Chronic Obstructive Pulmonary
Disease
By: Chantel Berenyi
2-16-12
Why I chose COPD?
o Internship at McKay-Dee Hospital
in Cardiac Rehab
o Career path
Overview
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What is COPD?
Disease Prevalence
Signs & Symptoms
Diagnosis
Tests & Evaluations
Complications
Treatment
 Effects on exercise
response
 Effects of medications on
exercise
 Effects of training
 Exercise testing
 Exercise prescription
 Summary & conclusions
What is COPD?
 COPD is defined as a chronic inflammatory disease of the lung that is
characterized by progressive and irreversible airflow limitation
 There are two main forms (most have a combination):
 Chronic bronchitis: involves a long-term cough with mucus
 Inflammations of bronchial tubes
 Irritations of cilia in bronchial-lining
 Airways become clogged by debris
 Heavy secretion of mucus
 http://www.youtube.com/watch?v=o7mgLxupRQ&feature=related
What is COPD?
 Emphysema: involves destruction of the lungs over time
 Alveoli lose elasticity (flabby balloon)
 Alveoli over expand to compensate, causing the to rupture
and form cysts
 CO2 cannot be expelled properly with damaged alveoli
 Stagnant air develops causing shortness of breath
 http://www.youtube.com/watch?v=lmZZlkrSu5o
Causes of CODP
 SMOKING (leading cause)
 80% of individuals with COPD are
current or former smokers
 Environmental factors
 Secondhand smoke & pollution
 Exposure to certain gases or
fumes
 Frequent use of cooking fire w/o
ventilation
 Lack of the protein “alpha-1
antitrypsin”
Prevalence
 Projected to be the world’s third most important cause of
mortality by 2020
 An estimated 24 million Americans have COPD
 kills more than 120,000 Americans each year—that’s 1 death
every 4 minutes
 An estimated 64 million people have COPD worldwide (2004)
 More than 3 million people worldwide died of COPD in 2005
 The disease now affects men and women almost equally
 Total deaths from COPD are projected to increase by >30% in
the next 10 yrs
http://www.cdc.gov/copd/data.htm
Signs & Symptoms
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Cough, with or without mucus
Fatigue
Weak quadriceps muscles
Low body weight
Cachexia
Many respiratory infections
Shortness of breath (dyspnea)
that gets worse with mild
activity
 Trouble catching breath
 Wheezing
Diagnosing COPD
 Best test for COPD- spirometry (FEV1/FVC)
 FEV1 (forced expiratory volume in one second) Involves the amount of
air which can be forcibly exhaled from lungs in the first second of a
forced exhalation
 FVC (forced vital capacity) Involves blowing out as hard as possible after
taking the deepest breath possible into a small machine that tests lung
capacity
 COPD= <.70
 http://www.youtube.com/watch?v=kiQcbXK7f5c
 Using a stethoscope- listen to lungs
 X-ray and CT scans of lungs (but can still look normal)
 Blood tests- measure amounts of oxygen and carbon dioxide in
blood
Spirometry
Treatment for COPD
 No cure for COPD
 Stop smoking- best way to slow down lung damage
 Medications:
 Inhalers (bronchodilators)
 Ipratropium (Atrovent)
 Tiotropium (Spiriva)
 Salmeterol (Serevent)
 Formoterol (Foradil)
 Albuterol
 Inhaled steroids- reduce lung inflammation
 Anti-inflammatory medication
 Montelukast (Singulair)
 Roflimulast
Treatment for COPD
 Severe cases or during flare-ups:
 Steroids by mouth or through a vein
 Bronchodilators through a nebulizer
 Oxygen therapy
 Assistance during breathing from a machine
 Antibiotics (infections can make COPD
worse)
Treatment for COPD
 May need oxygen therapy at home or constantly in
oxygen in blood is too low (< SpO₂ 80%)
 Pulmonary rehabilitation
 Can teach you to breath differently allowing you to stay
active
 Strengthen the lungs
 Help maintain muscular strength in legs
Complications
