COPD

Dara Delgado, Casey Polk, Ashley Hayes

Question:

I've been diagnosed with COPD after many years of smoking.

I feel out-of-breath when walking up the stairs in my house.
I've always wanted to try rowing and there is a lake and rowing
team near my house.
Would rowing alleviate my COPD symptoms?
 1. COPD
2. Risk factors
Overview 3. Signs and Symptoms
4. Diagnosis and Treatment
5. Rowing
6. Recommendations
What is COPD?
-Chronic obstructive pulmonary disease
progressive disease that makes it hard to breathe.

-Causes coughing that produces large amounts of

mucus, wheezing, shortness of breath,
chest tightness, and other symptoms.
The Lungs
1. Bronchial tubes
2. Bronchioles
3. Alveoli.
4. Capillaries
Oxygen passes through the air
sac walls into the blood in the
capillaries.
Carbon dioxide moves from the
capillaries into the air sacs.
Gas exchange.
In COPD, less air flows through the airways because of
one or more of the following:

The airways and air sacs lose their elastic quality.

The walls between many of the air sacs are destroyed.
The walls of the airways become thick and inflamed.
The airways make more mucus than usual, which can clog them.
In the United States, the term "COPD"
includes two main conditions.

Emphysema: The walls between many of the air sacs

are damaged & lose their shape.

Fewer and larger air sacs & the amount of gas

exchange in the lungs is reduced.

Chronic bronchitis: Lining of the airways is

constantly irritated and inflamed causing the lining to
thicken. Thick mucus forms in the airways, making it
hard to breathe.

Most people who have COPD have both emphysema and chronic bronchitis.
Pathophysiology
Obstructive lung disease
airflow limitation
air trapping
Shortness of breath
Narrowing of the air way
Inflamation
Scarring
Pathophysiology
Poor air flow
Emphysema
Small airway disease
poor absorption and release of respiratory gases.

Bullous emphysema.
Severe destruction of small airways
formation of large air pockets-known as bullae
replace lung tissue
History OF COPD
The term COPD is believed to have first
been used in 1965.
Rene Laennec, the physician who invented
the stethoscope, used the term
emphysema in his book A Treatise on the
Diseases of the Chest and of Mediate
Auscultation (1837) to describe lungs that
did not collapse when he opened the chest
during autopsy.
He noted that they did not collapse as
usual because they were full of air and
filled with mucus.
History of COPD
In 1953, Dr. George L. Waldbott, an
American allergist, first described a
new disease he named smokers
respiratory syndrome in the 1953
Journal of the American Medical
Association.
This was the first association between
tobacco smoking and chronic
respiratory disease.
History of COPD
Early treatments of COPD included garlic, cinnamon
and ipecac, among others. Modern treatments were
developed during the second half of the 20th century.
Evidence supporting the use of steroids in COPD were
published in the late 1950s.
Bronchodilators came into use in the 1960s. Further
bronchodilators came into use during the 1970s
followed by the use of LABAs in the mid 1990s.
Epidemiology
It typically occurs in people over the age of 40. Males and females are affected
equally commonly.
COPD may also occur in a number of other animals and may be caused by
exposure to tobacco smoke.
In horses it is known as recurrent airway obstruction and is linked to an allergic
reaction to a fungus contained in contaminated hay or straw.
COPD is also commonly found in old dogs.
Statistics
United States

3rd leading cause of death

11 million diagnosed in U.S.
Estimated 24 million have unknowingly
Men and women are affected equally

Worldwide

2013 - COPD affects 329 million people worldwide (nearly 5% of the population)
Risk Factors and causes of COPD
Tobacco Smoke Exposure
Occupational Exposure to Dust and Chemicals
Genetics - alpha-1-antitrypsin
Age
Diagnosis of COPD
Should be considered in anyone over the age of 40 with
shortness of breath, a chronic cough, sputum production,
frequent winter colds, or history of exposure to risk
factors for the disease.
Two main components measured:

