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Matthew YambaoMatthew YambaoAntonio ZunigaAntonio ZunigaKatherine Katherine PhillipsPhillipsDavid DalivaDavid Daliva
More than 140 different types of disease More than 140 different types of disease processes processes
many share a similar etiologymany share a similar etiology Pulmonary inflammation: common Pulmonary inflammation: common
etiologic factor. etiologic factor. Similar pulmonary anatomic alterationsSimilar pulmonary anatomic alterations Abnormal tissue repair process: produces Abnormal tissue repair process: produces
excess scar tissue excess scar tissue
Cavity: a gas containing space surrounded Cavity: a gas containing space surrounded by thick 1mm wall by thick 1mm wall
Granuloma: small nodular mass of Granuloma: small nodular mass of inflammatory cells (macrophages) which inflammatory cells (macrophages) which resemble epithelial cells resemble epithelial cells
Granuloma formation: inflammatory Granuloma formation: inflammatory response to infective and non response to infective and non infective agents infective agents
Honeycombing: numerous small air-Honeycombing: numerous small air-containing cystic spaces with thickened containing cystic spaces with thickened walls composed of dense fibrous tissue walls composed of dense fibrous tissue
Inflammation & Edema secondary to:Inflammation & Edema secondary to: Infiltration of WBCs (Leukocytes)Infiltration of WBCs (Leukocytes)
Into the alveolar walls and interstitial Into the alveolar walls and interstitial spacesspaces
neutrophils, eosinophils, basophils, neutrophils, eosinophils, basophils, macrophages, monocytes, and macrophages, monocytes, and lymphocyteslymphocytes
Sometimes:Sometimes: Bronchial inflammation and Bronchial inflammation and smooth muscle constriction (obstructive)smooth muscle constriction (obstructive)
Increased numerous WBCs (including Increased numerous WBCs (including some fibroblasts)some fibroblasts)
Extensive inflammation:Extensive inflammation: Interstitium continues to thickenInterstitium continues to thicken Fibrosis and granulomas proliferateFibrosis and granulomas proliferate Honeycombing and cavity formation Honeycombing and cavity formation
ensueensue Pleural effusions may occurPleural effusions may occur
(end stage Pulmonary Fibrosis) (end stage Pulmonary Fibrosis)
Fibrotic thickening of the bronchioles and Fibrotic thickening of the bronchioles and alveolar unitsalveolar units
Destruction of the alveoli and pulmonary Destruction of the alveoli and pulmonary capillariescapillaries
Honeycombing and cavity formationHoneycombing and cavity formation Granulomas Granulomas Airway obstruction: secondary to Airway obstruction: secondary to
inflammation and bronchial constrictioninflammation and bronchial constriction
Inhalation of: Inhalation of: pollen, animal dander, pollen, animal dander, organic dusts, spores of moldsorganic dusts, spores of molds
Farmers lung: moldy hayFarmers lung: moldy hay Bird breeder's lung: bird droppingsBird breeder's lung: bird droppings Malt workers lung: moldy barley, malt dustMalt workers lung: moldy barley, malt dust Maple bark pneumonitis: moldy Maple Maple bark pneumonitis: moldy Maple
barkbark Mushroom workers lung: mushroom Mushroom workers lung: mushroom
compostcompost Wheat weevil disease: infested wheat flour Wheat weevil disease: infested wheat flour
Inhalation of: Inhalation of: pollen, animal dander, pollen, animal dander, organic dusts, spores of moldsorganic dusts, spores of molds
Farmers lung: moldy hayFarmers lung: moldy hay Bird breeder's lung: bird droppingsBird breeder's lung: bird droppings Malt workers lung: moldy barley, malt dustMalt workers lung: moldy barley, malt dust Maple bark pneumonitis: moldy Maple Maple bark pneumonitis: moldy Maple
barkbark Mushroom workers lung: mushroom Mushroom workers lung: mushroom
compostcompost Wheat weevil disease: infested wheat flour Wheat weevil disease: infested wheat flour
Inflammation and destruction of the Inflammation and destruction of the pulmonary vesselspulmonary vessels
Wegener’s granulomatosisWegener’s granulomatosis Lymphomatoid granulomatosis Lymphomatoid granulomatosis Chung-Strauss SyndromeChung-Strauss Syndrome
Rapidly fatalRapidly fatal
