Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD)encompasses a group of lung disorders that include chronic bronchitis, emphysema, chronic obstructive airways disease and chronic asthma. COPD affects millions of people worldwide and this disease is mostly attributed to smoking. Air pollution, working in an environment with harmful effluents and passive smoking are also likely causes for Chronic Obstructive Pulmonary Disease. Sometimes a patient may suffer an inherited form of emphysema due to a deficiency of alpha-1-antitrypsin. With chronic bronchitis, the air passages and mucus glands are enlarged thereby leading to severe cough. Over time, the enlargement can lead to reduced oxygen supply to the lungs. Elevated blood pressure is noticed. This condition is more predominant in those who smoke or have a history of respiratory illness. While some patients develop wheezing and shortness of breath, others notice mucus while coughing. Chronic bronchitis is noticed with symptoms such as continuous cough, rapid breathing and cyanosis (bluish tint to the lips and nails). Morning headaches may be noticed on account of inability to remove carbon dioxide from the blood. Patients with severe case of COPD may face hemoptysis (alternatively haemoptysis) (blood while coughing). Emphysema occurs when the tiny alveoli in the lungs are destroyed thereby hampering efficiency of the lungs. It leads to labored breathing and the patient often feels out of breath. Other symptoms are loss of weight, disturbed sleep and tight constriction in the chest.

Diagnostic tests for COPD include blood tests and pulmonary function test. The pulmonary function test is an indicator of the extent of blockage of the lungs. Chest x-rays help in identifying damaged areas of the lungs and areas of fluid collection as well as any masses in the lungs. Sputum culture can identify any respiratory infection. A spirometry test measures the amount of air a person can blow in a second. Arterial blood gas analysis indicates how efficiently the lungs bring oxygen into the blood and remove carbon dioxide.

Antibiotics can help in tackling the bacterial infections in the lungs. Bronchodilators open up the air passages in the lungs thereby alleviating some of the symptoms of Chronic Obstructive Pulmonary Disease. Inhaled corticosteroids will reduce airway inflammation. In severe cases, oxygen is administered. In addition, some lifestyle changes must be followed:

• Avoid smoking
  
• Avoid exposure to secondhand tobacco smoke
  
• Adopt physical fitness regime to maintain good lung health
  
• As far as possible, avoid environmental irritants, hazardous inhaled substances such as paints, chemicals and cleaning agents
  
• Balanced diet
  
• Plenty of water and fluids
  
• Steam inhalation
  

Physiotherapy

Physical therapy also known as physiotherapy, includes evaluating, diagnosing and treating numerous disorders and disabilities through the physical way. This branch of medicine helps people restore, retain and maximize their strength, function, movement and overall well-being.

People who practice this branch of therapy are called physiotherapists. Diagnosis, treatment and rehabilitation of patients are their main areas of work. They primarily work with physical disorders and disabilities. Physiotherapy helps a person

• Become flexible
  
• Improve mobility
  
• Reduce pain
  
• Stay active
  
• Prevent injury
  
• Recover from injury

Physiotherapy helps the human body to remain functional. Physiotherapy is recommended when the human body suffers some physiological trauma. During physiotherapy the patient is examined physically and if required imaging studies are carried out so as to decide the right type of therapy. It is recommended in the following conditions:

• Post injury rehabilitation like fracture recovery, post surgical recovery.
  
• Spine problems like spina bifida, sciatica.
  
• Neck problems
  
• Muscular problems
  
• Joint disorders like osteoarthritis
  
• Neurological disorders like stroke, multiple sclerosis
  
• Backaches
  
• Headaches
  
• Urinary problems like urinary incontinence
  
• Lung and heart disease like chronic obstructive pulmonary disease

Heat therapy: Heat therapy improves the blood flow to the injured area thus speeding up healing. Heat therapy also loosens the tight tissues thereby relieving pain. Various heat treatments include ultrasound, hot pack, infrared heat, Paraffin wax bath, Diathermy

Cryotherapy: Cold therapy helps in minimizing the swelling and pain. It is very useful in acute injuries. Various treatments include ice massage and ice pack application

Strengthening exercises with Physical Therapy: Certain conditions may have caused the muscles to weaken, there are certain types of exercises aimed at strengthening the muscles thereby helping rehabilitation and improving performance.