FEV1 - forced expiratory volume in one second

FVC - forced vital capacity

Diagnosis of COPD
COPD = FEV1/FVC ratio of less than 70%
Chest X-ray or CT - over expanded lungs and a
flattened diaphragm
Spirometry
Measures amount of airflow obstruction
Generally carried out after the use of a
bronchodilator (medication used to
open up the airways)
Helps determine severity of airflow
limitation
Typically based on the FEV1 expressed
as a percentage of the predicted
normal for the persons age, gender,
height and weight
GOLD and other Programs
Divide people into four categories based on symptoms, assessment, and airflow
limitation.
GOLD and other programs
There are a number of
methods to determine
how much COPD is
affecting a person
including the modified
British Medical Research
Council questionnaire
(mMRC) or the COPD
assessment test (CAT),
which both determine the
severity of symptoms.
Signs and Symptoms
Cough Respiratory Distress
Rapid Breathing
Chest Discomfort
Peripheral Edema
Shortness of Breath Hyperinflation
Wheezing Abnormal Lung Sounds
Prolonged Expiration
Elevated Jugular Venous Pulse
Cyanosis
Nail Clubbing
Management of COPD
No known cure for COPD

Symptoms are treatable and progression can be delayed

Goals: reduce risk factors, manage stable COPD, prevent and treat acute

exacerbations, and manage associated illnesses

Other recommendations: influenza vaccination once a year, pneumococcal

vaccination once every five years, and reduction in exposure to environmental air

pollution.
Management of COPD
Stop Smoking
Avoid Irritants in the Air
Oxygen Therapy
Pulmonary Rehabilitation
Healthy Weight
Possible Exercise
Make Daily Tasks Easier
Oxygen Therapy
Those with low oxygen levels at rest
Decreases risk of heart failure and death if used 15 hours
per day
May improve ability to exercise
Low oxygen levels, if present for a prolonged period, can
result in narrowing of the arteries in the lungs

Pulmonary Rehabilitation
Breathing Exercises
Exercise Education
Nutrition
Exacerbations of COPD
An acute exacerbation of COPD is defined as
increased shortness of breath, increased
sputum production, a change in color of the
sputum from clear to green or yellow, or an
increase in cough in someone with COPD.
This may present with signs of increased work
of breathing such as fast breathing, a fast heart
rate, sweating, active use of muscles in the
neck, a bluish tinge to the skin, and confusion.
Exacerbations of COPD
An acute exacerbation, sudden worsening of symptoms, is commonly triggered by

infection or environmental pollutants.

Infections cause about 50% to 75% of cases

Bacteria in 25%

Viruses in 25%

Both in 25%.
Inactivity and COPD

Shortness of breath increasingly sedentary lifestyle, a progressive deterioration

in functional capacity, and possible isolation at home.
Inactivity = cardiovascular function and skeletal muscle mass decline.
The deterioration in aerobic fitness and strength creates a vicious cycle that leads
to greater breathlessness with exertion, muscular fatigue, and eventual loss of
functional independence, and depression.
A major goal of pulmonary rehabilitation exercise programs is to reverse the
physical disability resulting from inactivity (ACSM).
Benefits of Exercise
Increased physical capacity = decreased anxiety about breathlessness, greater
independence in daily activities, reduced fatigue and improved quality of life.
Positive outcomes occur even though impaired lung function continues to persist
after exercise training.
Regular exercise = more recreational and vocational activities
Gain in fitness and confidence with exercise reverses the spiral of deconditioning
associated with COPD.
Decrease in exercise anxiety
What type of exercise is best?
Aerobic:
Steady physical activity using large muscle groups.
Strengthens the heart and lungs, and improves the body's ability to use oxygen.
Decrease heart rate and blood pressure
Improve your breathing

Strengthening:
Repeated muscle contractions until the muscle becomes tired.
Strengthening exercises for the upper body help increase the strength of respiratory muscles.
Breathing During Activity
Breathe out slowly and gently through pursed lips = more complete lung
action when oxygen is exchanged
Exercise will not harm lungs.

Shortness of breath during an activity = body needs more oxygen.

