Mov 470 COPD, Asthma, CF [Recovered]

Mov 470 COPD, Asthma, CF [Recovered] - Chronic Obstruction...

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Unformatted text preview: Chronic Obstruction Pulmonary Disease Chronic Asthma Cystic Fibrosis Chronic Obstructive Pulmonary Disease Disease Meet the “Family Increased airway resistance usually when Increased trying to expire CO2.. creates a sorts of hypoxic environment..this is worse with exercise exercise Muscle fatigue, general weakness Exercise can help manage disease Richie “The Kid” Richie Richie Richie is a 28 year old male who spends most of his free time in the bars of Philadelphia. Growing up his parents smoked in the house and he picked up the habit at age 20. His first symptom was a morning cough that brought up mucus and that occurred at first only during the winter months. As the illness progressed, the cough began to last throughout the day and throughout the year. More about “The Kid” and “Big Poppa” and Richie’s Richie’s dad Rich “Big Poppa” (60 years old) was recently diagnosed with Emphesyma, due to his lifetime habit of smoking. Both men realize the extent of their disease and decide to come to you to help them out. Pathophysiology Pathophysiology In In chronic bronchitis, the air passages in the lungs are inflamed, and the mucus-producing glands in the larger air passages of the lungs (bronchi) are enlarged. These enlarged glands produce too much mucus, which triggers a cough. In emphysema, the tiny air sacs in the lungs, In called alveoli, are destroyed. The lungs are unable to contract fully and gradually lose elasticity. Holes develop in the lung tissue, reducing the lungs' ability to exchange oxygen for carbon dioxide. Chronic anxiety that sometimes leads to Chronic SOAPs SOAPs S: S: “I constantly cough in the bar” in O: Normal height, O: weight, blood pressure pressure Dyspnic during ADLs Dyspnic (feeling of not having enough air) enough Currently has a Currently respiratory infection respiratory Chest x-ray rules out Chest pneumonia pneumonia FVC: 50%of predicted S: “I feel like I can never catch my breath” O: Normal height, weight, blood pressure Dyspnic during ADLs Wheezing, coughing, and constant fatigue Chest x-ray reveals damage to some areas of the lungs FVC: 30% of predicted No GXT due to difficulty breathing A: A: SOAPs SOAPs Moderate COPD with chronic bronchitis bronchitis Hypoxemia with Hypoxemia moderate/high intensity intensity P: Prescribe an P: inhaler (albuterol) inhaler Take care of Take infection (antibiotic) infection Exercise program Work out with Work oxygen on oxygen A: Severe COPD with emphesyma, Hypoxemia during low intensity exercise Deconditioning P: Inhaled steroids Supplemental O2 during exercise Pulmonary rehab Exercise Program Exercise Mode Intensity Frequency Duration Aerobic 11-13/20 1-2 session 30 minutes RPE RPE Continuous Continuous 3-5 days/wk or intermittent (this is (pursed really lip difficullt) difficullt) breathin breathin g..deep g..deep in… long out through pursed Goals Increase Increase VO2 peak VO2 Less Less sensitive to dyspnea dyspnea More More efficient breathing patterns patterns Back to Back ADLs ADLs (avoid (avoid working out in extreme heat or Effects on Exercise Response Effects Impeded Impeded expiration requirements. Increased frequency leads to hyperinflation and lower TVs. hyperinflation May be limited by deconditioning. Impairment of gas exchange due to Impairment destruction of the alveolar-capillary membrane. (aveoli are were gas exchange occurs) exchange Dyspnea and psychological factors. Effects of Training Effects Cardiovascular reconditioning Desensitization of dyspnea (air Desensitization hunger..psychologically thinks you are suffocating) suffocating) Improved ventilatory efficiency Improved health-related fitness Meds/Management Meds/Management Sympathomimetic agonists Diuretics Glucocorticoids Antidepressents Management Management Optimize respiratory mechanics Correction of hypoxemia Desensitization to dyspnea Energy conservation Breathing retraining Reconditioning Reconditioning Testing Identify hypoxemia/ischemia Cycle ergometer Can do max with appropriate monitoring Can (monitoring O2 saturation) (monitoring Better to do later in the day Programming Programming Flexible Flexible to account for changes in clinical status status Respiratory therapists, PTs, exercise Respiratory physiologists, and OTs physiologists, Large muscle activities Should use supplemental O2 if necessary Interval training Group interaction (especially first 6 wks.. Group Doing a pulmonary rehab group) Doing Helps with consistency Pathophysiology Asthma Asthma classifications can range from mild to severe. Her asthma is provoked only by certain stimuli; exercise, allergens, and stress. Ariway obstruction can often times can Ariway limit exercise performance. limit Tawnie thinks that she had asthma while Tawnie in middle/high school but wasn’t diagnosed until she was in college. Exercise Induced Asthma (EIA) Exercise Of Of the three asthma categories, Tawnie would be considered EIA since she can exercise at a high intensity. The others include mild asthma (75% of