Pulmonary Rehabilitation - 12. Lesson PDF

PULMONARY REHABILITATION MSc. PT. Asya ALBAYRAK OBSTRUCTIVE PULMONARY DISEASES Chronic Obstructive Pulmonary Disease (COPD) Asthma Bronchiectasis Cyctic Fibrosis CHRONIC OBSTRUCTIVE PULMONARY DISEASE  CHRONIC...

PULMONARY REHABILITATION MSc. PT. Asya ALBAYRAK OBSTRUCTIVE PULMONARY DISEASES Chronic Obstructive Pulmonary Disease (COPD) Asthma Bronchiectasis Cyctic Fibrosis CHRONIC OBSTRUCTIVE PULMONARY DISEASE  CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) According to the COPD GOLD 2018 report: It is a common, preventable, and treatable disease characterized by persistent airflow limitation and respiratory symptoms, typically caused by significant exposure to harmful particles or gases leading to airway and/or alveolar abnormalities.  CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Typically progressive and not fully reversible airway limitation. Pathological changes: Central airways Peripheral airways Lung parenchym Pulmonary vascular system  CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Lung involvement is characterized by progressive airway obstruction. Extrapulmonary involvement findings affect the severity and prognosis of the disease. It progresses with exacerbations of increasing severity and frequency. COPD is one of the leading causes of mortality and morbidity worldwide, and its prevalence is increasing every day. The widespread use of cigarettes and other tobacco products, rising indoor and outdoor air pollution, population aging, and urbanization are among the reasons for this trend.  TYPES OF COPD Emphysema Small Airway Disease Chronic Bronchitis  PATHOPHYSIOLOGY OF COPD Lung Function Disorder Airway Clearance Airway Obstruction Dysfunction Gas Exchange Hyperinflation Abnormalities  RISK FACTORS FOR COPD Personal Factors: Environmental Factors: Alpha-1 antitrypsin deficiency Active – passive smoking Genetic factors Occupational factors Familial characteristics Air pollution – indoor/outdoor Ethnic factors Socioeconomic factors Age Nutritional disorders Bronchial hyperreactivity Infections Atopy Low birth weight  FACTORS THAT SHORTEN LIFE EXPECTANCY IN COPD Continuing to smoke Advanced age FEV1 < 50% Rapid decline in FEV1 Reduced response to bronchodilators Hypoxemia Cor pulmonale (Right heart failure)  PATHOLOGICAL CONDITIONS OCCURRING IN THE LARGE AIRWAYS The excessive mucus secretion, which is a key feature of chronic bronchitis, results from the involvement of the large airways. Exposure to smoke and other irritants leads to an increase in the number and size of submucosal glands, as well as an increase in the number of mucus-secreting goblet cells in the surface epithelium.  PATHOLOGICAL CONDITIONS OCCURRING IN THE PERIPHERAL AIRWAYS Mucous plugs Goblet cell metaplasia Infl ammation in the airway wall Peribronchial fi brosis Smooth muscle hypertrophy  PATHOLOGICAL CONDITIONS OCCURRING IN THE BOTH LARGER AND SMALLER AIRWAYS These changes cause thickening of the airway wall, leading to narrowing of the lumen and contributing to the development of airway obstruction. Inflammation in the airway wall causes damage to the surrounding alveolar walls, resulting in reduced alveolar attachment and leading to airway deformation.  SYMPTOMS OF COPD The main complaints of COPD: cough, sputum production, dyspnea, and wheezing. Patients typically begin to feel dyspnea during mild exercise when their FEV1 values drop to 50% of the expected level. One of the most important reasons that bring patients to a doctor is the acute exacerbations that occur during the course of the disease. Patients often have a chronic cough, which is frequently productive and tends to worsen in the mornings.  DSYPNEA Patients experience dyspnea, which initially occurs during intense exertion and later during daily activities. This exertional shortness of breath usually becomes more pronounced after the age of 50. At this stage, patients typically have functional impairment consistent with moderate to severe airflow obstruction.  RESPIRATORY SYMPTOMS Wheezing is observed in COPD. As the disease progresses, acute exacerbations become more frequent. In the advanced stages, cyanosis develops as a result of hypoxemia. With worsening hypoxemia, hypercapnia also occurs. Morning headaches should suggest hypercapnia. Right heart failure and edema also develop in hypoxemic and hypercapnic patients.  PHYSICAL SYMPTOMS In the advanced stages of COPD, anorexia and weight loss are observed. Weight loss not only leads to further deterioration of lung function, but worsening lung function can also cause weight loss. In some patients, obesity exacerbates dyspnea. Sleep-related symptoms, such as daytime sleeping and excessive snoring at night, should especially raise suspicion of obstructive sleep apnea syndrome in obese patients.  ASSESSMENT The gold standard for diagnosing COPD is the Pulmonary Function Test (PFT). It is used in diagnosing the disease, determining the severity of the disease, assessing its course and prognosis, and monitoring the response to treatment. In COPD patients, Functional Residual Capacity (FRC) is reduced, while Residual Volume (RV) is characteristically increased.  ASSESSMENT COPD severity based on the degree of airflow limitation: Mild FEV1≥% 80 Moderate % 50≤FEV1