Necrotizing vasculitisNecrotizing vasculitis
Desquamative Interstitial Pneumonia Desquamative Interstitial Pneumonia (DIP)(DIP)
Hyperplasia (excessive proliferation of Hyperplasia (excessive proliferation of tissue) tissue)
Desquamation (surface shedding) of Desquamation (surface shedding) of alveolar type II cells alveolar type II cells
Usual Interstitial Pneumonia (UIP)Usual Interstitial Pneumonia (UIP) Thickening of the interstitium and Thickening of the interstitium and
alveolar wallsalveolar walls Severe cases: connective tissue Severe cases: connective tissue
replaces alveolar wallsreplaces alveolar walls
Prognosis is better for DIPPrognosis is better for DIP
Drug Induced ILDDrug Induced ILD Chemotherapeutical cytotoxic agents Chemotherapeutical cytotoxic agents
(anticancer agents)(anticancer agents) Bleomycin, CyclophosphamideBleomycin, Cyclophosphamide
Radiation Induced ILDRadiation Induced ILD almost always occurs with administration almost always occurs with administration
of doses above 6000 rads for more than of doses above 6000 rads for more than 6 weeks6 weeks
Fibrosis occurs 6-12 months after Fibrosis occurs 6-12 months after exposureexposure
Irritant gas inhalationIrritant gas inhalation
Rheumatoid arthritis:Rheumatoid arthritis: when it involves the when it involves the lungslungs
Atelectasis, pleurisy (with or without Atelectasis, pleurisy (with or without effusion)effusion)
Systemic lupus erythematosus (SLE)Systemic lupus erythematosus (SLE) Lungs , nervous system, heartLungs , nervous system, heart
Progressive systemic sclerosis Progressive systemic sclerosis (scleroderma) (scleroderma)
Lungs, pulmonary vasculature Lungs, pulmonary vasculature Sjogrens Syndrome:Sjogrens Syndrome: salivary and lacrimal salivary and lacrimal
glands glands Dry mucus membranesDry mucus membranes Pleurisy, mucus plugging, atelectasis, Pleurisy, mucus plugging, atelectasis,
secondary infectionssecondary infections
Good Pastures Syndrome:Good Pastures Syndrome: affects the affects the lungs and kidneys.lungs and kidneys.
unknown etiologyunknown etiology pulmonary hemorrhagepulmonary hemorrhage increased DLCO: increased blood increased DLCO: increased blood
retained in the pulmonary tissue retained in the pulmonary tissue Alveolar proteinosis:Alveolar proteinosis: unknown etiology unknown etiology
alveoli fill with a lipoprotein material: alveoli fill with a lipoprotein material: similar to pulmonary surfactantsimilar to pulmonary surfactant
indistinguishable from pulmonary edema indistinguishable from pulmonary edema except for the absence of cardiac except for the absence of cardiac enlargementenlargement
Bronchiolitis obliterans with organizing Bronchiolitis obliterans with organizing pneumonia (BOOP) pneumonia (BOOP)
plugs of connective tissue in the small plugs of connective tissue in the small airways (bronchiolitis obliterans)airways (bronchiolitis obliterans)
infiltration of the surrounding parenchyma by infiltration of the surrounding parenchyma by mononuclear cells (organizing pneumonia)mononuclear cells (organizing pneumonia)
Lymphangioleiomyomatosis (LAM)Lymphangioleiomyomatosis (LAM) rare disease: affects women of childbearing rare disease: affects women of childbearing
ageage clinical complications: recurrent clinical complications: recurrent
pneumothoraces, hemoptysis, and pneumothoraces, hemoptysis, and chylothorax chylothorax
Hard metal dustsHard metal dusts cobalt and berryliumcobalt and berrylium
Silica dust and asbestos fibersSilica dust and asbestos fibers Irritant gasesIrritant gases
ammonia (commercial refrigeration, ammonia (commercial refrigeration, smelting of sulfide ores)smelting of sulfide ores)
chlorine (chemical and plastic industries, chlorine (chemical and plastic industries, water disinfection),water disinfection),
ozone (manufacture of bleaches and ozone (manufacture of bleaches and peroxides, welding)peroxides, welding)
Moldy hay, moldy barley, moldy sugarcane Moldy hay, moldy barley, moldy sugarcane husks and mushroom composthusks and mushroom compost
Airborne organic dusts or fibersAirborne organic dusts or fibers grain dust, dust from animal and bird grain dust, dust from animal and bird
droppings, cotton and hemp fibers, flax droppings, cotton and hemp fibers, flax dust, malt dust and cork dust dust, malt dust and cork dust
