Pulmonary Conditions and Diseases

OT Dude Academy’s Free NBCOT® Exam Prep Course Pulmonology Pulmonary Conditions and Diseases
Contents Hide
1 Emphysema
2 Chronic Bronchitis
3 Asthma
4 Bronchiectasis
5 Cystic Fibrosis
6 Acute Respiratory Distress Syndrome (ARDS) & COVID-19
7 Pulmonary Edema
8 Pulmonary Embolism (PE)
9 Pulmonary Hypertension (PH)
10 Pneumonia (PNA)
11 Pleural Effusion
12 Atelectasis
13 Pneumothorax/Hemothorax
14 Empyema
15 Obstructive Sleep Apnea
16 Tuberculosis

Emphysema

A form of COPD and progressive lung disease. Emphysema is caused by the permanent destruction of alveolar walls that results in enlarged airspace. Can be divided into 3 subtypes at autopsy: centrilobular (abnormal enlargement of the airspace), paraseptal (emphysematous lung changes adjacent to the pleura), and panacinar/panlobular (abnormal dilation in pulmonary lobules. End-stage emphysema may lead to pulmonary fibrosis. May be smoking-related or due to an α1-antitrypsin-deficiency.1  Patients in a study with severe emphysema responded well to the National emphysema Treatment Trial (NETT) with the pulmonary rehabilitation protocol. NETT was comprised of supervised exercise training, education, psychosocial treatment, and nutritional treatment.2 

Chronic Bronchitis

A form of COPD characterized by inflamed bronchi that may cause severe coughing and productive cough with mucus, wheezing, angina, and shortness of breath. Acute bronchitis usually develops due to a respiratory infection, whereas chronic bronchitis is a more serious condition that develops over time, such as due to smoking. Other symptoms include dyspnea, nasal congestion, or nocturnal awakenings due to symptoms.3  Symptoms never go away. Other causes include air pollutants, dust, or toxic gases. There is no cure but bronchodilators may help to reduce inflammation along with oxygen therapy and pulmonary rehabilitation.4 

Asthma

Asthma is a chronic condition that results in inflammation and narrowing of the airways. May affect people of all ages. Symptoms may be mild to severe and include wheezing, coughing, or feeling a tightness in the chest. Environmental triggers such as cold air may worsen asthma symptoms. A worsening of symptoms causes an asthma attack. Treatment depends on age and severity. Most people find short-term relief with an inhaler (bronchodilator). Oral and IV corticosteroids and short-acting anticholinergics may help. In emergency cases, people may need to receive oxygen therapy or ventilator assistance for breathing.5  One application of occupational therapy for people with asthma is education, modification, and prevention of environmental irritants such as through home health therapy.6  Occupational therapy practitioners may work with clients of all ages, such as children to promote participation in occupations to minimize the potential of missing school days or poor sleep.7  OTPs can also help people with asthma cope with other stressors or comorbidities such as PTSD to minimize asthma symptoms and attacks.8 

Bronchiectasis

Bronchiectasis is a chronic lung condition resulting in the bronchi walls thickening from inflammation and infection. The cause stems from bronchi no longer being able to eliminate secretions and mucus builds up and becomes infected. A cycle occurs between inflammation and infection leading to decreased lung function over time.9  Symptoms include cough, shortness of breath, and increase in sputum volume.10  Specific causes include autoimmune disease, HIV, diabetes, IBD, COPD, and alpha-1 antitrypsin deficiency. Complications include pneumonia, pertussis, tuberculosis, and fungal infections.9  Treatment may include a multidisciplinary approach with a respiratory therapist. Occupational therapy practitioners may promote participation in occupations to improve the quality of life for people with bronchiectasis as pulmonary rehabilitation in addition to regular chest physiotherapy has shown to be effective for improving QoL and exercise tolerance.11 

Cystic Fibrosis

Cystic fibrosis (CF) is a progressive genetic disease that causes recurrent lung infections and dyspnea. A dysfunctional expression of the CFTR protein causes mucus to clog the airways and become susceptible to infections, inflammation, respiratory failure, and other complications. CF also affects other organs such as the pancreas and liver and interferes with their functions causing malnutrition, poor growth, and liver disease. CF may affect the ability of men to have children. Symptoms of CF include a persistent cough, productive phlegm, lung infections (pneumonia and bronchitis), wheezing, shortness of breath, poor growth or weight gain, and irregular stool or bowel movements. Treatment may include airway clearance, inhaled medicines, antibiotics, nutritional supplements, and an individualized fitness plan12  Diseases such as CF may affect multiple areas of occupation including activities of daily living. It may lead to missed days from school and rehospitalizations.13  Techniques for occupational therapy practitioners working with children include energy conservation, prevocational, recreational, and psychosocial support groups.14 

