CHRONIC OBSTRUCTIVE

PULMONARY DISEASES
Respiratory System
Anatomy
 Pulmonary ventilation…
 Inspiration
 is an active process of the diaphragm and the external
intercostal muscles.
 air rushes in into the lungs to reduce a pressure
difference.
 forced inspiration is further assisted by the scalene,
sternocleidomastoid, and pectoralis muscles.
 Expiration
 is a passive relaxation of the inspiratory muscles and the
lung recoils.
 increased thoracic pressure forces air out of the lungs
 forced expiration is an active process of the internal
intercostal muscles (latissimus dorsi, quadratus
lumborum & abdominals).
Pulmonary ventilation…
 Pulmonary diffusion…
…which is the exchange of
oxygen and carbon dioxide
between the lungs and the
blood.
It serves two major functions:
 It replenishes the blood’s
oxygen supply which is
depleted at the level, where it
is used for oxidative energy
production.
 It removes carbon dioxide from
returning venous blood.
 Pulmonary diffusion…
 Respiratory membrane… composed of the alveolar wall, the
capillary wall, and their basement membranes.
 gas exchange occurs between the air in the alveoli,
through the respiratory membrane, to the red blood cells
in the blood of the pulmonary capillaries.
 Partial pressure of gases…
 the individual pressures from each gas in a mixture
together create a total pressure.
 air we breathe = 79% (N2), 21% (O2), and .03% (CO2) =
760mmHg
 differences in the partial pressures of the gases in the
alveoli and the gases in the blood create a pressure
gradient.
Pulmonary
diffusion…
 ASTHMA
Asthma is a disease of airway inflammation
and airflow obstruction characterized by the
presence of intermittent symptoms including
wheezing, chest tightness, shortness of breath,
and cough together with demonstratable
bronchial hyper-responsiveness.
 Etiology:
Common in children, boys > girls
Production of IgE antibodies in response to
exposure to allergens
 Proactive factors:
 Physiologic and pharmacologic mediators of
normal smooth muscle contraction
 Histamine
 Methacholine
 Physiochemical agents
 Exercise: hyperventilation with cold and dry air
 Air pollutants: nitrogen dioxide
 Viral resp infection: influenza A
 Ingestants: aspirin, NSAIDs
 Allergens
 Low molecular weight chemicals: penicillin
 Organic molecules: animal danders, dust, enzymes,
wood dust
Cellular inflammatory events:

 Epithelial cells activation or injury

 Lymphocytes activation
 Mast cells and eosinophils activation
 Pathophysiology:
 Increased airflow resistance due to
 Airway inflammation
 Airway narrowing
 Smooth muscle hyper-responsiveness

 Mucus hyper secretion

 Additional broncho-constrictor stimuli
 Stimulation of bronchial irritant receptors
 Clinical features:
 Cough
 Wheezing
 Dyspnea with chest tightness
 Tachypnea and tachycardia
 Pulsus paradoxus
 Hypoxemia
 Respiratory acidosis
 The New York Heart Association
classification of breathlessness

Class I No symptoms with ordinary activity,

breathlessness only occurring with
severe exertion, e.g. running up hills,
fast bicycling, cross-country skiing
Class II Symptoms with ordinary activity, e.g.
walking up stairs, making beds,
carrying large amounts of shopping
Class III Symptoms with mild exertion, e.g.
bathing, showering, dressing.
Class IV Symptoms at rest
 SPUTUM ANALYSIS
Description Causes

Saliva Clear watery fluid

Mucoid Opalescent or white Chronic bronchitis without

infection, asthma
Mucopurulent Slightly discoloured, but not Bronchiectasis, cystic fibrosis,
frank pus pneumonia
Purulent Thick, viscous: Haemophilus
Yellow Pseudomonas
Dark green/brown Pneurnococcus. mycoplasma
Rusty Klebsiella
Red currant jelly
Frothy Pink or white Pulmonary oedema
Haemoptysis Ranging from Wood specks to Infection (tuberculosis,
frank blood, bronchiectasis), infarction,
old blood (dark brown) carcinoma, vasculitis, trauma,
also coagulation
disorders, cardiac disease
Black Black specks in mucoid Smoke inhalation (fires, tobacco,
secretions heroin), coal dust
 Diagnosis:
 Chest examination
 Nasal polyps or increased amounts of nasal
secretions
 Skin changes: atopic dermatitis or eczema
 spirometry measures
 blood test
 chest x ray
 Treatment
 METHYLXANTHINES. The chief methylxanthine drug is
theophylline.
 BETA-RECEPTOR AGONISTS. These drugs, which are
bronchodilators, are the best choice for relieving sudden
attacks of asthma and for preventing attacks from being
triggered by exercise.
 STEROIDS. These drugs, which resemble natural body
hormones, block inflammation and are extremely effective in
relieving symptoms of asthma.
 LEUKOTRIENE MODIFIERS. Leukotriene modifiers are a
new type of drug that can be used in place of steroids, for
older children or adults who have a mild degree of asthma
that persists.
 OTHER DRUGS. Cromolyn and nedocromil are anti-
inflammatory drugs that are often used as initial treatment
to prevent asthmatic attacks over the long term in children.
 PT management:
 Relaxation techniques
 Breathing exercises
 Assisted coughing
 Spirometer exercises
 Postural drainage
 Prevention of exposure to irritants