents) (ie steering wheel comes in a collapses chest)
• Diaphragm restriction—weakness, paralysis
• Pneumonia- not breathing as deeply
• Presence of foreign body

Pneumonia

• Community acquired
• Hospital acquired
• 48 hrs of admission (if it happens within then = hospital acquired)
• Single or multiple lobes
• Unilateral or bilateral

Acute Respiratory Distress Syndrome

• ARDS
• Critical illness
• Lengthley recovery
• High mortality rate
• Prone position may be used in ICU !! good evidence that this can improve oxygenation
• People w covid – prone seemed to help w recovery

Pulmonary Embolism (PE)

• Partial or full occlusion of pulmonary vasculature due to emboli
  • 90% due to DVT
• Signs and symptoms (STOP TXT)
  • Rapid onset tachypnea,
  • Chest pain?
  • Anxiety
  • Dysrhythmia
  • Lightheadedness
  • Hypotension
  • Tachycardia

Interstitial lung disease

• Destruction of respiratory membranes in multiple lung regressions
• Inflammatory phase
• Fibrosis phase

Lung contusion

• Compression and decompression of lung tissue against chest wall
• Shearing of alveolar capillary membrane
• Microhemorrhage
• Usually below rib fxs
• Associated w PTX and flail chest
  • MVAs or Boxers

Restrictive extrapulmonary conditions

Pleural effusion

• Fluid in pleural space

Pneumothorax

Air in the pleural space

Hemothorax

Blood in pleural space

Flail chest

Double tx of 3 + adjacent ribs

Emphysema

Pus in the pleural space

Blue Bloaters vs. Pink Puffers

This is a phrase we should not call our patients anymore, but is helpful for understanding the differences between these pathologies

Blue Bloaters

• Clinical dx: daily productive cough for 3 months or more in at least 2 consectuive years
• Blue
  • Cyanotic
• Bloater
  • Overweight
  • Peripheral edema
• Rhochi
• Wheezing

Pink Puffers

• Pathologic diagnosis , permanent enlargement and destruction of airspaces distal to the terminal bronchiole
• Older and thin
• Dyspnea
• Quiet chest
• Puffer:
  • X ray - hyperinflation w flattened diaphragms