Chronic Obstructive Pulmonary Disease
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Transcript Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary
Disease
By: Chantel Berenyi
2-16-12
Why I chose COPD?
o Internship at McKay-Dee Hospital
in Cardiac Rehab
o Career path
Overview
What is COPD?
Disease Prevalence
Signs & Symptoms
Diagnosis
Tests & Evaluations
Complications
Treatment
Effects on exercise
response
Effects of medications on
exercise
Effects of training
Exercise testing
Exercise prescription
Summary & conclusions
What is COPD?
COPD is defined as a chronic inflammatory disease of the lung that is
characterized by progressive and irreversible airflow limitation
There are two main forms (most have a combination):
Chronic bronchitis: involves a long-term cough with mucus
Inflammations of bronchial tubes
Irritations of cilia in bronchial-lining
Airways become clogged by debris
Heavy secretion of mucus
http://www.youtube.com/watch?v=o7mgLxupRQ&feature=related
What is COPD?
Emphysema: involves destruction of the lungs over time
Alveoli lose elasticity (flabby balloon)
Alveoli over expand to compensate, causing the to rupture
and form cysts
CO2 cannot be expelled properly with damaged alveoli
Stagnant air develops causing shortness of breath
http://www.youtube.com/watch?v=lmZZlkrSu5o
Causes of CODP
SMOKING (leading cause)
80% of individuals with COPD are
current or former smokers
Environmental factors
Secondhand smoke & pollution
Exposure to certain gases or
fumes
Frequent use of cooking fire w/o
ventilation
Lack of the protein “alpha-1
antitrypsin”
Prevalence
Projected to be the world’s third most important cause of
mortality by 2020
An estimated 24 million Americans have COPD
kills more than 120,000 Americans each year—that’s 1 death
every 4 minutes
An estimated 64 million people have COPD worldwide (2004)
More than 3 million people worldwide died of COPD in 2005
The disease now affects men and women almost equally
Total deaths from COPD are projected to increase by >30% in
the next 10 yrs
http://www.cdc.gov/copd/data.htm
Signs & Symptoms
Cough, with or without mucus
Fatigue
Weak quadriceps muscles
Low body weight
Cachexia
Many respiratory infections
Shortness of breath (dyspnea)
that gets worse with mild
activity
Trouble catching breath
Wheezing
Diagnosing COPD
Best test for COPD- spirometry (FEV1/FVC)
FEV1 (forced expiratory volume in one second) Involves the amount of
air which can be forcibly exhaled from lungs in the first second of a
forced exhalation
FVC (forced vital capacity) Involves blowing out as hard as possible after
taking the deepest breath possible into a small machine that tests lung
capacity
COPD= <.70
http://www.youtube.com/watch?v=kiQcbXK7f5c
Using a stethoscope- listen to lungs
X-ray and CT scans of lungs (but can still look normal)
Blood tests- measure amounts of oxygen and carbon dioxide in
blood
Spirometry
Treatment for COPD
No cure for COPD
Stop smoking- best way to slow down lung damage
Medications:
Inhalers (bronchodilators)
Ipratropium (Atrovent)
Tiotropium (Spiriva)
Salmeterol (Serevent)
Formoterol (Foradil)
Albuterol
Inhaled steroids- reduce lung inflammation
Anti-inflammatory medication
Montelukast (Singulair)
Roflimulast
Treatment for COPD
Severe cases or during flare-ups:
Steroids by mouth or through a vein
Bronchodilators through a nebulizer
Oxygen therapy
Assistance during breathing from a machine
Antibiotics (infections can make COPD
worse)
Treatment for COPD
May need oxygen therapy at home or constantly in
oxygen in blood is too low (< SpO₂ 80%)
Pulmonary rehabilitation
Can teach you to breath differently allowing you to stay
active
Strengthen the lungs
Help maintain muscular strength in legs
Complications
Exacerbations: increase in coughing, shortness of breath
