Angela Voraotsady Outline Definition Epidemiology Clinical Aspects Treatment Effects of Exercise Exercise Testing Exercise Prescription Summary and Conclusion References Chronic Obstructive Pulmonary Disorder ID: 671550
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Slide1
Chronic Obstructive Pulmonary Disease (COPD)
Angela
VoraotsadySlide2
Outline
Definition
Epidemiology
Clinical Aspects
Treatment
Effects of Exercise
Exercise Testing
Exercise Prescription
Summary and Conclusion
ReferencesSlide3
Chronic Obstructive Pulmonary Disorder
Chronic:
It’s long-term and doesn’t go away
Obstructive:
The flow of air from the lungs is limited
Pulmonary:
Another word for lungs and breathing
Disease:
It’s a health problem that needs to be taken seriouslySlide4
What is COPD and what causes it
A progressive condition that includes chronic bronchitis or emphysema or both.
Smoking is the primary cause of COPD.
80% of the people affected by COPD are current or former smokers.
Other risk factors are: occupational and environmental pollutants, alpha antitrypsin deficiency, allergies and asthma, poor nutrition, periodontal disease and low birth weight.Slide5
So what does that mean?
Chronic Bronchitis
Airflow is limited by narrowed airways. The narrowed airways are caused when damaged airways get tight, swollen, and filled with mucus.
Emphysema
The tiny air sacs get over-stretched and break down. When this happens old air gets trapped inside and new air cannot get in.Slide6
Epidemiology
COPD is the most prevalent chronic pulmonary disease and affects an estimated 24 million Americans.
COPD is the fourth most common cause of death in the United States and is the only cause in the top ten that continues to rise.
COPD accounts for approximately 100,000 deaths each year.
By 2020, it is estimated to be the third leading cause of death in the United States and the fifth leading cause of disability in the world.
It is most commonly found in white males over the age of 60. Slide7
Clinical Aspects
Symptoms
Cough that produces mucus, may be blood streaked
Shortness of breath aggravated by exertion or mild activity
Wheezing
Rales (small clicking, bubbling, or rattling sounds in the lung)FatigueAnkle, feet and leg edema that affects both sidesReddish cheeksReddish face, palms, or mucous membranes (such as the inside of the mouth)
Headaches
Vision abnormalitiesSlide8
Laboratory Diagnosis
Spirometry
is the best way to test for COPD. It is simple and can be interpreted immediately.
Listening to the lungs with a stethoscope can sometimes work too but sometimes the lungs sound normal even when COPD is present.
X-rays and CT scans can also be performed; but these can also look normal even if COPD is present.
Sometimes a blood test called a “blood gas” is required to measure the amounts of oxygen and carbon dioxide in the blood.Slide9
Treatment
Medical
Bronchodilators are prescribed to open the airways
Inhaled steroids to reduce lung inflammation.
In severe cases or during flare-ups steroids may be needed intravenously or by mouth.
Antibiotics can also be prescribed when a patient has an infection prevent COPD from becoming worse. Oxygen therapy may also be needed at home if the patient has low oxygen levels in their blood. Slide10
Treatments
Surgical
Removal of parts of diseased lung in patients with emphysema.
Lung transplants may be required in severe casesSlide11
Effects on Ability to Exercise
Hyperinflation
resulting from impeded exhalation, incomplete lung emptying, and air trapping.
Static hyperinflation can be caused from daily living and when exercise occurs dynamic hyperinflation can be superimposed on static hyperinflation. Dynamic hyperinflation is related to increased breathing frequency and affects the mechanical efficiency of ventilation leading to breathlessness. Slide12
Effects on Ability to Exercise
In patients with emphysema there is a impairment of gas exchange due to the destruction of the alveolar-capillary membrane. Breathing efficiency is thus worsened by an increase in VD/VT and can also cause hypoxemia during exercise.
Chronic hypoxemia can also cause
erythrocytosis
which can further complicate circulation during exercise.
Smokers will have an increase in carboxyhemoglobin, impairing the blood oxygen transport system. Other symptoms of COPD can also affect different individuals personally. Slide13
Effects of Medication on Exercise
Beta2-adrenoceptor
(
sympathomimetic
) agonist
reduce peripheral vascular resistance and can cause tachycardia, palpitations and tremulousness.Methylxanthines can cause tachycardia, cardiac dysrhythmias, and CNS stimulation with increased respiratory drive and a risk of seizures.Thiazide diuretics and loop diuretics can cause hypokalemia that can in turn cause cardiac dysrhythmias and muscle weaknessGlucocorticoids
(prednisone) can
cause skin atrophy and fragility, osteoporosis, muscle atrophy, and myopathy.
Antidepressants cause resting and exercise tachycardia.
COPD often coexists with cardiovascular diseases so the effects of medications taken for cardiovascular disease needs to be reviewed as well. Slide14
Effects of Exercise
Acute effects
Increased verbal
processing
Dynamic hyperinflation – further reduces
inspiratory capacity and smaller tidal volumeChronic effects
Cardiovascular reconditioning
Reduced
ventilatory
requirement at a given work rate
Improved
ventilatory
efficiency
Reduced hyperinflationDesensitization to dyspnea
Increased muscle strengthImproved flexibilityImproved body compositionBetter balance
Enhanced body image Slide15
Exercise Testing
Maximal testing is safe with appropriate monitoring.
