Chronic Obstructive Lung Disease Restrictive Lung Disease Vascular Lung Disease Lung disease is the third leading cause of death; 1/7 deaths are due to lung diseases 35,000,000 Americans are living with lung disease Every year 350,000 American die of lung diseases Lung disease is the fastest growing disease: ↑ 40% in the last 5 years and ↑ 60% since 1982

Chronic Obstructive Lung Disease Airway narrowing can be with in the lumen, intramural (in the wall) or extramural (outside the wall) of the bronchioles.

Restrictive Lung Disease Reduction in Lung Volume Skeletal

Restrictive Lung Disease Reduction in Lung Volume Skeletal Neuromuscular

Restrictive Lung Disease Reduction in Lung Volume Skeletal Pleural Interstitial Neuromuscular

Restrictive Lung Disease Reduction in Lung Volume Skeletal Pleural Interstitial Alveolar Neuromuscular

Restrictive Lung Disease Reduction in Lung Volume Reduced lung volume Altered maximal expiratory flow Increased work of breathing Misdistribution of VE/Q

Vascular Lung Disease

Vascular Lung Disease ↓ # Capillaries Loss of vessel tone & distensibility Low blood flow

Vascular Lung Disease Pulmonary edema Pulmonary embolism/Chronic venous thromboembolic disease Pulmonary hypertension Hepatopulmonary syndrome Lymphtic spread of metastatic cancer Pulmonary edema (American English), or oedema (British English), is swelling and/or fluid accumulation in the lungs. It leads to impaired gas exchange and may cause respiratory failure. It is due to either failure of the heart to remove fluid from the lung circulation ("cardiogenic pulmonary edema") or a direct injury to the lung parenchyma ("noncardiogenic pulmonary edema").[1] Treatment depends on the cause, but focuses on maximizing respiratory function and removing the cause. Pulmonary embolism (PE) is a blockage of the pulmonary artery (or one of its branches), usually when a venous thrombus (blood clot from a vein), becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs. This process is termed thromboembolism. In medicine, pulmonary hypertension (PH) is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion. Depending on the cause, pulmonary hypertension can be a severe disease with a markedly decreased exercise tolerance and right-sided heart failure. It was first identified by Dr. Ernst von Romberg in 1891.[1] It can be one of five different types: arterial, venous, hypoxic, thromboembolic, or miscellaneous. Hepatopulmonary syndrome is a syndrome characterized by chronic liver disease with pulmonary vascular dilatations and reduced arterial oxygenation. It is seen in patients with advanced liver disease, such as cirrhosis or portal hypertension.

CHRONIC OBSTRUCIVE LUNG DISEASE COPD

Etiology

Etiology - Bronchitis 82% due to cigarette smoking

Etiology - Bronchitis 82% due to cigarette smoking

STATIC LUNG VOLUMES

DYNAMIC LUNG FUNCTIONS

Pathophysiology - Bronchitis Vital Capacity FEV1

Gas Exchange depends on ventilation (VE) matching perfusion (Q)

Lower gas pressures will be in the obstructed part of the lung higher blood flows will go into the affected area because of the lower gas pressures Higher gas pressures will go into the healthy lung Lower blood flows will go into the healthy lung because of the higher gas pressures. Ventilation will not match perfusion

Pathophysiology - Bronchitis Blood Gases? PaO2 PaCO2

Etiology - Emphysema

Etiology - Emphysema Elastic Tissue Breakdown Elastic tissue in the lung is dynamic; it turns over regularly Elastase breaks down elastic tissue Protease increases elastase Protease is controlled by protease inhibitors Elastic Tissue Breakdown

Etiology - Pathophysiology

Pathophysiology - Emphysema Vital Capacity FEV1

Overinflation of alveoli increases pressures in alveoli, New gases don’t’ go in decreasing blood flow to affected area More blood flow goes to unaffected area Good gas exchange; mild hypoxemia

Pathophysiology - Emphysemia PaO2 Room Air 78 mm Hg PaCO2 Room Air 40 mm Hg

Etiology - Asthma

Etiology - Asthma

Lower gas pressures will be in the obstructed part of the lung higher blood flows will go into the affected area because of the lower gas pressures Higher gas pressures will go into the healthy lung Lower blood flows will go into the healthy lung because of the higher gas pressures. Ventilation will not match perfusion

Pathophysiology - Asthma PaO2 Room Air PaCO2 Room Air Blood gases in asthma may be different from bronchitis, depending on the stage of the attack