Slow rate of breathing and concentrate on exhaling through pursed lips =
restore oxygen to your system more rapidly.
 16 patients

Aerobic (continuous and interval) training group and a control group (no training)

Maximal cardiopulmonary exercise test on treadmill (initial speed of 2.0 kmh-1,

constant slope of 3%, and increments of 0.5 kmh-1 every 2 minutes)

Voluntary exhaustion
Training group: 3x per week:

4 weeks @ 60% of the peak velocity reached in the incremental test (vVO2peak)

(50 minutes of continuous effort)

4 weeks of sessions @ 75% of vVO2peak

(30 minutes of continuous effort)

4 weeks of interval training

(53-minute effort at vVO2peak, separated by 1 minute of passive recovery).

Intensities were adjusted through an incremental test performed at the end of each
period.
Results: Aerobic training group = increase in peak oxygen uptake
(VO2peak) and anaerobic threshold

No significant changes were observed in the control group

group.
Neither of the groups presented changes in mucociliary
clearance after 12 weeks.
 Improved heart rate
Better adaptation and efficiency of the cardiovascular system
Better respiratory capacity and response to physical activity
Resistance Arm Training in Patients with COPD
Aim: Upper extremity resistance training for those with COPD during Activity of
Daily Life (ADL), arm function, arm exercise capacity, muscle strength, and health-
related quality of life (HRQL)
36 Patients with COPD (M = 66, SD = 9 years)
Intervention: arm resistance training
Control: flexibility training
Time: 3 times per week for 6 weeks
 Results: 6-minute pegboard and ring test, unsupported upper limb exercise test,
elbow flexion force, elbow extension force, shoulder flexion force, and shoulder
abduction force all increases
Not significant: ADL, HRQL, or symptoms during 6-minute pegboard and ring test, or
unsupported upper limb exercise test
Rowing How hard can it be?

https://www.youtube.com/watch?v=GN4KTFMXATo
Rowing
Rowing was the first intercollegiate sport contested in the United States. The
first rowing race was between Harvard and Yale in 1852.

Rowing a 2,000-meter race (equivalent to 1.25 miles) is equal to playing back-

to-back basketball games.

Endurance training is very important - the aerobic system contributes 70-80%

of the energy in a rowing race.

The physical demands will vary a little for rowers in different disciplines
 Muscle Activation

Rowing is one of the few non-weight bearing

sports that exercises all the major muscle
groups, including quads, biceps, triceps, lats,
glutes and abdominal muscles.

The sport also improves cardiovascular

endurance and muscular strength.
 I've been diagnosed with COPD after many years of smoking.
I feel out-of-breath when walking up the stairs in my house.
I've always wanted to try rowing and there is a lake and rowing team near my house.
Would rowing alleviate my COPD symptoms?

Recommendations
Assume Stage 2 COPD
Start on rowing machine or other aerobic training
Wear a life jacket
Try Kayaking or Canoeing
Recommendations
References
American Lung Assoication http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/?referrer=http://my.clevelandclinic.
org/health/diseases_conditions/hic_Understanding_COPD/hic_Coping_with_COPD/hic_COPD_Exercise_and_Activity_Guidelines

Leite, M. R., Kalva-Filho, C. A., Freire, A. P., Silva, B.S., Nicolino, J., Toledo-Arruda, A., . . . Ramos, E. M. (2015). Effects of 12 weeks of aerobic training on
autonomic modulation, mucociliary clearance, and aerobic parameters in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease
COPD,2549. doi:10.2147/copd. s81363

Jorgen Vestbo, Suzanne S. Hurd, Roberto Rodriguez-Roisin. (2012). The 2011 revision of the global strategy for the diagnosis, management and prevention of
COPD (GOLD)-why and what?The Clinical Respiratory Journal,1752. doi:10.1111/crj.12002

Benjamin Waschki, MD et al. (2011). Physical Activity is the Strongest Predictor of All-Cause Mortality in Patients With COPD.Chest Journal,140(2):331-342.
doi:10.1378/chest. 10-2521

Centers for Disease Control and Prevention http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6146a2.htm

National Heart, Lung and Blood Institute http://www.nhlbi.nih.gov/health/health-topics/topics/copd

Global Initiative for Chronic Obstructive Lung Disease http://goldcopd.org/uploads/users/files/GOLD_Report_2011_Feb21.pdf