Group 4

Diagnose certain types of lung disease (such as asthma, bronchitis, and emphysema)

Find the causes of shortness of breath.

It is also used to measure whether exposure to chemicals at work affects lung function.

But sometimes the mucus is produced in excess and changes in nature.

Mucus production in the airways is normal. Without it, airways become dry and malfunction.

(COPD patient)

• This results in the urge to cough and expectorate this mucus as sputum. Sputum expectoration is not normal and there is always an underlying pathological cause.

This also can be caused from exposure to the aluminum and the fine dust in the bauxite mining area. It may be chronic cough or acute cough.

a chronic illness characterized by airway inflammation and increase responsiveness of the tracheobronchial tree to diverse stimuli that result in varying degrees of airway obstruction.

a syndrome of Chronic Dyspnea with expiratory airflow obstruction that, unlike asthma, does not fluctuate markedly over periods of several months of observation. The term COPD includes chronic bronchitis and emphysema

inflammation and swelling of the lining of the airways that leads to narrowing and obstruction. Excess production of mucous and bacterial infections and is defined clinically by a daily cough with production of sputum for 3 months, two years in a row.

permanent enlargement of the alveoli due to the destruction of the walls between alveoli –LIMITED GASEOUS EXCHANGE. The destruction of the alveolar walls reduces the elasticity of the lung overall. Loss of elasticity leads to the collapse of the bronchioles, obstructing airflow out of the alveoli. Air becomes "trapped" in the alveoli reducing the ability of the lung to shrink during exhalation. The reduced expansion of the lung during the next breath reduces the amount of air that is inhaled

Signs and Symptom Asthma COPD

Emphysema Chronic

Bronchitis

Coughing with excess

mucus

Yes Yes Yes

Anterior/ Posterior chest

width (barrel chest)

Yes Yes Yes

Respiratory Rate Increases Increases increases

Lung Function Test

FEV( Force Expiratory

Volume)

Decreases Decreases Decreases

Effects of

Salbutamol(brochcodilator)

Increases FEV Increases FEV Increases FEV

Total lung Capacity Increases Increases Increases

Residual Volume Increases Increases Increases

Arterial Blood Gases

PCO2 Does not affect Increases Increases

PH Slight decrease Slight decrease

% saturation of

Heamoglobin

HCO3

Pulmonary function Normal in

remission

Limited only on

onset

Limited Limited

Airflow inhalation and hyperinflation.- limitation of airflow inhalation can be due to intrinsic or extrinsic factors.-hyperinflation leads to an increase in functional residual capacity. This is the amount of air remaining in the lungs at the end of tidal exhalation.

Gas exchange disturbances.-inequalities of ventilation and perfusion.

Ventilatory muscle dysfunction.-limitation of force generation & endurance causes a mechanical disadvantage.

Cardiovascular disturbances. -pulmonary hypertension can occur along with other factors such as endothelial dysfunction remodelling od pulmonary arteries, and pulmonary capillary bed destruction.

Reduced exercise capacity. -deconditioning may result from lack of physical activity.

The vital capacity measured was far less than the predicted value. The vital capacity is the maximum amount of air a person can expire after a full breath. Therefore this means that the patient is expiring less air and keeping more air within the lungs. This decrease in the vital capacity leads to an increase in the residual volume. Because COPD traps/limits gaseous exchange expiratory residual volume will increase. This excess residual volume significantly affect gaseous exchange.

Both the FEV and expiratory flow rate increases after the administration of salbutamol. Salbutamol is a known bronchodilator which causes the airways to widen thus allowing a easier passage into and out of the lungs

While the PCO2 increased significantly one would expect the pH to decrease significantly as the arterial blood would become more acidity..

The pH shifted slightly to a measured value of 7.35 falling slightly to the predicted value. A possible reason behind this is that there is a metabolic compensation ( increase serum bicarbonate) which maintains the arterial blood pH near normal.

Tests Measured Predicted

Vital capacity (L) 2.3 4.2

Functional Residual Capacity (L)

4.0 3.8

Residual Volume (L) 3.8 2.1

Total Lung Capacity (L) 6.8 6.2

FEV1.0 sec (%) 45 78

FEV1.0 sec (after administration of

salbutamol) (%)

58 ------

Peak Expiratory Flow Rate (L/min)

400 550

Peak Expiratory Flow Rate (after salbutamol (L/Min)

475 ----

pH 7.35 7.4

PaCO2 (kPa) 8.29 5.71

HCO3- (mEq/L) 30 25

% Saturation of Haemoglobin(%)

90 97.5

Use of a Bronchodilator can be used for both asthma and COPD

Salbutamol is a bronchodilator and as such it dilates (widens) the airways. It works by opening up the airways so that the air can flow into the lungs more freely. This helps to relieve the symptoms of conditions such as asthma and COPD.

is the measurement of how much the patient can blow out of their lungs in one breath.