Etiology - Asthma Exercise Induced Asthma - EIA Exercise Induced Bronchospasm - EIB

Etiology – Cyctic Fibrosis Cystic fibrosis is an inherited chronic disease that affects the lungs and digestive system of about 30,000 children and adults in the United States (autosomal recessive) Cystic fibrosis is one of the most common life-shortening, childhood-onset inherited diseases. In the United States, 1 in 3900 children are born with CF exocrine (mucus) glands of the lungs, liver, pancreas, and intestines, causing progressive disability due to multisystem failure. A defective gene and its protein product cause the body to produce unusually thick, sticky mucus that: clogs the lungs and leads to life-threatening lung infections; and obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food. About 1,000 new cases of cystic fibrosis are diagnosed each year. More than 70% of patients are diagnosed by age two. More than 40% of the CF patient population is age 18 or older. In 2006, the predicted median age of survival was 37 years.

Exercise Intervention

Exercise Intervention Dyspnea – Shortness of Breath

Exercise Intervention Upper Body Training Lower Body Training Ventilatory Muscle training Lower body exercises like walking or riding a stationary bicycle will help strengthen your leg muscles and increase muscle tone and flexibility. These exercises will help you move about more easily, often for longer periods of time. They can also make certain tasks, like walking up stairs, easier to do. Lower body training Many patients find that as their technique improves, their motivation to continue with the exercise program increases as well. As a result, many patients report feeling better about themselves and their ability to control symptoms such as breathing difficulties. Upper body training Upper body training increases the strength and endurance of arm and shoulder muscles. Strengthening these muscles is important because they provide support to the ribcage and can improve breathing. These exercises can also help in tasks that require arm work such as carrying groceries, cooking dinner, lifting items, making the bed and vacuuming, taking a bath or shower, and combing hair. They can also decrease the amount of oxygen needed for these activities. This may be due to less worry about breathing difficulties and better coordination of the muscles involved in raising the arms. Many patients with lung diseases are not in very good physical condition or have never exercised on a regular basis. Don't worry. Your pulmonary rehabilitation team will meet with you to assess your needs and will work with you to develop an exercise program designed specifically for you. They will advise you about which exercises will give you the best results, how often you should do them, for how long, and at what level. They will give you information on how to maintain your exercise abilities on a regular basis. Ventilatory muscle training Weakness of the respiratory muscles can contri-bute to breathing problems and make exercising difficult. For some patients, ventilatory muscle training (VMT) may improve respiratory muscle function, help reduce the severity of breathlessness, and improve the ability to exercise. Research at this time does not support the use of VMT for everyone. However, it may be helpful for some patients with COPD who have respiratory muscle weakness and breathlessness. Your pulmonary rehabilitation team will let you know if you are a candidate for VMT. Psychosocial support and education In addition to exercise training, many pulmonary rehabilitation programs provide help with the em-otional stresses common to COPD. Some patients never experience any significant emotional distress as a result of their disease. But for many, COPD can cause depression, anxiety, or other emotional problems. These might include concerns about: Body image. Increased loneliness. Relationships with family and friends. Lack of social support. Negative self-concept and low self-esteem. Support may be provided through patient education programs, or as part of support or stress management groups. Patients are counseled about depression and anxiety, taught relaxation skills, encouraged to talk about their feelings, and learn the importance of giving and receiving emotional support from others. It is important to remember that support for psychological or emotional difficulties is most beneficial over a longer period of time—there is no such thing as a "quick fix." If you are experiencing any of the above feelings, make sure you discuss them with your pulmonary rehabilitation team. Since smoking is well known to be the primary risk factor for the onset and working of COPD, many pulmonary rehabilitation programs provide educational sessions and counseling to help patients stop smoking. Most patients with COPD have quit smoking by the time they begin a pulmonary rehabilitation program. Others may continue to smoke as a way to cope with depression, anxiety, and loneliness. Other patient education classes often cover a wide variety of topics. These might include: How the lungs work. Information about COPD and other chronic lung diseases. Information about medications, including drug action, side effects, using an inhaler, and self-care techniques. Understanding and using oxygen therapy. Diet, nutrition, and weight management. Breathing retraining. Importance of exercise. Strategies for managing breathing problems. Symptom assessment and knowledge about when to seek medical treatment. Travel.

Exercise Intervention Ventilatory Muscle Training Progressive Resistance Training Exhale Inhale

Exercise Intervention Upper Body Training Lower Body Training Ventilatory Muscle training

Exercise Intervention Psychological Outcomes Morbidity & Mortality