 Exacerbations: increase in coughing, shortness of breath
and/or amount or color of mucus coughed up
 More frequent lung infections (pneumonia)
 Increased risk of osteoporosis
 Depression or anxiety (reduction in independence)
 Problems with loosing too much weight
 Heart failure (right side of heart)
 A collapsed lung
 Sleep problems (not enough oxygen)
Effects on Exercise Response
 Hyperinflation (crucial aspect): impeded exhalation,
incomplete lung emptying, and air trapping
 When exercising: Dynamic hyperinflation is
superimposed on static hyperinflation
 Reduction in inspiratory capacity
 Smaller tidal volume
 Increased elastic and threshold work of breathing
 Dynamic hyperinflation is directly linked to
breathlessness
Effects on Exercise Response
 Exercise limited by cardiovascular factors:
 Deconditioned
 Impaired left ventricle function (low SpO2)
 Reduced pulmonary blood flow (low SpO2)
 Lactic acid accumulation at low work rates (peripheral
muscle deconditioning)
 Increased CO2 output (bicarbonate buffering)
 Increased ventilator requirement
Effects of Walking
 Study conducted on the effects of walking on COPD patients
 Evaluated the cardiac and respiratory responses as well as electrical
activity of lower limb muscles during walking
 6 min walk test
 Walking distance & speed were significantly lower in COPD patients
 However, COPD patients walked at a higher % of peak VO2
 Surface EMG data taken on muscles were about same for both
 Specifically the vastus lateralis & rectus femoris were more fatigued
 CONCLUSIONs:
 6 min walk test was performed at a relatively higher intensity in
patients with COPD compared with healthy controls
 Walking cause those with COPD to be more vulnerable to muscle
fatigue
Effects of Progressive Resistance
Exercise
 Review of 18 controlled trials conducted to see if resistance
training improves elements of performance of daily
activities
 Found effects favoring the addition of 12 weeks of progressive
resistance training exercise to aerobic exercise for increases in
LBM
 Progressive Resistance Exercise showed no effect on oxygen
uptake
 Found an improvement in walking distance in field-walking tests
 Found an improvement in timed stair-climbing performance
 Found overall improvements in arm & leg muscle strength
Effects of Intermittent Exercise
 Conducted to see the hemodynamic adaption during highintensity intermittent exercise in COPD patients
 30 min exercise session, alternating a 4 min work set at first
ventilatory threshold with a 1 min set at 90% of maximal tolerated
power output
 Found an increase in VO2, cardiac output & ventilation during first
minutes of exercise, but remained STABLE thereafter
 Pulmonary arterial pressure increased from rest and significantly
decreased thereafter
 Total pulmonary vascular resistance decreased from rest to the end of
the test
 CONCLUSION:
 High intensity 1 min bouts of work of intermittent work exercise are
well tolerated w/o pushing pulmonary arterial pressure too high
Effects of Medications
 Beta2-adrenoceptor agonists:
 Relax bronchial smooth muscle & produce bronchodilation
 Methylxanthines:
 Produce bronchodilation & CNS stimulation
 Thiazide diuretics:
 Control fluid retention
 Glucocorticoids (steroids):
 Reduce inflammation & improve pulmonary function
Medications
Heart rate
Blood
Pressure
ECG
Exercise
capacity
Selective Beta2adrenoceptor
agonists
(Sympathomimetic
Agent)
↑ or ⟷
(R&E)
↑, ↓, or ⟷
(R&E)
↑ or ⟷ HR (R&E)
⟷
Methylanthines
(Bronchodialators)
⟷ (R&E)
⟷ (R&E)
⟷ (R&E)
↑EC
Thiazide Diuretics
⟷ (R&E)
⟷ or ↓ (R&E) ⟷ or PVCs (R) May
cause PVCs and “false
positive” test results if
hypokalemia occurs
May cause PVCs if
hypomagnesemia
occurs (E)
⟷
Glucocorticoids
(steroids)
⟷ (R&E)
⟷ (R&E)
⟷ (R&E)
⟷
Antidepressants
↑ or ⟷
(R&E)
↓or ⟷ (R&E)
Variable (R)