Acute Respiratory Distress Syndrome (ARDS) & COVID-19

Pulmonary Edema

Pulmonary edema is an abnormal buildup of fluid in the lungs that leads to shortness of breath. Often caused by congestive heart failure (CHF) as the heart is not able to pump efficiently and blood backs up through the lungs. Pressure builds in the blood vessels and fluid is pushed into the alveoli and interferes with oxygen gas change, which causes shortness of breath. Associated with cardiomyopathy, leaky heart valves, and sudden hypertension. May also be caused by medications, high altitude exposure, kidney failure, lung damage, or major injuries.15 

Neurogenic pulmonary edema is a form of pulmonary edema that is different than ARDS but has similar features resulting in acute onset of pulmonary edema followed by central nervous system (CNS) insult. A complication is increased intracranial pressure (ICP) and epileptic seizures. Patients present with dyspnea, tachypnea, hypoxia, fever, hypertension, or leukocytosis. Symptoms typically resolve within 24 to 48 hours.16 

Pulmonary Embolism (PE)

The broader term venous thromboembolism (VTE) refers to DVT, PE, or to a combination of both.17 

Prophylaxis means = prevention. Examples of DVT or PE prophylaxis are early mobilization and compressive stockings (SCDs).18 

Pulmonary embolism is a potentially life-threatening condition in which one of the arteries in the lungs gets occluded by a blood clot. It often originates from a clot from another part of the body such as deep vein thrombosis (DVT).19  Massive pulmonary embolism may cause sudden cardiac shock and be potentially fatal.20  Signs and symptoms of PE include chest pain or upper back pain, difficulty breathing, coughing up blood, or pain/redness/swelling in one of the legs (symptoms of DVT). Treatment may include anticoagulation medications and continued oral tablets after discharge. Contributors to PE include sitting for long periods of time without moving, alcohol, caffeine drinks, and sleeping pills. Occupational therapy practitioners play a role in preventing readmissions and promoting healthy lifestyle choices.21  Well’s Criteria can be used to screen for PE and be confirmed with non-invasive ultrasound. Occupational therapy’s role in preventing acute readmissions. American Journal of Occupational Therapy, 68(3), 254-259.)) Practices such as sitting comfortably and lying down, wearing loose-fitting clothing, having plenty of leg room, hydration, taking breaks from sitting, ROM for lower extremities, and other stretches may help to prevent PE. Other approaches include early mobilization, physical activity, and education.

Pulmonary Hypertension (PH)

Also known as pulmonary arterial hypertension – is characterized by increased pressure in the blood vessels from the heart to the lungs. PH may occur on its own or be caused by another condition. The most common cause of PH is left heart disease. Sickle cell disease, pulmonary embolus (PE), and COPD may also cause PH. Due to increased pressure in the blood vessels of the lungs, the heart has to work hard to pump blood into the lungs. This causes symptoms of shortness of breath, chest pain, and lightheadedness. There is no cure. Over time, PH may damage the heart and cause life-threatening conditions such as heart failure or arrhythmias. Treatment includes healthy lifestyle changes, medications, increased exercise tolerance, and improving quality of life. Procedures may include oxygen therapy, balloon angioplasty, and pulmonary endarterectomy.22 

A type of PH is called pulmonary arterial hypertension (PAH) which is characterized by increased pulmonary vascular resistance and arterial pressure. It eventually leads to right heart failure and death. The impact can be on physical mobility, emotional state, and all aspects of life.23  Some patients face social isolation, have anxiety, may be depressed, stressed and have associated major depressive disorder or panic disorders.24  Occupational therapy practitioners may provide psychosocial support, referral to support groups, and helping patients cope with the disease for management and participation in occupations.25 26 

Pneumonia (PNA)

PNA is an infection of the lungs that causes inflammation of the alveoli. The alveoli may fill with fluid or pus and cause symptoms of cough, fever, chills, and dyspnea. Other symptoms include shallow breathing, sharp or stabbing chest pain, low energy and fatigue, loss of appetite, nausea and vomiting, and confusion.27  PNA may be caused by bacteria, viruses, parasites, and fungi.28  Pneumonia may be a complication of viral infection from SARS-CoV-2 causing COVID-19 and confirmed by X-ray.29 30  Occupational therapy is associated with lower readmission rates due to pneumonia.31  Nonpharmacologic strategies include prevention (early mobilization and activity) 32 , postoperative training in ADLs33 , breathing techniques, minimizing aspiration during meals34 , bed positioning of the head of bed, and good oral hygiene.35  Outcome measures include FIM/CARE Tool, 6-minute walking test, Mini-Mental State Exam (MMSE), Depression Scales, and balance scales.36 

