Student%20Lecture%2026%20%28COPD%29 - Lecture 26 COPD COPD...

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Unformatted text preview: Lecture 26 COPD COPD Tuesday 4­20­10 Announcements Outline Outline – Proof of completion of online course evaluation (Began 4­19­10). Due 5­7­10. – Proof of attending a Purdue Sporting event (ticket stub and picture) plus ½ page summary of applying concept learned in HK368 to what you observed. Due 5­7­10. – Ultrasound practice subject. Contact: [email protected] Monday and Friday – 8:30am to 12:30pm Tuesday and Thursday – 9:30am Wednesday – 8:30am to 11:30am Quiz Demonstration Lecture – COPD – Review Session 5/4, 7pm­9pm, Civil 2102 COPD COPD COPD Comprised of several respiratory tract diseases – – Chronic Bronchitis – Chronic Obstructive Pulmonary Disease Technically not part of COPD classification but people that have asthma may develop COPD over time. COPD General Statistics COPD 11.4 million Americans have COPD – Emphysema 3.6 million – Chronic Bronchitis 9.0 million Approximately 120,000 deaths a year 4th leading cause of death in the United States. COPD Distribution COPD – Whites 44 per 1000 – African Americans 36.4 per 1000 – Hispanics 25 per 1000 – Asians no data – Pacific Islanders no data – Native Americans no data What are the causes of COPD? What Causes of COPD Causes Primary Secondary Deficiency in α1­antitrypsin (less than 1% of COPD) Emphysema Emphysema Pathophysiology Leads to airway collapse during expiration Pursed­lip breathing, increases resistance to outflow of air and prevents airway collapse by increasing airway pressure. Leads to increased total lung capacity (TLC) Leads to decrease in diffusion of oxygen Cigarette Smoking and Emphysema Emphysema Smoking initiates inflammatory cell migration into lung tissue (macrophages and neutrophils) Release enzymes that digest proteins (proteases) α1­antitrypsin, an antiprotease enzyme, is reduced with smoking Elastase is free to breakdown elastin in lung with decrease in α1­antitrypsin. Porth – Elastase “Pink Puffer” Relatively normal blood gas levels maintained through . Overventilation and trapped air due to airway collapse leads to changes in physical features. – – Pink ­ skin color – Puffer – puffed out chest McArdle, Katch and Katch Chronic Bronchitis Chronic Pathophysiology – for several years – – Secretion of mucus in small bronchi and bronchioles – Goblet cells Hypertrophy of submucosal glands Why is there an excessive secretion of mucus with chronic bronchitis? mucus Smoking, dusts and air pollution can stimulate the secretion of mucus. “Blue Bloater” Obstructed airways lead to mismatch of Overventilation is not effective. Development of hypoxemia and cyanosis. – Leads to pulmonary hypertension and right side heart failure. – Blue – skin color – Bloater – peripheral edema McArdle, Katch and Katch COPD and Lung Volumes COPD Increase in Increase in Increase in the Figure 10.9 Diagnosing COPD Diagnosing Decreased Decreased Figure 10.10 What are the reasons for exercise intolerance in patients with COPD? patients Ventilation Ventilation ↑ ↑ ↑ (due to ↑ frequency) ↑,=,or ↓ arterial oxygen concentration ↑ Recruitment of accessory muscles – Abdominal – Internal intercostals Cardiovascular Cardiovascular ↑ results from a destruction of vascular beds. ↑ Pulmonary BP ↓ Stroke volume and right ventricle ejection fraction. Right ventricle dysfunction Peripheral abnormalities also contribute to exercise intolerance in patients with COPD exercise Patients that undergo lung transplant are unable to regain normal exercise capacity even though pulmonary function is normal! Skeletal muscle Skeletal 70% of COPD patients report with exercise – 20­30% reduction in . – 13% reduction in of gastrocnemius. ↓ Type fibers number and CSA. ↓ Decreased . ↑ formation during exercise What are the effects of chronic exercise training on exercise capacity in patients with COPD? capacity Effects of Exercise on Mortality Rates Rates COPD patients on oxygen therapy for 2 years The strongest predictor of mortality in a three year study on survival rates in patients participating in a pulmonary rehabilitation program was 12 minute walk distance. The interpretation of both studies are limited by their research design. – – Normal activity 70% survival rate Bed rest 20% survival rate Exercise Tolerance Exercise Patients with COPD that undergo aerobic exercise training have been shown to significantly increase their aerobic capacity (VO2max). The degree of increase depends on training program and severity of exercise. What are the potential mechanisms for increased exercise tolerance in COPD patients after chronic exercise training? patients Mechanisms for Increased Exercise Tolerance Tolerance – No change – Hypertrophy – Increased ability to utilize oxygen – Decreased lactic acid formation Increase oxidative enzymes Increased blood flow ...
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This note was uploaded on 02/17/2011 for the course HK 458 taught by Professor Newcomer during the Spring '10 term at Purdue.

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