presented by Jennifer Ryan
The pathophysiology of COPD impacts many body systems. The disease of COPD is classified in four stages using the GOLD (Global Initiative for Chronic Obstructive Lung Disease) Standards. While most people think of the direct pulmonary changes that are a result of the pathophysiology of COPD, the disease impacts multiple body systems. Changes in connective tissue quality lead to both increased compliance in the lung tissue as well as accelerated airway collapse on rapid exhalation, which both impact the propensity for CO2 retention and can alter pH. There is a direct impact on muscle physiology in COPD that is not related to impaired oxygenation but that does relate to both the morbidity and mortality of patients with COPD. Cor pulmonale is a term related to right heart failure that is a result of changes in pulmonary pressures and the heart’s ability to flow blood forward into the pulmonary vasculature that is altered by the connective tissue environment of the lungs that surrounds it. Common medications required to manage the respiratory symptoms of COPD further impact tissue quality of the skin that reduce turgor and resilience. And, ongoing breathlessness impacts a patient’s ability to manage their respiratory rate and volume. All of these sequelae will be explored to best understand the multisystem impairments of a patient with COPD as they progress through the continuum of the first through fourth stages.
Jennifer Marie Ryan, PT, DPT, MS, CCS, graduated from the Physical Therapy program at the University of Illinois in 1990 and went on to complete both a Master of Science in Physical Therapy and a Transitional Doctor of Physical Therapy degree at Rosalind Franklin University of Medicine and Science. In July 2006, she was awarded board certification as a Cardiovascular and Pulmonary Clinical Specialist by the American Board of Physical Therapy Specialties. In 2012 she was awarded the Mary Sinnott Award for Excellence in Acute Care and she was awarded the Acute Care Section Lecture for 2014.
Throughout her physical therapy career, she has specialized in physical therapy care for critically ill patients. In her current position at the University of Chicago Medical Center she mentors staff and students about management of acutely ill patients along with her patient care. Her teaching in the area of cardiovascular and pulmonary physical therapy includes several continuing education seminars, and as a contract faculty member in the Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine.
She serves as: a delegate from the Illinois Chapter of the American Physical Therapy Association, the Education Chair for the Cardiovascular and Pulmonary Section of APTA, and as a member of the Subject Matters Expert Task Force of the Acute Care Section of APTA. She founded Rehab Education Formula, an online resource for therapist-focused education.
COPD is an umbrella term that alludes to emphysema, bronchiectasis and asthma. The changes specifically related to emphysema will be explored in depth due to it’s prevalence in society and impact on public health.
This segment addresses the components of the work of breathing, including the work against elastic recoil and non-elastic resistance, and changes in this work that occur with age and the development of COPD.
Gaining an understanding of the tissue changes that lead to CO2 trapping will be addressed in this segment. While the mechanics are vital to understand to plan interventions, it is also vital to understand the impact of elevated CO2 levels on a patient’s ability to oxygenate in the periphery based upon their pH and their tissue respiration.
The prolonged changes in pulmonary mechanics related to COPD have an impact on the forward flow of the right heart. The changes in pulmonary compliance an subsequent vascular resistance impact the ability of the right heart to flow deoxygenated blood into the pulmonary vasculature and optimize percentage of hemoglobin groups bound to oxygen. The possible changes in a person’s cardiac function will be explored specifically related to changes with COPD.
Prolonged use of steroids to reduce airway inflammation and improve ventilation and exhalation through optimizing airway mechanics has a negative impact on the patient’s skin integrity. The risks related to this potential change will be explored as it can impact a patient’s exercise tolerance and overall safety with progressive mobility.
The changes in connective tissue quality put a patient at risk of CO2 retention, but the negative outcomes related to the changes can be mitigated with the use of paced breathing patterns. The role of pursed lip breathing to manage respiratory rate as much as it is used to manage optimized exhalation and reduced CO2 retention will be explained for the clinician to understand how to facilitate a patient to participate in prolonged exercise sessions and advance their independence in and tolerance for ADL’s.