COMMON PULMONARY

CONDITIONS IN PHYSICAL
THERAPY

Catherine Rose A. Barrios, PTRP, RN,PT

TOPIC OUTLINE

 COPD
 INFECTIOUS DISORDERS
 PULMONARY EDEMA
 PLEURAL DISEASES
 ATELECTASIS
CHRONIC OBSTRUCTIVE
PULMONARY DISEASES

 Emphysema
 Chronic Bronchitis
 Bronchiectasis
 Asthma
 Cystic Fibrosis
EMPHYSEMA

 Primary structure affected: ALVEOLI

 Most common cause: SMOKING
 Hallmark: excessively large and
ineffective air spaces
 Pathogenesis:
 Lack of proteolytic enzyme inhibitors
 Over abundance of proteolytic enzymes
EMPHYSEMA
 TYPES:
 Centrilobular
 Dominant form; associated with smoking
 Destruction of central portion of acinus
 Panlobular
 Acini destruction: generalized & evenly distributed
 More evenly distributed in the lungs
 Paraseptal
 Localized emphysema
 Local areas of distal acinus
 Involvement of alveolar sac and alveolar duct
 Paracicatricial
 Airspace enlargement with fibrosis
 Preprevious pulmonary lesion
EMPHYSEMA
 S/SX
 Dyspnea (hallmark Sx)
 Couhging
 Prolonged expiration
 Physical inactivity
 Deconditioning
 Use of accessory muscles
 Barrel chest
 Hyperinflated lungs
 Flattened diaphragm
 Wheezes / crackles, not obvious
 Thin and wasted
• On chest x-ray, you notice that there is bullae
formation and loss of peripheral vascular
markings. Spirometry reveals obstrucxtive
pattern unimproved with bronchodilator. What
is the possible diagnosis?
1. Emphysema
2. Asthma
3. Cystic fibrosis
4. Chronic bronchitis
 CHRONIC BRONCHITIS

 Dx: productive cough for 3 months

for 2 consecutive years
 M>F
 Age: >40 y.o.
 Cause: SMOKING
 Pathophysiology
 Hallmark: productive cough
CHRONIC BRONCHITIS

 S/SX
 (+) infection
 Severe cough
 Increased mucous production
 Dyspnea
 Wheezes / crackles during expiration
 Cyanosis: “BLUE BLOATERS”
 Peripheral edema:
• A physical therapist completes an examination on a 46
y/o male with a history of obstructive pulmonary
disease. The patient complains if intermittent dyspnea
and persistent cough. Breonchial drainage reveals
excessive sputum production that appears to be
purulent. The most likely disease classification is:
1. Chronic bronchitis
2. Emphysema
3. Atelectasis
4. Pneumonia
 BRONCHIECTASIS
 IRREVERSIBLE ABNORMAL
DILATION of bronchus.
 Affects medium sized
bronchioles: 4th to 9th
generation
 May occur following infection,
aspiration, tumor or abnormal
immune system
 May include Cystic Fibrosis
 Pulmonary perfusion and
ventilation are severely
REDUCED or ABSENT
BRONCHIECTASIS

 S/SX
 Bronchial artery hypertrophy
 Chronic, productive of copious amounts
of sputum (most common symptom)
 Foul-smelling breath
 Loud, harsh breath sounds
 Low-pitched crackles, wheezes
 X-Ray: increased bronchial markings
ASTHMA
 Narrowing of airways secondary to
bronchospasm
 Types:
 Extrinsic:
 Most common form

 Intrinsic
 Hyperactive parasympathetic nervous system

 Exercise-induced
 Onset of sx between 6-7 minutes

 HR: 170 bpm

ASTHMA
 PATHOLOGY:
 Bronchial smooth muscle contraction and
hypertrophy
 Mucous secretions
 Inflammation of the airways
 S/SX:
 Wheezes
 Dyspnea
 Cough
 hyperinflation
• A physical therapist listens to the lung sounds of a 56
y.o. male with chronic bronchitis. The patient was
admitted to the hospital two days ago after
complaining of shortnewss of breath and difficulty
breathing. While performing auscultation, the
therapist identifies distinct lung sounds with a
relatively high constant pitch during exhalation. This
type of sound is consistent with___.
1. Crackles
2. Rales
3. Rhonchi
4. Wheezes
CYSTIC FIBROSIS
 Most common lethal genetic d/o affecting
whites
 Widespread abnormalities in ALL exocrine
glands; INC secretion leading to
obstruction
 Pancreas
 Sweat glands
 Mucous glands
 AR Ch7 long arm
 INC. NaCl content in sweat
CYSTIC FIBROSIS
 Hallmark SX:
 CHRONIC COUGHING & production of copious
amounts of THICK PURULENT mucous
 EARLY S/SX:
 Tachypnea
 Bradypnea
 Cough
 Wheezing
 Barrel chest
 Lethargic
 Anorexic
 Cyanotic
 hypoxemia
CYSTIC FIBROSIS

