Lung Expansion FRT Lec Finals

• Lung expansion Therapy or Hyperinflation Therapy


  • Basic therapeutics modalities that we offer to patients
  • One of the respiratory care procedures both home care and hospitals
• BREATHING


  Process of taking air into the lungs and expel it
• RESPIRATION


  Exchange of gases between the air and the blood stream to the cellular level
• TWO TYPES OF RESPIRATION

  • EXTERNAL
  • INTERNAL
• EXTERNAL respiration


  • Exchange of gases in alveoli
  • Gas exchange
• INTERNAL respiration


  • Exchange of gases between your blood and tissues
  • Gas transport
• Oxygen transport in blood


  • Dissolved in plasma and bound to hemoglobin
  • 98% bound to hemoglobin, 2% dissolved in plasma
• Carbon dioxide transport in blood

  • 70% converted to bicarbonate
  • 23% bound to CO2 "carbaminohemoglobin"
  • 7% dissolved in plasma
• 4 PROCESSES OF RESPIRATION

  • PULMONARY VENTILATION - move air from environment to lungs
  • GAS INTERCHANGE/ EXCHANGE - diffusion
  • GAS TRANSPORT - transport oxygen from lungs to tissues
  • CELLULAR RESPIRATION - utilization of oxygen and production of carbon dioxide
• Palv and Patm are equal when AT REST

  • Lung pressures are expressed relatively atmospheric pressure kaya your alveolar pressure is set to be zero.
• The lung has the natural tendency to collapse, and the chest wall has the natural tendency to expand
• At FRC, the opposing forces of the lungs trying to collapse and the chest wall that is trying to expand will create a negative pressure in the intrapleural space that's why your Pip (intrapleural pressure) is negative
• The thorax can increase its diameter in 3 dimensions

  • Vertical increase
  • Transverse increase
  • AP increase
• TRANSVERSE INCREASE OR LATERAL EXPANSION


  • Moves laterally as they are elevated
  • BUCKET HANDLE MOVEMENT
• AP INCREASE


  • Superior are elevated
  • The sternum moves forward anteriorly and posteriorly
  • PUMP HANDLE INSPIRATORY
• DURING INSPIRATION

  1. Inspiratory muscle contract and cause the volume of the to increase

  2. Pip becomes more negative

  3. Lung volume increases by one VT
• What Happens During Inspiration

  1. Alveoli is below your atmospheric pressure

  2. Intrapleural pressure progressively decreases, while diaphragm progressively moves downward
• DURING EXPIRATION

  1. Palv becomes > than Patm

  2. Pip return to its resting value

  3. Lung volume returns to FRC
• What Happens During Expiration

  1. Alveoli pressure becomes greater than your atmospheric pressure

  2. Intrapleural pressure returns to its resting value which around -4mmHg

  3. Your alveoli pressure is compressed by the elastic forces of your lungs, thus your alveolar pressure is now higher than your atmospheric pressure. IT BECOMES POSITIVE
• BRONCHIAL ASTHMA


  • Obstructive disease
  • Decreased FVC, FEV1, FEV1/FVC
  • Increased FRC
• Narrowing of your airway in bronchial asthma is usually reversible but in some patient with chronic asthma there may be an element of an irreversible airway obstruction
• PHYSIOLOGIC ABNORMALITY IN ASTHMA

  Airway hyperresponsiveness
• COMMON ALLERGENS THAT TRIGGER ASTHMA

  • House dust mites or dermatophagoides
• FOUND IN PATIENT WITH ASTHMA: Charcot Leyden crystal
• CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)


  • Obstructive disease
  • Increase lung compliance
  • Decreased FVC, FEV1, FEV1/FVC
  • Increase FRC
• COPD is characterized by an airflow limitation that is not fully reversible
• FEV1 IS QUANTIFY - a reversibility of 12% or 200ml must be observe
• BRONCHODILATOR CHALLENGE TEST

  • AT LEAST 3 SALBUTAMOL IN 10-15MINS
  • To know if there is reversibility or not
• SPIROMETRY IS DONE TO DISTINGUISHED THE TWO DISEASE ENTITIES AND TO DIAGNOSE YOUR AIRWAY DISEASE
• LUNG FIBROSIS


  • Restrictive disease
  • Decrease lung compliance
  • Increased FEV1/FVC
• LUNG FIBROSIS

  • Idiopathic pulmonary fibrosis
  • Asbestos related diseases
  • Cold dust related diseases - Anthracosis
• According to Harrison, one of the most common indications for lung transplantation is IDIOPHATIC PULMONARY FIBROSIS followed by COPD
• LUNG EXPANSION THERAPY

  • INCENTIVE SPIROMETRY
  • IPPB THERAPY
• MAIN GOAL OF LUNG EXPANSION THERAPY

  Increase the transpulmonary pressure gradient
• TRANSPULMONARY PRESSURE GRADIENT


  Pressure difference of alveolar pressure and pleural pressure
• MECHANISM OF LUNG EXPANSION THERAPY

  • Increasing transpulmonary gradient
  • Inspiratory hold
  • Interdependence
• TO INCREASE TPP GRADIENT

  1. Decrease pleural pressure

  2. Increase alveolar pressure
• HOW TO ACHIEVE THE INCREASE TPP BY DECREASING YOUR PLEURAL PRESSURE

  Spontaneous deep inspiration
• ALVEOLAR INTERDEPENDENCE


  • Alveoli have a tendency to collapse
  • Produces forces that tend to prevent collapse
• INSPIRATORY HOLD


  Additional of inspiratory hold to breathing exercise will improve collateral ventilation of alveoli