Chronic
Obstructive
Pulmonary Disease
(COPD)
Angela Voraotsady
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Definition
Epidemiology
Clinical Aspects
Treatment
Effects of Exercise
Exercise Testing
Exercise Prescription
Summary and Conclusion
References
Outline
• Chronic:
It’s long-term and doesn’t go away
• Obstructive:
The flow of air from the lungs is limited
• Pulmonary:
Another word for lungs and breathing
• Disease:
It’s a health problem that needs to be taken seriously
Chronic Obstructive
Pulmonary Disorder
• A progressive condition that includes chronic bronchitis
or emphysema or both.
• Smoking is the primary cause of COPD.
• 80% of the people affected by COPD are current or
former smokers.
• Other risk factors are: occupational and environmental
pollutants, alpha antitrypsin deficiency, allergies and
asthma, poor nutrition, periodontal disease and low birth
weight.
What is COPD and what
causes it
Chronic Bronchitis
Emphysema
• Airflow is limited by
narrowed airways. The
narrowed airways are
caused when damaged
airways get tight,
swollen, and filled with
mucus.
• The tiny air sacs get overstretched and break down.
When this happens old air
gets trapped inside and
new air cannot get in.
So what does that mean?
• COPD is the most prevalent chronic pulmonary disease and
affects an estimated 24 million Americans.
• COPD is the fourth most common cause of death in the United
States and is the only cause in the top ten that continues to rise.
• COPD accounts for approximately 100,000 deaths each year.
• By 2020, it is estimated to be the third leading cause of death
in the United States and the fifth leading cause of disability in
the world.
• It is most commonly found in white males over the age of 60.
Epidemiology
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Symptoms
Cough that produces mucus, may be blood streaked
Shortness of breath aggravated by exertion or mild activity
Wheezing
Rales (small clicking, bubbling, or rattling sounds in the lung)
Fatigue
Ankle, feet and leg edema that affects both sides
Reddish cheeks
Reddish face, palms, or mucous membranes (such as the inside of the
mouth)
Headaches
Vision abnormalities
Clinical Aspects
Spirometry is the best way to test for COPD. It is simple and can be
interpreted immediately.
Listening to the lungs with a stethoscope can sometimes work too but
sometimes the lungs sound normal even when COPD is present.
X-rays and CT scans can also be performed; but these can also look normal
even if COPD is present.
Sometimes a blood test called a “blood gas” is required to measure the
amounts of oxygen and carbon dioxide in the blood.
Laboratory Diagnosis
Medical
• Bronchodilators are prescribed to open the airways
• Inhaled steroids to reduce lung inflammation.
• In severe cases or during flare-ups steroids may be needed
intravenously or by mouth.
• Antibiotics can also be prescribed when a patient has an infection
prevent COPD from becoming worse.
• Oxygen therapy may also be needed at home if the patient
has low oxygen levels in their blood.
Treatment
Surgical
• Removal of parts of diseased lung in patients with
emphysema.
• Lung transplants may be required in severe cases
Treatments
• Hyperinflation resulting from impeded exhalation,
incomplete lung emptying, and air trapping. Static
hyperinflation can be caused from daily living and when
exercise occurs dynamic hyperinflation can be
superimposed on static hyperinflation. Dynamic
hyperinflation is related to increased breathing frequency
and affects the mechanical efficiency of ventilation
leading to breathlessness.
Effects on Ability to
Exercise
• In patients with emphysema there is a impairment of gas
exchange due to the destruction of the alveolar-capillary
membrane. Breathing efficiency is thus worsened by an
increase in VD/VT and can also cause hypoxemia during
exercise.
• Chronic hypoxemia can also cause erythrocytosis which can
further complicate circulation during exercise.
• Smokers will have an increase in carboxyhemoglobin,
impairing the blood oxygen transport system.
• Other symptoms of COPD can also affect different individuals
personally.
Effects on Ability to
Exercise
• Beta2-adrenoceptor (sympathomimetic) agonist reduce peripheral
vascular resistance and can cause tachycardia, palpitations and
tremulousness.
• Methylxanthines can cause tachycardia, cardiac dysrhythmias, and
CNS stimulation with increased respiratory drive and a risk of
seizures.
• Thiazide diuretics and loop diuretics can cause hypokalemia that can
in turn cause cardiac dysrhythmias and muscle weakness
• Glucocorticoids (prednisone) can cause skin atrophy and fragility,
osteoporosis, muscle atrophy, and myopathy.
• Antidepressants cause resting and exercise tachycardia.
• COPD often coexists with cardiovascular diseases so the effects of
medications taken for cardiovascular disease needs to be reviewed as
well.
Effects of Medication on
Exercise
Acute effects
Chronic effects
• Increased verbal
processing
• Dynamic hyperinflation –
further reduces
inspiratory capacity and
smaller tidal volume
• Cardiovascular reconditioning
• Reduced ventilatory
requirement at a given work
rate
• Improved ventilatory
efficiency
• Reduced hyperinflation
• Desensitization to dyspnea
• Increased muscle strength
• Improved flexibility
• Improved body composition
• Better balance
• Enhanced body image
Effects of Exercise
• Maximal testing is safe with appropriate monitoring.