Bacterial or fungal overgrowth may occur Bacterial or fungal overgrowth may occur within air conditioners, air humidifiers, and within air conditioners, air humidifiers, and hot tubshot tubs
Cigarette smoke should to be avoided Cigarette smoke should to be avoided
Excessive secretions not clinically manifestedExcessive secretions not clinically manifested Bronchopulmonary hygiene usually not indicated Bronchopulmonary hygiene usually not indicated General airway managementGeneral airway management adequate humidification of inspired gas (if presence adequate humidification of inspired gas (if presence
of a bypassed upper airway)of a bypassed upper airway) removal of secretions: endotracheal, tracheal, or removal of secretions: endotracheal, tracheal, or
nasotracheal suctioning as needednasotracheal suctioning as neededIntubated PatientIntubated Patient management of cuff pressure using MLT or MOV management of cuff pressure using MLT or MOV
techniquetechnique to avoid tracheal stenosis and/or tissue to avoid tracheal stenosis and/or tissue
necrosis necrosis Some cases of ILD may develop constriction of Some cases of ILD may develop constriction of
bronchial smooth muscle bronchial smooth muscle aerosolized beta 2 adrenergic or aerosolized beta 2 adrenergic or
anticholinergic medications can be anticholinergic medications can be admimistered to relieve the associated admimistered to relieve the associated bronchospasm bronchospasm
SYMPTOMS OF ILDSYMPTOMS OF ILD
Symptoms of ILDSymptoms of ILD
SOBSOBDry coughDry coughRapid, shallow breathingRapid, shallow breathingChest discomfortChest discomfortGradual, unintended weight lossGradual, unintended weight lossFatigueFatigueAching muscles and jointsAching muscles and jointsClubbingClubbing
SYMPTOMS MANAGEMENTSYMPTOMS MANAGEMENT
Symptoms ManagementSymptoms Management
Avoid dust related irritants Avoid dust related irritants Avoid second hand smoke Avoid second hand smoke Be aware of one’s level of activity Be aware of one’s level of activity Breathing techniques Breathing techniques Oxygen therapy Oxygen therapy Benefits of supplemental oxygen Benefits of supplemental oxygen (Reduce heart strain, reduce SOB, (Reduce heart strain, reduce SOB, alleviate chest discomfort, reduce alleviate chest discomfort, reduce fatigue, improve sleep)fatigue, improve sleep)Devices that one’s doctor might Devices that one’s doctor might order are: oxygen concentrator, order are: oxygen concentrator, liquid oxygen liquid oxygen
BREATHING TRAINING TECHNIQUESBREATHING TRAINING TECHNIQUES
Breathing Training TechniquesBreathing Training Techniques
Relax – reduces the amount of oxygen Relax – reduces the amount of oxygen one’s body requires (conscious and one’s body requires (conscious and deliberate effort is required)deliberate effort is required)Diaphragmatic BreathingDiaphragmatic BreathingPursed lip breathingPursed lip breathing
SMOKING CESSATIONSMOKING CESSATION
Ways to QuitWays to Quit
Chantix Chantix ZybanZybanNicotine nasal sprayNicotine nasal sprayNicotine gumNicotine gumNicotine patchNicotine patchCold turkeyCold turkey
MEDICATIONSMEDICATIONS
MedicationsMedications
Corticosteroids – Corticosteroids – anti-inflammatory drugsanti-inflammatory drugs (Prednisone)(Prednisone)Cytotoxic Drugs – Azathioprine, Cytotoxic Drugs – Azathioprine, CyclophosphamideCyclophosphamide AntifibroticsAntifibrotics
BosentanBosentanPenicillaminePenicillamine
Antioxidants Antioxidants OxygenOxygen
• Why is it required as Why is it required as a part of pulmonary a part of pulmonary rehabilitation?rehabilitation?
• The benefits of The benefits of having Relaxation having Relaxation Techniques Techniques
• Ways to relaxWays to relax
Get into shape! Get into shape! Benefits of ExerciseBenefits of Exercise Safety Guidelines Safety Guidelines
Know your limitsKnow your limits
What you should you eat?What you should you eat? Modified eating habits Modified eating habits Oxygen consumption of eatingOxygen consumption of eating AntioxidantsAntioxidants Losing WeightLosing Weight
Correct diagnosisCorrect diagnosis At home therapyAt home therapy
Medicine Medicine OxygenOxygen
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