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The Pathophysiology of Chronic Obstructive Pulmonary Disease

presented by Jennifer Ryan, PT, DPT, MS, CCS

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Disclosure Statement:

Financial: Jennifer Ryan receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course.

Non-Financial: Jennifer Ryan has no competing non-financial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Video Runtime: 68 Minutes; Learning Assessment Time: 42 Minutes

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.

Meet Your Instructor

Jennifer Ryan, PT, DPT, MS, CCS

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…

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1. The Pathophysiological Changes of the Lung Related to COPD

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.

2. The Work of Breathing

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.

3. How CO2 Retention Happens and How It Alters Tissue Oxygenation

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.

4. Cor Pulmonale as a Result of Prolonged Right Heart Strain from Pulmonary Dysfunction

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.

5. The Skeletal Muscle Changes Related to 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.

6. How Breathing Mechanics Need to be Managed to Optimize Ventilation and Exhalation: How Does It All Fit Together

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.

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