It is a crude measurement and not as accurate as Spirometry.

However it is useful for patients to perform themselves, especially when they are having a flare up of their respiratory disease e.g. asthma.

It is beneficial to check the patient’s understanding of their condition. If they do not fully understand then you should explain what is happening and that when they have an exacerbation they will find breathing more difficult.

Furthermore, you should explain why measuring their PEFR is important as a guide to how well-controlled their asthma is at this time.

Explain to the patient that they should be checking their PEFR regularly, particularly if their asthma is worse than usual.

• Stand up or sit upright.

• Take as deep a breath in as you can and hold it.

• Place the mouthpiece in your mouth and form as

tight a seal as possible around it with your lips.

Breathe out as hard as you can

Observe and record the reading

• Repeat the process 3-4 times and record the highest reading.

• Note down the reading in a diary to allow comparison with readings on other days.

Once you have discussed the process with the patient, you should show the patient how to perform the measurement.

Do this by measuring your own PEFR.

Once the technique has been demonstrated, ask the patient to show you how they would perform the measurement themselves.

Make sure they are doing it correctly, and resolve any mistakes which they might be making.

Finish by asking the patient if they have any questions or concerns about either their asthma or taking their PEFR measurement.

FEV 1.0 sec is described as the volume exhaled during the first second of a forced expiratory maneuver started from the level of total lung capacity.

The grouping of tests used to measure lung capacities is known as spirometry, thus tests to measure FEV 1.0 sec fall under this category.

• The instrument used is a spirometer which is available in two types: Volume Type and Flow Type

• Volume Type: Accumulates air and directly measures the volume of exhaled air.

• Flow Type: Measures speed of exhaled air and integrates speed to obtain volume.

For most accurate results, the person conducting the test is required to explain, demonstrate and actively coach the pt on what he/she is expected to do.

Apply noseclips. If they do not fit well, pt may use his fingers to pinch nostrils.

Pt is instructed to take the deepest breath possible such that the lungs are filled.

Mouthpiece is placed on top of the tongue and between the teeth.

Lips are to be tightly sealed around mouthpiece, not pursed behind it.

Chin is elevated slightly and the tongue is kept out of the way. Pt is instructed to give a sharp blast into the mouthpiece as hard,

fast and completely as possible, w/o hesistating.

People with COPD often lack important nutrients in their bodies. Low levels of antioxidants and certain minerals including vitamins A, C and E, Potassium, Magnesium, selenium and zinc are associated with having COPD and may contribute to poor lung function. Therefore eating lots of vegetables and whole grains is recommended to get then nutrients you need. In addition, eating food rich in protein helps with patients with body wasting. (Cachexia)

Although it may seem strange to recommend exercise when patients have breathing problems, exercise does help many people with COPD. By strengthening your legs and arms and improving endurance, you may be able to breathe better.

Walking is a good exercise to build endurance. Exercise is essential due to the fact that there may be wasting away of the muscles and bones

There are breathing exercises such as the pursed lip technique where it helps to change pressure in the airways and prevents small airways from collapsing.

In addition, the patient can breathe from their diaphragm or use the breathing device called a spirometer 2 times a day.

Using the spirometer may help improve lung function.

Defend against infections: People with COPD are at special risk for respiratory infections, which can trigger flare-ups. Infections that affect airways can often be avoided with good hand-washing hygiene. Therefore, wash hands often when out in public.

Don’t Smoke: Smoking is the number one cause of chronic bronchitis and emphysema. Together these diseases compromise COPD. People with COPD should avoid all inhaled irritants whenever possible. This can mean avoiding air pollution, dust or smoke from wood-burning fireplaces.

Keifer, D. Lifestyle changes to help manage COPD. Medically reviewed February 12, 2014 by George Krucik, MD, MBA. Retrieved on February 2, 2015 from World Wide Web: www.healthline.com/health-slideshow/lifestyle-changes-help-manage-copd#1

Fox, S. I. (2011). Human Physiology TwefthEdition. New York: McGraw-Hill.