and/or amount or color of mucus coughed up
More frequent lung infections (pneumonia)
Increased risk of osteoporosis
Depression or anxiety (reduction in independence)
Problems with loosing too much weight
Heart failure (right side of heart)
A collapsed lung
Sleep problems (not enough oxygen)
Effects on Exercise Response
Hyperinflation (crucial aspect): impeded exhalation,
incomplete lung emptying, and air trapping
When exercising: Dynamic hyperinflation is
superimposed on static hyperinflation
Reduction in inspiratory capacity
Smaller tidal volume
Increased elastic and threshold work of breathing
Dynamic hyperinflation is directly linked to
breathlessness
Effects on Exercise Response
Exercise limited by cardiovascular factors:
Deconditioned
Impaired left ventricle function (low SpO2)
Reduced pulmonary blood flow (low SpO2)
Lactic acid accumulation at low work rates (peripheral
muscle deconditioning)
Increased CO2 output (bicarbonate buffering)
Increased ventilator requirement
Effects of Walking
Study conducted on the effects of walking on COPD patients
Evaluated the cardiac and respiratory responses as well as electrical
activity of lower limb muscles during walking
6 min walk test
Walking distance & speed were significantly lower in COPD patients
However, COPD patients walked at a higher % of peak VO2
Surface EMG data taken on muscles were about same for both
Specifically the vastus lateralis & rectus femoris were more fatigued
CONCLUSIONs:
6 min walk test was performed at a relatively higher intensity in
patients with COPD compared with healthy controls
Walking cause those with COPD to be more vulnerable to muscle
fatigue
Effects of Progressive Resistance
Exercise
Review of 18 controlled trials conducted to see if resistance
training improves elements of performance of daily
activities
Found effects favoring the addition of 12 weeks of progressive
resistance training exercise to aerobic exercise for increases in
LBM
Progressive Resistance Exercise showed no effect on oxygen
uptake
Found an improvement in walking distance in field-walking tests
Found an improvement in timed stair-climbing performance
Found overall improvements in arm & leg muscle strength
Effects of Intermittent Exercise
Conducted to see the hemodynamic adaption during highintensity intermittent exercise in COPD patients
30 min exercise session, alternating a 4 min work set at first
ventilatory threshold with a 1 min set at 90% of maximal tolerated
power output
Found an increase in VO2, cardiac output & ventilation during first
minutes of exercise, but remained STABLE thereafter
Pulmonary arterial pressure increased from rest and significantly
decreased thereafter
Total pulmonary vascular resistance decreased from rest to the end of
the test
CONCLUSION:
High intensity 1 min bouts of work of intermittent work exercise are
well tolerated w/o pushing pulmonary arterial pressure too high
Effects of Medications
Beta2-adrenoceptor agonists:
Relax bronchial smooth muscle & produce bronchodilation
Methylxanthines:
Produce bronchodilation & CNS stimulation
Thiazide diuretics:
Control fluid retention
Glucocorticoids (steroids):
Reduce inflammation & improve pulmonary function
Medications
Heart rate
Blood
Pressure
ECG
Exercise
capacity
Selective Beta2adrenoceptor
agonists
(Sympathomimetic
Agent)
↑ or ⟷
(R&E)
↑, ↓, or ⟷
(R&E)
↑ or ⟷ HR (R&E)
⟷
Methylanthines
(Bronchodialators)
⟷ (R&E)
⟷ (R&E)
⟷ (R&E)
↑EC
Thiazide Diuretics
⟷ (R&E)
⟷ or ↓ (R&E) ⟷ or PVCs (R) May
cause PVCs and “false
positive” test results if
hypokalemia occurs
May cause PVCs if
hypomagnesemia
occurs (E)
⟷
Glucocorticoids
(steroids)
⟷ (R&E)
⟷ (R&E)
⟷ (R&E)
⟷
Antidepressants
↑ or ⟷
(R&E)
↓or ⟷ (R&E)
Variable (R)
Exercise Testing for COPD
Assessment of physiological function:
Cardiopulmonary capacity
Pulmonary function
Determination of arterial blood gases/ arterial O2 saturation
(direct/indirect)
Modifications:
Extended stages
Smaller increments
Slower progression
Example: Naughton Protocol- only speed not grade increases every 2
min instead of every 3 min
6 minute walk test
Popular for assessing functional exercise capacity
Walking is usually best, COPD patients usually lack muscle strength for
stationary cycling & arm ergometry may cause increased dyspnea
Effects of Exercise Training
Almost any level of physical activity can improve oxygen
utilization, work capacity and anxiety
Benefits of exercise
Cardiovascular reconditioning
Reduced ventilatory requirement at a given work rate
Improved ventilatory efficiency
Reduced hyperinflation
Desensitization to dyspnea
Increased muscle strength
Improved flexibility
Improved body composition
Better balance
Enhanced body image
Exercise Programming
Recommended mode of exercise: walking, cycling,
swimming or conditioning exercises (tai chi)
enjoyable & improves ability to perform daily activities
Oxygen administered if SpO2 < 88%
Goal is have SpO2 >90% during exercise
Modifications to duration & frequency might be necessary
5-10 min sessions vs. 20-30 min
6 week exercise program w/ group intervention is helpful
Rehabilitation exercises should be LIFELONG
COPD patients are at risk for relapsing
Conclusions
COPD is a chronic inflammatory disease of the lung
that is characterized by progressive and irreversible
airflow limitation (no cure)
COPD is usually a combination of Bronchitis &
Emphysema
An estimated 24 million Americans have COPD
Smoking is the leading cause of COPD
Best test for COPD- spirometry
Conclusions
Inhalers, steroids & anti-inflammatory medication are
used to help off set symptoms
Hyperinflation is a crucial aspect of COPD
Progressive resistance & intermittent exercise can be
beneficial
Walking may improve endurance better than cycling
6 min walk test is most popular for testing COPD patients
Numerous benefits of exercise
Rehabilitation should be a lifelong process
References
Durstine, Larry J., Moore, Geoffrey E., Painter, Partricia L., & Roberts, Scott O. (2009). ACSM’s Exercise
Management for Persons With Chronic Diseases and Disabilities. Champaign, IL: Human Kinetics.
LifeExtension (2011). Chronic Obstructive Pulmonary Disease, Emphysema and Chronic Bronchitis.
Retrieved from http://www.lef.org/protocols/respiratory/copd_01.htm
Lonsdorfer-Wolf, E., Bougault, V., Doutreleau, S., Charloux, A., Lonsdorfer, J., & Oswald-Mammosser, M.
(2004). Intermittent exercise test in chronic obstructive pulmonary disease patients: how do the
pulmonary hemodynamics adapt?. Medicine & Science In Sports & Exercise, 36(12), 2032-2039.
Marquis, N., Debigare R, Bouyer L, et. al. 2009. Physiology of walking in patients with moderate to
severe chronic obstructive pulmonary disease. Med. Sci. Sports Exerc. 41:1540-1548.
O'Shea, S., Taylor, N., & Paratz, J. (2009). Progressive resistance exercise improves muscle strength and
may improve elements of performance of daily activities for people with COPD: a systematic review.
Chest, 136(5), 1269-1283. doi:10.1378/chest.09-0029
The Credit Valley Hospital (2011). Screening for COPD. Retrieved from http://www.cvhon.ca/podcasting/video.php
Thompson, Walter R., Gordon, Neil F., & Pescatello, Linda S. (2009) ACSM’s Guidelines for Exercise
Testing and Prescription, 8th edition.
WebMD. (2011) COPD-Ongoing Concerns. Retrieved from
http://www.webmd.com/lung/copd/tc/chronic-obstructive-pulmonary-disease-copd-ongoing-concerns
World Health Organization (2011). Chronic Obstructive Pulmonary Disease (COPD). Retrieved from
http://www.who.int/mediacentre/factsheets/fs315/en/index.html
ANY QUESTIONS??