Exercise Testing for COPD
 Assessment of physiological function:
 Cardiopulmonary capacity
 Pulmonary function
 Determination of arterial blood gases/ arterial O2 saturation
(direct/indirect)
 Modifications:
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Extended stages
Smaller increments
Slower progression
Example: Naughton Protocol- only speed not grade increases every 2
min instead of every 3 min
 6 minute walk test
 Popular for assessing functional exercise capacity
 Walking is usually best, COPD patients usually lack muscle strength for
stationary cycling & arm ergometry may cause increased dyspnea
Effects of Exercise Training
 Almost any level of physical activity can improve oxygen
utilization, work capacity and anxiety
 Benefits of exercise
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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
Exercise Programming
 Recommended mode of exercise: walking, cycling,
swimming or conditioning exercises (tai chi)
 enjoyable & improves ability to perform daily activities
 Oxygen administered if SpO2 < 88%
 Goal is have SpO2 >90% during exercise
 Modifications to duration & frequency might be necessary
 5-10 min sessions vs. 20-30 min
 6 week exercise program w/ group intervention is helpful
 Rehabilitation exercises should be LIFELONG
 COPD patients are at risk for relapsing
Conclusions
 COPD is a chronic inflammatory disease of the lung
that is characterized by progressive and irreversible
airflow limitation (no cure)
 COPD is usually a combination of Bronchitis &
Emphysema
 An estimated 24 million Americans have COPD
 Smoking is the leading cause of COPD
 Best test for COPD- spirometry
Conclusions
 Inhalers, steroids & anti-inflammatory medication are
used to help off set symptoms
 Hyperinflation is a crucial aspect of COPD
 Progressive resistance & intermittent exercise can be
beneficial
 Walking may improve endurance better than cycling
 6 min walk test is most popular for testing COPD patients
 Numerous benefits of exercise
 Rehabilitation should be a lifelong process
References
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Durstine, Larry J., Moore, Geoffrey E., Painter, Partricia L., & Roberts, Scott O. (2009). ACSM’s Exercise
Management for Persons With Chronic Diseases and Disabilities. Champaign, IL: Human Kinetics.
LifeExtension (2011). Chronic Obstructive Pulmonary Disease, Emphysema and Chronic Bronchitis.
Retrieved from http://www.lef.org/protocols/respiratory/copd_01.htm
Lonsdorfer-Wolf, E., Bougault, V., Doutreleau, S., Charloux, A., Lonsdorfer, J., & Oswald-Mammosser, M.
(2004). Intermittent exercise test in chronic obstructive pulmonary disease patients: how do the
pulmonary hemodynamics adapt?. Medicine & Science In Sports & Exercise, 36(12), 2032-2039.
Marquis, N., Debigare R, Bouyer L, et. al. 2009. Physiology of walking in patients with moderate to
severe chronic obstructive pulmonary disease. Med. Sci. Sports Exerc. 41:1540-1548.
O'Shea, S., Taylor, N., & Paratz, J. (2009). Progressive resistance exercise improves muscle strength and
may improve elements of performance of daily activities for people with COPD: a systematic review.
Chest, 136(5), 1269-1283. doi:10.1378/chest.09-0029
The Credit Valley Hospital (2011). Screening for COPD. Retrieved from http://www.cvhon.ca/podcasting/video.php
Thompson, Walter R., Gordon, Neil F., & Pescatello, Linda S. (2009) ACSM’s Guidelines for Exercise
Testing and Prescription, 8th edition.
WebMD. (2011) COPD-Ongoing Concerns. Retrieved from
http://www.webmd.com/lung/copd/tc/chronic-obstructive-pulmonary-disease-copd-ongoing-concerns
World Health Organization (2011). Chronic Obstructive Pulmonary Disease (COPD). Retrieved from
http://www.who.int/mediacentre/factsheets/fs315/en/index.html
ANY QUESTIONS??