• The cycle ergometer is best for controlling external work
rate, measuring gas exchange and blood sampling.
• But patients might be more willing to perform treadmill
testing.
• During testing a near-linear increase in work rate should
be attempted with incremental adjustments being made to
speed and grade.
• The goal is to be able to get between 8-12 minutes of
exercise data.
Exercise Testing
• The Bruce Protocol
• Equipment
required: treadmill,
stopwatch, pencil,
paper for recording
• Procedure: The
treadmill is started
at 1.7 mph and at
an incline of 10%.
At three minute
intervals the
incline of the
treadmill increases
by 2% and the
speed increases as
in the table to
follow.
Stage
Speed (km/hr)
Speed (mph)
Gradient
1
2.74
1.7
10
2
4.02
2.5
12
3
5.47
3.4
14
4
6.76
4.2
16
5
8.05
5.0
18
6
8.85
5.5
20
7
9.65
6.0
22
8
10.46
6.5
24
9
11.26
7.0
26
10
12.07
7.5
28
Exercise Testing
• Exercise rehabilitation should include several different professionals
including respiratory therapists, physical therapists and exercise
professionals, and occupational therapists.
• Respiratory therapists will evaluate, teach, and ensure effective use of
bronchodilator medications and oxygen therapy.
• Physical therapists and exercise professionals will evaluate exercise
endurance, muscle strength, flexibility and body composition along with
monitoring the exercise prescription and monitoring exercise
performance.
• Occupational therapists will evaluate activities of daily living and quality
of life so they are able to teach energy conservation and body mechanics
aimed at reducing the oxygen requirement for specific activities
• All therapists will teach improved breathing efficiency with methods
such as pursed lips and diaphragm breathing.
Exercise Prescription
Pursed lips method
Diaphragm breathing
• Breathe in slowly through
your nose for 1 count
• Purse your lips as if you
were going to whistle
• Breathe out gently through
pursed lips for 2 slow
counts (breathe out twice as
escape naturally- don't force
the air out of your lungs
• Keep doing pursed lip
breathing until you're no
longer short of breath
• Put one hand on your upper
chest, and the other on your
belly just above your waist
• Breathe in slowly through your
nose - you should be able to
feel the hand on your belly
moving out. The hand on your
chest shouldn't move.
• Breathe out slowly through
your pursed lips - you should
be able to feel the hand on
your belly moving in as you
exhale (breathe out).
Exercise Prescription
• Modes of exercise can be walking, cycling, swimming, or
conditioning exercises such as tai chi. The mode should
be enjoyable to the patient and directly improve ability to
perform usual daily activities.
• For patients with oxyhemoglobin desaturation of less than
88% or a documented reduction in arterial oxygen tension
of less than 55 mmHg oxygen should be administered
during exercise. The goal for oxygen therapy is to
maintain oxyhemoglobin saturation above 90%.
Exercise Prescription
• Aerobic – large muscle activities
• 1-2 sessions, 3-5 days/week
• 30 min/sessions with an emphases of duration rather than
intensity
• Strength – free weights, isokinetic/isotonic machines
• Low resistance, high reps 2-3 days/week
• Flexibility – stretching, tai chi
• 3 days/week
• Neuromuscular – walking, balance exercises, breathing
exercises
Exercise Prescription
• Often patients with COPD cannot perform 20-30 min of
exercise so 5 or 10 min intervals of exercise may be
necessary in the beginning.
• Group interaction is helpful in the reconditioning process
since an individual with COPD is at a particular risk of
relapsing into a state of inactivity and physical
deconditioning.
Exercise Prescription
• COPD is a major killer in the world.
• It cannot be controlled but quality of life can be enhanced
through medications and lifestyle changes.
• Exercise training is a crucial aspect of clinical
management and the rehabilitation of individuals
suffering from COPD.
Summary
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Cooper, C. B. (2001). Exercise in chronic pulmonary disease: limitations and rehabilitation.
Medicine & Science in Sports & Exercise, 33(7), S643-S646.
Durstine, J. L., Moore, G. E., Painter, P. L., & Roberts, S. O. (2009). ACSM's Exercise
management for Persons With Chronic Diseases and Disabilities (3 ed.). Champaign, IL: Human
Kinetics.
Emery, C. F., Honn, V. J., Frid, D. J., Lebowitz, K. R., & Diaz, P. T. (2001). Acute Effects of
Exercise on Cognition in Patients with Chronic Obstructive Pulmonary Disease . American Journal
of Respiratory and Critical Care Medicine, 164, 1624-1627. Retrieved February 14, 2011, from
http://ajrccm.atsjournals.org/cgi/content/full/164/9/1624
Expert's Guide to Better Breathing. (2006). USA: Boehringer Ingelheim Pharmaceuticals.
McArdle, W. D., Katch, F. I., & Katch, V. L. (2006). Optimizing Body Composition, Successful
Aging, and Health-Related Exercise Benefits. Essentials of Exercise Physiology (3 ed., pp. 665704). Philiadelphia, PA: Lippincott Williams &Willkins.
PubMed Health - Chronic obstructive pulmonary disease. (n.d.). National Center for
Biotechnology Information. Retrieved February 16, 2011, from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001153
APA formatting by BibMe.org.
References