1. Chronic ObstructivePulmonary Disease

2. Chronic ObstructivePulmonary Disease
COPD is a general term that refers to a number of chronic pulmonary conditions (chronic bronchitis, emphysema) characterized by:
Narrowing and obstruction of airways.
Increased retention of pulmonary secretions.
Structural deterioration of alveoli.
Other terms used:
CORD : chronic obstructive respiratory disease.
COAD: chronic obstructive airways dysfunction.
COLD : chronic obstructive lung disease.
CAL :chronic airway limitation.

3. Chronic Bronchitis
Inflammation of the bronchi that causes irritating and productive cough that lasts up to 3 months and recurs over at least for 2 consecutive years.

4. causes 1. Cigarette smoking (Predominant cause)
2. Atmospheric pollution (e.g. industrial smoke, smog ( A form of air pollution) and coal dust.

5. pathology
The hallmark is hypertrophy and increase in number of, mucous glands in the large bronchi and evidence of inflammatory changes in the small airways.
Some irritative substance stimulates over activity of the mucus-secreting glands and the goblet cells in the bronchi and bronchioles which causes secretion of excess mucus.
The cells increase in size and their ducts become dilated and may occupy as much as two-thirds of the wall thickness. The airways become narrowed.

6. Clinical picture Cough Sputum Wheeze Dyspnea or shortness of breath
Exercise intolerance
Cyanosis
Cor pulmonale
Deformity - barrel chest

7. investigation 1) PULMONARY FUNCTION TEST:
Decrease in FVC, FEV1, FEV1/FVC, PEFR
Increase in RV, TLC
2) ABG : Respiratory acidosis, ↓PaO2, PaCO2
3) Auscultation signs
- Expiratory wheeze - Coarse crepitations
- Vesicular breath sounds
4) X-ray - Flattening of the diaphragm

8. Emphysema
It is a chronic inflammation , thickening and destruction of respiratory bronchioles and alveoli.

9. Types and causes * May be caused by alpha 1-antitrypsin deficiency.
Congenital Or Primary Emphysema
* May be caused by alpha 1-antitrypsin deficiency.
Secondary Emphysema: to other factors
obstructive airways disease - e.g. asthma, cystic fibrosis, chronic bronchitis
occupational lung diseases - e.g. pneumoconiosis
compensatory to contraction of one section of the lung - e.g. fibrous collapse or removal

10. pathology
Toxins (smoke) cause inflammation
Infiltration of neutrophils, macrophages and lymphocytes
Inflammatory cytokines increase protease activity,
inhibiting normal antiprotease activity (antitrypsin- It protects tissues from enzymes of inflammatory cells)
Alveoli are destroyed because elastin is being broken down by proteases

11. Clinical picture Progressive dyspnea Barrel chest
Pursed lip breathing- Fish like inspiratory gasp
Tachpynea with prolonged expiration
Hypoxemia &/or hypercapnia
Chronic hypoventilation (later stage)

12. X-ray Flattened diaphragm Hyperinflation Translucency of lung
Hypertrophy of heart
Emphysematous Bullae (small air filled cyst)

14. What is athma?
It is an obstructive lung disease seen in young patients , related to hypersensitivity of the trachea and bronchi

15. pathology Sever spasm of smooth muscles of the bronchial tree.
Narrowing of airways.
Inflammation of the mucosal lining of the tracheobronchial tree.
Hyper secretion of mucus.
Sever asthma over a prolonged number of years can lead to emphysema.

16. COPD: Diagnostic Tests
Pulmonary Function Testing
An arterial blood gas test
Evaluation of functional exercise capacity
Pulmonary Function Testing

17. Examples of functional assessment walk tests
the 2-min walk test (2MWT),
6-min walk test (6MWT),
12-min walk test (12MWT),

18. Record

19. Blood pressure

20. Heart rate

21. Oxygen saturation

22. Dyspnoea score.*.Borg scale
The Borg Scale is a simple method of rating perceived exertion (RPE) and can be used to determine a patient level of intensity in training.

23. Types of scales
There are a number of RPE scales but the most common are the 15 point scale (6-20), and the 11 point scale (0-10).

24. complication chronic respiratory failure Pneumothorax
Chronic pulmonary heart disease

25. Medical management Stop smoking Avoid environment pollution
Antibiotic therapy
Bronchodilators- β2 - agonists
Glucocorticoids
Expectorant – Mucolytics
Oxygen therapy

26. surgery
Lung volume reduction surgery
Lung transplantation

27. Physical therapy for COPD
General clinical problems :-
dyspnea on exertion.
Prolonged expiration. Air trapped as airways narrowed during expiration.
Chronic accumulation of pulmonary secertions.
Decreased endurance and exercise capacity .
Associated postural defects.

28. Physical therapy for COPD
1- to relief dysnea by:
Relaxed positions

29. Physical therapy for COPD
1- To relief dysnea by:
2-breathing exercises
Diaphragmatic
Pursed lip breathing
posterior lower basal
3-respiratory ms training
Diaphragmatic breathing ex
Pursed lip breathing

30. Physical therapy for COPD
1- To relief dysnea by:
3-Respiratory ms training
A- Inspiratory Muscle Trainer
B-Incentive Spirometer
Inspiratory muscle trainer
Incentive Spirometer

31. Physical Therapy of COPD
2) To remove secretions by:
1-cough.
2-postural drainage.
3-vibration.
4-percussion.
5- PEP
Positive Expiratory Pressure
The Flutter
The RC-Cornet
The Flutter

32. Different postural drainage positions:

33. Physical therapy for COPD
Methods
Aims
exercise training:-
Treadmill Walking.
Bicycling on bicycle.
Free Walking.
3) To increase exercise tolerance

34. Physical therapy for COPD
Methods
Aims
Massage or
hot application for the neck and upper back muscles
4) To relax accessory muscles of respiration.

35. Physical therapy for COPD
Methods
Aims
Exercise connected with respiration
stretching exercises
5)To prevent postural defomities

36. THANK YOU

37. Quiz Explain role of CO2 in maintaining exercise intensity.
What is criteria for discontinuing postural drainage

38. 10 Point Scale 0 - Nothing at all 1 - Very light 2 - Fairly light
3 - Moderate
4 - Some what hard
5 - Hard 6
7 - Very hard 8 9
10 - Very, very hard

39. 15 Point Scale 6 - 20% effort 7 - 30% effort - Very, very light (Rest)
9 - 50% effort - Very light - gentle walking
% effort
% effort - Fairly light
% effort
% effort - Somewhat hard - steady pace
% effort
% effort - Hard
% effort
% effort - Very hard
% effort
% effort - Very, very hard
20 - Exhaustion