Range Of Motion exercises: ROM exercises help in improving and maintaining the flexibility of joints. They also help in reducing the stiffness of the joints. Various exercises include:

Passive Range of Motion exercises: (PROM)

Active Range of Motion exercises: (AROM)

Active Assistive Range of Motion exercises: (AAROM)

Soft tissue mobilization/Therapeutic massage:This relaxes the tight muscles thus relieving pain and reducing swelling

Electrical stimulation: This method is used to prevent muscle atrophy in people with paralysis. Electrodes are placed on the surface of the skin thus causing the muscle to shorten.

TENS: Transcutaneous Electrical Nerve Stimulation is a type of never stimulation wherein a low degree electrical current is passed through the surface of the skin to the affected part. This process helps in relieving pain momentarily.

Other types of physical therapy treatment include taping, bandaging, joint mobilization, ergonomic training, postural training, balance exercise, traction, fitting of orthosis, etc. Physiotherapy has various specializations like geriatric, pediatric, orthopedic, neurological, sports, cardiovascular and pulmonary.

Cylindrical Bronchiectasis

Bronchiectasis is an inflammatory condition of the bronchus present in the lungs. It is caused because of a preexisting lung infection. It was first identified by Laennec in 1819. The symptoms associated with it are categorized by persistent exacerbation. There are three predominant forms of bronchiectasis - cylindrical, varicose and cystic respectively. Bronchiectasis is one of the causes associated with chronic obstructive pulmonary disease. Bronchiectasis occurs at a specific location initially and then the locus of the inflamed tissue progresses to other parts.

Bronchiectasis is caused by damage to the bronchiolar tissue. The inflammation weakens the elasticity of the respective tissue causing muscular damage and eventually weakens the bronchial walls. A scarred tissue is the evidence of its onset and this leads to conditions such as edema and secondary microbial infections which further damage the parenchymatic tissue of the bronchus. In case of cylindrical bronchiectasis the bronchus becomes enlarged because of the inflammation and appears cylindrical. It is also called tram track appearance and signet ring appearance referring to the dilation caused in the bronchus. Radiological findings of cylindrical bronchiectasis indicate that the diameter of the luminary air way becomes more than the vessels adjacent to it.

The secondary microbial infections in bronchiectasis are caused by atypical forms of Mycobacteria, Klebsiella pneumonia, Staphylococcus species predominantly aureus and also plasma. Pertussis, Respiratory syncytial and influenza viruses also cause much damage in the form of secondary infections. In some cases, aspirations have also been reported to cause bronchiectasis especially associated with food particles. In addition to these, bronchiectasis can occur because of several acquired and congenital reasons such as Young's syndrome, alpha 1 antitrypsin deficiency and allergic bronchitis associated with aspergillosis.

Diagnosis of Bronchiectasis

Many factors contribute to its occurrence which also includes lifestyle patterns such as stress and smoking. These factors damage the bronchial tissue thus leading to the onset of the obstructive disease. Patients suffering from bronchiectasis of any form suffer symptoms such as purulent cough which persists for a long time, low grade fever, weight loss in case associated with tuberculosis, edema and fatigue.

Radiology helps in identifying the type of bronchiectasis which can be clinically correlated with the associated microbial infection. Specificity of cylindrical bronchiectasis is identified by the presence of dilated bronchus (increased luminary space) with inflammation. Patient history examination is also necessary to identify congenital pulmonary abnormalities.

Treatment of Bronchiectasis

Bronchiectasis patients are treated with standard anti-inflammatory and antimicrobial regimens. The prognosis is closely associated with change of lifestyle. Complications include pneumothorax, persistent hospital acquired pneumonia, antimicrobial resistance, lung abscesses and emphysema.

Tags: #Chronic Obstructive Pulmonary Disease #Physiotherapy #Cylindrical Bronchiectasis