The cycle ergometer is best for controlling external work rate, measuring gas exchange and blood sampling.
But patients might be more willing to perform treadmill testing.
During testing a near-linear increase in work rate should be attempted with incremental adjustments being made to speed and grade.
The goal is to be able to get between 8-12 minutes of exercise data. Slide16
Exercise Testing
Stage
Speed (km/
hr
)
Speed (mph)
Gradient
1
2.74
1.7
10
2
4.02
2.5
12
3
5.47
3.4
14
4
6.76
4.2
16
5
8.05
5.0
18
6
8.85
5.5
20
7
9.65
6.0
22
8
10.46
6.5
24
9
11.26
7.0261012.077.528
The Bruce Protocol
Equipment required: treadmill, stopwatch, pencil, paper for recording
Procedure: The treadmill is started at 1.7 mph and at an incline of 10%. At three minute intervals the incline of the treadmill increases by 2% and the speed increases as in the table to follow. Slide17
Exercise Prescription
Exercise rehabilitation should include several different professionals including respiratory therapists, physical therapists and exercise professionals, and occupational therapists.
Respiratory therapists will evaluate, teach, and ensure effective use of bronchodilator medications and oxygen therapy.
Physical therapists and exercise professionals will evaluate exercise endurance, muscle strength, flexibility and body composition along with monitoring the exercise prescription and monitoring exercise performance.
Occupational therapists will evaluate activities of daily living and quality of life so they are able to teach energy conservation and body mechanics aimed at reducing the oxygen requirement for specific activities
All therapists will teach improved breathing efficiency with methods such as pursed lips and diaphragm breathing.Slide18
Exercise Prescription
Pursed lips method
Breathe in slowly through your nose for 1 count
Purse your lips as if you were going to whistle
Breathe out gently through pursed lips for 2 slow counts (breathe out twice as
escape naturally- don't force the air out of your lungs
Keep doing pursed lip breathing until you're no longer short of breath
Diaphragm breathing
Put one hand on your upper chest, and the other on your belly just above your waist
Breathe in slowly through your nose - you should be able to feel the hand on your belly moving out. The hand on your chest shouldn't move.
Breathe out slowly through your pursed lips - you should be able to feel the hand on your belly moving in as you exhale (breathe out).Slide19
Exercise Prescription
Modes of exercise can be walking, cycling, swimming, or conditioning exercises such as tai chi. The mode should be enjoyable to the patient and directly improve ability to perform usual daily activities.
For patients with
oxyhemoglobin
desaturation of less than 88% or a documented reduction in arterial oxygen tension of less than 55 mmHg oxygen should be administered during exercise. The goal for oxygen therapy is to maintain
oxyhemoglobin saturation above 90%. Slide20
Exercise Prescription
Aerobic – large muscle activities
1-2 sessions, 3-5 days/week
30 min/sessions with an emphases of duration rather than intensity
Strength – free weights, isokinetic/isotonic machines
Low resistance, high reps 2-3 days/weekFlexibility – stretching, tai chi3 days/weekNeuromuscular – walking, balance exercises, breathing exercisesSlide21
Exercise Prescription
Often patients with COPD cannot perform 20-30 min of exercise so 5 or 10 min intervals of exercise may be necessary in the beginning.
Group interaction is helpful in the reconditioning process since an individual with COPD is at a particular risk of relapsing into a state of inactivity and physical deconditioning. Slide22
Summary
COPD is a major killer in the world.
It cannot be controlled but quality of life can be enhanced through medications and lifestyle changes.
Exercise training is a crucial aspect of clinical management and the rehabilitation of individuals suffering from COPD. Slide23
References
Cooper, C. B. (2001). Exercise in chronic pulmonary disease: limitations and rehabilitation.
Medicine & Science in Sports & Exercise
,
33
(7), S643-S646.Durstine, J. L., Moore, G. E., Painter, P. L., & Roberts, S. O. (2009). ACSM's Exercise management for Persons With Chronic Diseases and Disabilities (3 ed.). Champaign, IL: Human Kinetics.Emery, C. F., Honn
, V. J.,
Frid
, D. J.,
Lebowitz
, K. R., & Diaz, P. T. (2001). Acute Effects of Exercise on Cognition in Patients with Chronic Obstructive Pulmonary Disease .
American Journal of Respiratory and Critical Care Medicine
, 164
, 1624-1627. Retrieved February 14, 2011, from http://ajrccm.atsjournals.org/cgi/content/full/164/9/1624Expert's Guide to Better Breathing. (2006). USA:
Boehringer Ingelheim Pharmaceuticals.McArdle
, W. D.,
Katch
, F. I., &
Katch
, V. L. (2006). Optimizing Body Composition, Successful Aging, and Health-Related Exercise Benefits.
Essentials of Exercise Physiology
(3 ed., pp. 665-704).
Philiadelphia
, PA: Lippincott Williams &
Willkins
.
PubMed Health - Chronic obstructive pulmonary disease. (
n.d.
).
National Center for Biotechnology Information
. Retrieved February 16, 2011, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001153
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