max HR to produce symptoms), and moderate to severe asthma (submax @ 50-70ish% max HR..cant do high intensity work outs). max Her EIA usually hits her about 5-10 Her minutes after exercise. It takes the form of wheezing and coughing. If she is out on a long run, it may manifest during activity. long SOAP Notes SOAP S: S: “I think that my asthma is stopping me from running faster than a 9.0 minute mile.” running O: Young female in no respiratory distress at O: rest or during light exercise. rest Chest/lung sounds and x-ray are normal. Pulmonary Function – normal (FVC,FEV) EIA test: 25% decrease in FEV 10% decrease in FEV after meds 10% Max test: HRmax 198bpm, MVV 80% of predicted, VO2max 50 ml/kg/min (>99% ile) VO2max 50 6-8 minutes Warm up and cool down reduces likely hood of Warm Notes Notes A: A: Mild EIA, high aerobic exercise tolerance, muscle strength is excellent. tolerance, P: Advise that high levels of aerobic P: activity may exacerbate EIA. activity Begin a program to track peak flow. Be sure that medication is proper type. Exercise Program Exercise Mode Frequency Duration Aerobic 3-7 3-7 days/wk (Initial) days/wk (Goal) 30-45 30-45 minutes minutes Intensity RPE11-14/20 6 days/wk 45 minutes RPE 14 Effects of Exercise/Training Effects Exercise Exercise response is typically unaffected. However, if there is an asthmatic response, the exercise response is proportional to the ventilatory limitation. proportional If controlled, there is no effect on If adaptations to exercise training. If severe, there may be an increase in endurance, but no increase in fitness. but Meds (all used to improve brionchiole dilation) brionchiole Beta-selective sympathomimetic agonist Long Long acting beta agonists (activity lasting longer than 30 min) longer Inhaled Inhaled steriods ( more prone to pnemuonia, inflammation usually take this pnemuonia, Exercise Testing >75% of predicted HRmax or greater 8 minutes in duration Measurement of airflow obstruction EIA: Fall in FEV > 15% Fall in Peak flow >20% Programming Programming Improved Improved fitness (typically 6 weeks needed) needed) Mild Mild asthma Dyspnea Scale Improved exercise tolerance Moderate to severe asthma Encouraged Option If to work at 60% maxHRR to move to higher intensity tolerated Musculoskeletal conditioning Cystic Fibrosis Mikey “Two Forks” Mikey Mikey Mikey is a 25 year old male who was diagnosed with cystic fibrosis (CF) as an infant. CF is an inherited disease that causes abnormal transport of Cl-, excessive Na+ absorption, and transport extracellular dehydration resulting in increased mucus production. His pancreas and lungs have been most affected by this disease. He has lost a significant amount of weight and has increased mucus production in the lungs. increased Mucus block\s fat and protein absorption Salty sweat SOAP Notes SOAP S: S: “I have a hard time catching my breath and I can’t seem to stop coughing.” and O: Height 5’8” Weight 130lbs O: BMI:19.8kg/m2 BMI:19.8kg/m HR 85bpm BP 120/76 mmHg RR 18bpm RR Malnourished male, dyspnic with ADLs O2 sat 95%,FVC:80%, FEV:45% Notes Notes A: Cystic fibrosis (obstruction) Possible infection Possible Unnecessary weight loss Unnecessary P: Chest PT to decrease mucus Inhaled bronchiodilator or steroid Inhaled High calorie shakes High No exercise RX at present time No Exercise Programming (long term goal) uration Frequency term Mode Goals Intensity D Duration Frequency Aerobic Increase Increase VO2, endurance, SaO2, resp. m endurance and mucus clearance clearance 60-85% 60-85% Karvonen Karvonen Monitor Monitor SaO2, RPE, dyspnea dyspnea 10 min, 10 goal 20goal 30 min 3-4 3-4 days/wk, may need intermittent sessions sessions Effects on Response Effects Healthy Healthy CF patients have normal aerobic fitness and responses to exercise. fitness As pulmonary function deteriorates, so As does exercise tolerance. Therefore use greater minute ventilation, greater desaturation, and increased CO2 retention. HRmax may be lower and retention. max malnutrition may cause a decrease in muscle strength and endurance. muscle May need supplemental oxygen. Effects of Training Effects Increased Increased capacity and VO2max. ventilatory muscle endurance. Improvement in cardiopulmonary Improvement efficiency. efficiency. Greater mucus clearance. Increase or delayed decreased in Increase pulmonary function. pulmonary Submax activity is the only group to see Submax results results Meds Meds Pancreatic Chest enzyme supplements PT Bronchodilator therapy Antibiotic therapy Supplemental oxygen Testing Testing Objectives Assess severity Assess capacity and fitness Responses to exercise SaO2 during exercise Basis for EXRX Assess changes in fitness Use submax test if desaturation with max test Programming Programming Aim should be to improve fitness. Moderate intensity, 20-30 minutes. May need to do chest PT first. May need to alter program with pulmonary May infection. infection. Special Considerations Special You You do not need to supervise/monitor these patients – except with hypoxic individuals individuals May also have EIA Increased risk for Diabetes ...
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