By
Dr. Mohamed Seyam
Ass. Professor of physical therapy for Cardiovascular
\Respiratory Disorder and Geriatrics
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.
Chronic Bronchitis
Inflammation of the
bronchi that causes
irritating and productive
cough that lasts up to 3
months and repeated
over at least for 2
successive years.
causes
1. Cigarette smoking (Predominant cause)
2. Atmospheric pollution (e.g. industrial
smoke, smog ( A form of air pollution) and
coal dust.
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.
Clinical picture
Cough
Sputum
Wheeze
Dyspnea or shortness of breath
Exercise intolerance
Cyanosis
Cor pulmonale
Deformity - barrel chest
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
It is a chronic inflammation , thickening and
destruction of respiratory bronchioles and
alveoli.
Types and causes
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
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
Clinical picture
Progressive dyspnea
Barrel chest
Pursed lip breathing- Fish like inspiratory
gasp
Tachpynea with prolonged expiration
Hypoxemia &/or hypercapnia
Chronic hypoventilation (later stage)
X-ray
 Flattened diaphragm
 Hyperinflation
 Translucency of lung
 Hypertrophy of heart
 Emphysematous Bullae (small air filled
cyst)
What is asthma?
It is an obstructive lung disease seen in
young patients , related to hypersensitivity
of the trachea and bronchi
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.
COPD: Diagnostic Tests
Pulmonary Function Testing
An arterial blood gas test
Evaluation of functional
exercise capacity
Pulmonary Function Testing
Examples of functional
assessment walk tests
the 2-min walk test (2MWT),
6-min walk test (6MWT),
12-min walk test (12MWT),
Record
Blood pressure
Heart rate
Oxygen saturation
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.
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).
complication
chronic respiratory failure
Pneumothorax
Chronic pulmonary heart disease
Medical management
Stop smoking
Avoid environment pollution
Antibiotic therapy
Bronchodilators- β2 - agonists
Glucocorticoids
Expectorant – Mucolytics
Oxygen therapy
surgery
Lung volume reduction surgery
Lung transplantation
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.
Physical therapy for COPD
1- to relief dysnea by:
Relaxed positions
Physical therapy for COPD
1- To relief dysnea by:
2-breathing exercises
Diaphragmatic
Pursed lip breathing
posterior lower basal
Diaphragmatic breathing ex
3-respiratory ms training
Pursed lip breathing
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
Physical Therapy of COPD
2) To remove
secretions by:
1-cough.
2-postural
drainage.
3-vibration.
4-percussion.
5- PEP
Positive Expiratory Pressure
The RC-Cornet
The Flutter
The Flutter
Different postural drainage
positions:
Physical therapy for COPD
Aims
Methods
3)
To
increase exercise training:exercise tolerance
– Treadmill Walking.
– Bicycling on bicycle.
– Free Walking.
Physical therapy for COPD
Aims
4)
To
accessory
muscles
respiration.
Methods
relax •
•
of
Massage or
hot application for the
neck and upper back
muscles
Physical therapy for COPD
Aims
5)To prevent
postural
defomities
Methods
Exercise
connected
with
respiration
stretching
exercises
Quiz
Explain role of CO2 in maintaining
exercise intensity.
What is criteria for discontinuing
postural drainage
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
15 Point Scale
6 - 20% effort
7 - 30% effort - Very, very light (Rest)
8 - 40% effort
9 - 50% effort - Very light - gentle walking
10 - 55% effort
11 - 60% effort - Fairly light
12 - 65% effort
13 - 70% effort - Somewhat hard - steady pace
14 - 75% effort
15 - 80% effort - Hard
16 - 85% effort
17 - 90% effort - Very hard
18 - 95% effort
19 - 100% effort - Very, very hard
20 - Exhaustion