20 subjective questions


20 subjective questions:
Specific questions to ask for COPD patients:
Can you tell me your problem?
When did it start (sudden / gradual)?
Does it occurring on day or night?
Does difficulty in breathing is occur during particular positions?
When you feels difficulty in breathing (in / out)?
Have you had any injury on chest before?
Do you feel breathless when climbing stairs (number of stairs)?
Do you having chest pain during breathless?
Do you feels burning sensation in the middle of chest?
Is your cough is dry or accompanied by mucus?
Is your breathing noisy (wheezing)?
Do you feel feverish?
Are you on bronchodilators?
Do you tend to lean forward?
Have you been treated for any illness previously?
Did you done any surgery on chest?
Do you smoke? If yes how much per day and how long?
Do you drink alcohol? If yes what is the amount?
Is there any illness that runs in your family like asthma, TB, COPD?
Are you on medications?
Explain the factors that causes Obstructive lung Disorders (OLD)
The most important causes of COPD is tobacco smoking, which cause of 85 – 90% of all individuals with COPD in the industrialized world. The effect of smoking were brings from the cradle to the grave. The factor seems to be extend of inhalation and the amount smoked. History of smoking usually more than 20 packs – years. The inhalation of the cigar smoke, damage your airways, narrowing of air sacs and cause COPD. Smoking during pregnancy may cause COPD as this may affect fetal lung growth.

Although smoking is the stronger factor of COPD, other factors definitely play a role and deserve an attention; such as air pollution. Long term exposure to outdoor air pollution such as sulphur dioxide and particulates (black smoke) may develop COPD. Because day – to – day variations in environmental pollution are associated with various in admission to hospital and mortality. Indoor air pollution such as biomass fuel, wood and animal dung for cooking and heating is the important risk factor for COPD and high rated of disease among women than men. Because women have greater exposure during burning cooking fuels.

In addition, occupation also one of the significant cause of COPD due to inhalation of particulates, gases, exposures to dust, construction and plastics manufacturing. These occupation may lead to severe cough and increase in sputum production. However the effect is smaller than smoking, they effect larger amount of population.

Since the bacterial and viral infections in very early childhood predicts lower respiratory tract infections (LRIs) in later life, affect lung development and increase the risk of developing COPD. Who had pneumonia up to age 2, however lung function in children infrequently reduced in function 10 years after the infection. Most often restrictive, if there was a ventilatory defect. Reduced airflow was observed, an adenovirus may cause amplification of inflammation and predispose to the development of pneumonia and COPD.

Explain the problems you identify in OLD patients

The problems that identified in COPD patient were dyspnea. The air (gases) trapped in the alveoli due to reduce in lung elastic recoil by pressures in the lung due to over – inflation of the alveoli (air sacs in the lung). Gas exchange and ventilation – circulation mismatch due to loss of alveolar walls and pulmonary capillary necrosis. Both altered mechanics of breathing contribute to dyspnea.
Presence of barrel shaped chest in COPD due to hyperinflation of the lungs and weakening of elastic tissue. This cause decreases the tension and resulting diaphragmatic pressure generated by diaphragmatic contraction in a more shortened, low flat position.
Mucus hyper secretion with cough be seen in COPD patient due to increase hyperplasia of goblet cells and hypertrophy of glands by in ratio of glandular mucus cells to serous cells. Cough and sputum production can be variable from day – to – day by colors of sputum. Other Clinical features, wheezing, weight loss, cyanotic because of hypoxemia and edematous because of venous stasis and right heart failure.
How do you relieve dyspnea in OLD patients?
Pursed lips breathing techniques aimed at helping patients relieve and control breathlessness, improve their ventilatory pattern and improve gas exchange particularly COPD patients.

Mucociliary transport system removing excessive secretions from bronchus of lung segment to the tracheobronchial tree by postural drainage which using gravity and standard positions are presented.

Active cycle of breathing techniques that includes breathing control, thoracic expansion exercise, and forced expiratory technique can perform to clear secretions from airways. Once secretions are ‘milked’ and moved from smaller to larger airways, huffs from high lung volumes to remove the secretions from airways. This technique may effective as postural drainage, percussion, and shaking.

Lower extremity exercise typically emphasize for COPD patients because upper extremity exercise cause dyspnea to COPD patients (e.g. lifting, grooming)
Positioning reduces dyspnea and improves breathing efficiency and volume. Such as relaxed sitting with arm supported, relaxed standing and forward leaning on sitting position.

Reference:
Cardiorespiratory physiotherapy adults and paedriatrics.5th edition by Eleanor Main, Linda Denehy 2016. Publisher : Elsevier
Cardiovascular and pulmonary physical therapy, 2nd edition Joanne Watchie, PT, CCS; 2010. Publisher: Elsevier.

Cardiovascular/ respiratory physiotherapy, Mandy Smith, Val Ball; Publish: 1998 by Mosby.

Fishman’s pulmonary diseases and disorders, 5th edition, Micheal A. Gippi. ISBN: 978-1-25-958912-6
Physical rehabilitation, 6th edition, Susan B. O’ Sullivan, Thomas J. Schmitz, George D. Fulk.

Ellen Hillgass.(2017) Essentials of Cardiopulmonary Physical therapy,4th Ed, Elsevier.

Robert M. Kacmarek and etc. (2017), Egan’s Fundamental of Respiratory Care, 11th edition, Elsevier.

https://books.google.com.my/books?id=sqWqDAAAQBAJ;printsec=frontcover;vq=COPD#v=onepage;q=copd;f=false