Chapter 7: Pulmonary Pathology

INTRODUCTION

The goal of this chapter is to provide a review of pulmonary diseases and disorders that impact pulmonary function and thus impact human performance. The pulmonary system is responsible for the delivery of oxygen and the release of carbon dioxide, which is vital for normal cellular function. The lungs also assist the renal system in the regulation and maintenance of acid-base balance. When lung function becomes impaired, multiple systems may be affected. Consequently, it is important that physical therapists have an understanding of lung pathologies and their clinical presentation to perform a thorough evaluation, properly monitor the patient, and design an appropriate treatment plan.

This chapter is divided into sections that are based on common pathological impairments and clinical presentations. The first group of pathologies has been classified as chronic obstructive pulmonary diseases (COPDs). The second group involves diseases that cause a pulmonary restrictive breathing pattern. Other smaller categories include infections, diseases that disrupt the pulmonary vascular system, and diseases that have pleural involvement. Separate chapters (Chapters 13 and 14) address neuromuscular and musculoskeletal disorders that affect pulmonary functioning.

CHRONIC OBSTRUCTIVE PULMONARY DISEASES

Chronic obstructive pulmonary disease (COPD) is a generic term that refers to lung diseases that result in air trapping in the lungs, causing hyperinflation of the lungs, and a barrel-chest deformity. The Global Initiative for Chronic Obstructive Lung Disease recently updated the definition of COPD, which commonly refers to emphysema and chronic bronchitis as “a disease state characterized by airflow limitation that is not fully reversible. Although there is a genetic component to COPD, it is largely believe that many cases are preventable.¹ The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles/gases, primarily caused by cigarette smoking. Although COPD affects the lungs it also produces systemic consequences.”² This classification of pulmonary disease can be further subdivided based on the presentation of chronic production of purulent sputum. Nonseptic obstructive diseases typically do not clinically present with chronic and consistent sputum production. Nonseptic obstructive disease includes diagnoses such as emphysema, α₁-antitrypsin deficiency (α₁-ATD), and asthma. Patients with a nonseptic disease may produce a small quantity of sputum, but it is not as significant as it is in diseases like cystic fibrosis (CF), chronic bronchitis, and bronchiectasis, which are classified as septic obstructive pulmonary diseases. These diseases are clinically associated with large volumes of sputum production, colonization of bacteria and fungus, and chronic infections. This division may assist the physical therapist in anticipating where airway clearance techniques will need to be a primary focus of intervention.

Nonseptic Obstructive Airway Diseases

As a classification of pulmonary disease, COPD is the third leading cause of death in the United States, afflicting 24 million Americans are affected with some type of COPD. By 2020, it is ...