 X-RAY:
 HONEYCOMB LUNGS
Infectious Disorders

 Bacterial Pneumonia
 Viral Pneumonia
 Aspiration Pneumonia
 Tuberculosis
 Pneumocyctis Carinii Pneumonia
 Severe Acute Respiratory Syndrome
BACTERIAL PNEUMONIA
 Gram positive
 Community-acquired
 Pneumococcal pneumonia
 Most common type

 Gram negative
 Develops if the host has an underlying
condition (chronic)
 Results in tissue necrosis & abscess formation
 Influenza

 Psuedomonas Aeruginosa
BACTERIAL PNEUMONIA
 FINDINGS:
 Shaking chills
 Fever
 Cough: productive & purulent
 Tachypnea
 Dec. breath sounds
 Inc. WBC count
 Hypoxemia, hypocapnea
 Hypercapnea
VIRAL PNEUMONIA

 Intra-alveolar
 Viral agents:
 Influenza
 Adenovirus
 Cytomegalovirus
 Herpes
 Measles
VIRAL PNEUMONIA

 Findings:
 HISTORY of upper airway infection
 Fever, chills
 Dry cough
 (N) WBC count
 Headaches
 Hypoxemia, hypercapnea
 Dec. breath sounds
ASPIRATION PNEUMONIA

 Aspiration will cause an

inflammatory response
 Usually in patients with
DYSPHAGIA, impaired
consciousness, neuromuscular dse.
ASPIRATION PNEUMONIA

 FINDINGS:
 Cough: dry to putrid secretions
 Dyspnea
 Tachypnea
 Wheezes, crackles
 Chest pain over involved area
 Fever
 WBC count: leukocytosis
TUBERCULOSIS

 Mycobaterium tubereculosis
 Aerosolized droplets
 Incubation: 2-10 weeks
 Primary disease: 10-2 weeks
 Post-infection phase:
REACTIVATION
TUBERCULOSIS
 REMEMBER:
 ISOLATE THE PATIENT DURING THE
INFECTION PHASE
 Keep in mind the universal precautions
 Wear TB mask
 If patient must leave the isolation room,
have the patient wear a specialized mask
to contain the infection
 Medication:
 Duration: 3-12 months
TUBERCULOSIS
 Symptoms (Primary Disease)
 Slight productive cough
 Low grade fever
 Chest x-ray changes consistent with primary
disease findings
 Symptoms (Post-infection)
 Fever
 Weight loss
 Cough
 Hilar adenopathy
 Night sweat
 Crackles
 Hemoptysis
 INC. WBC
PNEUMOCYSTIS CARINII

 Protozoan
 Infects immunocompromised hosts
 Patients with
 Transplantation
 Neonates
 HIV patients
PNEUMOCYSTIS CARINII

 Progressive SOB
 Non productive cough
 Crackles
 Weakness
 Fever
 Infiltrates seen on X-ray
 CBC: NO evident infection!!!
SARS

 Severe Acute Respiratory Syndrome

 Coronovirus
 Findings:
 High temp.
 Dry cough
 Dec. WBC, platelets, lymphocytes
 Increased liver function test
 Abnormal x-ray
PULMONARY EDEMA
 Seepage of fluid from the vascular
system into the interstitial space
 Cardiogenic:
 Left ventricular failure
 Valvular disease (aortic or Mitral)
 Non-cardiogenic:
 Increased permeability of alveolar
capillary membrane due to inhalation of
toxic fumes
PLEURAL EFFUSION
 Excessive fluid between the visceral and
parietal pleura
 Cause: INC pleural permeability to
proteins from inflammatory disease
 Findings:
 Dec. breath sounds
 Pleural friction rub: possible if with
inflammation
 Mediastinal shift
 Breathlessness
 Pain and fever: if with empyema
ATELECTASIS

 Collapsed / airless alveolar unit

 Cause: hypoventilation secondary to
pain during the ventilatory cycle
CRPD

 Due to alterations in lung

parenchyma and pleura
 Due to alterations in the chest wall
 Due to alterations in the
neuromuscular apparatus
REFERENCES

 Siegelman
 Teklin
End…

“He who deliberates fully will spend

his entire lifetime standing on one
leg.”