Pleural Effusion

Pleural effusion is a build-up of fluid between the layers of tissue of the lungs and chest cavity. While pleural fluid in small amounts is needed to lubricate the surfaces of the pleura, pleural effusion is an abnormal excess collection of this fluid. The two types are transudative (fluid leaking into the pleural space) and exudative (blocked blood vessels). Risk factors include smoking, alcohol, and history with asbestos contact.37  Pleural effusions may be malignant.38  Diseases associated with undiagnosed pleural effusion include CHF, cirrhosis, nephoritic syndrome, edema, CSF leaks, malignancy, pneumonia, TB, pulmonary embolism, infections, and CABG bypass surgery.39 
Symptoms include difficulty breathing and chest pain. Treatment includes drainage (thoracentesis) to remove excess fluid or with a chest tube.40 

Atelectasis

Partly Collapsed lung

Atelectasis is a condition in which the airways and alveoli collapse or do not expand properly. It can occur due to airway blockage, the pressure outside the lung, or decreased surfactant for normal lung expansion. Due to the lung not being to fully expand and fill with air, the body may not receive enough oxygen. Can occur at any age, including in newborns due to respiratory distress syndrome, tumors, excess mucus, blockage, pneumothorax, or pleural effusion. May not cause signs or symptoms, but larger involvement includes fever, shallow breathing, wheezing, or coughing. Treatment includes breathing, coughing exercises, inhaled medications, breathing devices, or surgery.41  Occupational therapy practitioners may work with neonates to assess their feeding in the NICU.42  Occupational therapy practitioners can promote pody positioning can improve in therapeutic breathing, e.g., three-quarter sitting, long sitting, and chair sitting as well as other breathing strategies.43 

Pneumothorax/Hemothorax

Total lung collapse; blood in the lung

Pneumothorax occurs when air escapes from the lung and the lung collapses. Air builds up outside of the lung and puts pressure on it causing it to expand less than normal during inspiration. Can be caused by acute trauma (e.g., gunshot), rib fractures, or certain medical procedures. Lung diseases such as asthma, COPD, cystic fibrosis, TB, and whooping cough cause an increased risk of pneumothorax. Treatment includes observation, needle aspiration, chest tube, nonsurgical repair, or surgery. Patients are advised to avoid activities that place extra pressure on the lungs such as scuba diving or playing a wind instrument.44 

Hemothorax is the collection of blood in the pleural space. It may be caused by blunt force trauma, penetrating injury, or result from structures that bleed into the thorax. Symptoms include respiratory distress and tachypnea. A large hemothorax may exert pressure on the vena cava and pulmonary parenchyma causing preload impairment and increased pulmonary vascular resistance, which result in hemodynamic instability, cardiovascular collapse, and death. Drainage (thoracotomy ) may alleviate symptoms of hemothorax.45 

Empyema

The collection of pus in the pleural space. Usually caused by an infection that spreads from the lung. Risk factors include bacterial pneumonia, TB, chest surgery, lung abscess, or trauma to the chest.46 

Obstructive Sleep Apnea

OSA is a disorder characterized by repeated episodes of nocturnal breathing sessions due to upper airway collapse. Symptoms include daytime somnolence, and weight loss, and is associated with cardiovascular morbidity and mortality. Other symptoms include morning headaches, depression, irritability, memory loss, decreased libido, snoring, choking at night, nocturia, and insomnia. Treatment includes the use of a continuous positive airway pressure device (CPAP) at bedtime.47  Occupational therapy plays a role in rest and sleep for patient switch OSA as it is essential to physical, cognitive, and emotional functioning as well as occupational performance and participation. OTPs may assess for sleep including routines, life conditions, behaviors, environmental factors, and other impacts of sleep on daily occupational performance. Measures include BEARS Sleep Screening Assessment, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Insomnia Severity Index, or the Diagnostic Interview for Insomnia. Interventions include optimizing sleep, environmental modifications, pacing strategies, planning rest breaks, organizing daily schedules according to peak energy levels, and multidisciplinary collaboration.48 

Tuberculosis

TB is an infectious disease that involves the lungs primarily but can affect any part fo the body. TB can spread through the air and be fatal if not treated. Symptoms include a persistent cough, loss of appetite, weight loss, fever, chills, night sweats, or coughing up blood. Bone pain indicates bacterial invasion of the bones. Treatment includes antibiotics and antibacterial medications. It is important for patients to finish taking their medications and occupational therapy practitioners can promote medication compliance as part of health management. Other occupations that OTPs may address include the resumption of daily activities and improvement in activity tolerance based on TB’s impact on quality of life.49 

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