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Exercise intolerance and physical training in obstructive lung disease college
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Exercise physiology college
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Exercise intolerance and physical training in obstructive lung diesease college blok 2.3Your not able to diagnose a patient with COPD by an X-ray. COPD is a preventable and treatable
diseaus. The main characteristics is persistent airflow limitation. This is usually progressive, and
associated with an enhanced chronic inflammatory response in the airways and the lung to noxious
particles or gases. Exacerbations and comorbidities contributie to the severities of the patient.
COPD is 2 diseases in 1:
1. Small airway remodelling and obstruction: bronchitis.
2. Alveolar destruction: loss of lung recoil: emphysema.
both lead to airway limitation FEV1 daalt.
About 90% of the patients have a smoking history. Some sort of exposure leads to inflammation in
the lung. The alveolar macrophages secrete chemotactic factors.
Lung with emphysema:
- holes.
- much bigger: because of the loss of elastic recoil(elasticity has reduced).
Bronchitis is a disease of the bronchi (not of the alveoli). Complaints of cough and sputum.
About 1/4e of all adults in Maastricht had a lung function defect that was vergelijkbaar met COPD :
hoe ouder hoe hoger de prevalentie.
Diagnose COPD:
3 ways:
1. Spirometry
2. Bodybox
3. Diffusion capacity.
Spirometry
Most common way.Vertical axes you see the airflow, horizontal the volume.
FVC = total amount of air that the patient can breath out.
FEV1 = how much air the patient can breath out in the first second.
FEV1/FVC = marker of airflow limitation: below 0,7: characteristic for COPD. Only way of diagnosis at
the moment.
The expiratory flow declines very rapidly. Inhalation curve is completely normal: expiration problem,
not inspiration.
Residual volume is about 1,5 L. With maximal inspiration you can get about 6 L in your lungs.
In COPD the residual volume, and expiratory rest volume are decreased.
Blood gas analysis: Arterial blood sample in the radial artery. Assesment of arterial PaO2, PaCO2 and
pH. You can get a impression of severity of pulmonary impairment.
We used to classify COPD according to 4 stages. This was purely based on the FEV1. Since 4 years
there is a different classification: with a, b, c, d.
The symptoms of COPD: see ppt.
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