RCS 6080 Medical and Psychosocial Aspects of Rehabilitation CounselingChronic Obstructive Pulmonary Disease (COPD)Slide 3Slide 4Slide 5Functional Disability and COPDSlide 7Slide 8Treatment of COPDSlide 10Vocational Implications of COPDAsthmaSlide 13Slide 14Treatment of AsthmaVocational Implications of AsthmaInterstitial Lung Disease (ILD)Main Types of ILDFunctional Disability of ILDSlide 20Vocational Implications of ILDCystic FibrosisSlide 23Slide 24Functional Disability and Cystic FibrosisSlide 26Treatment of Cystic FibrosisVocational Implications of CFAdditional Resources and Information from the WebSlide 30RCS 6080 Medical and Psychosocial Aspects of Rehabilitation CounselingPulmonary DisordersChronic Obstructive Pulmonary Disease (COPD)•Characterized by decreased expiratory airflow•Reduction in expiratory airflow has 2 causes:–Decreased expiratory air flow pressure (decrease in driving pressure)–Increased resistance to expiratory air flow (results from narrowing of the airways)Chronic Obstructive Pulmonary Disease (COPD)•Emphysema and chronic bronchitis are often considered together under the term COPD because most people have a combination of chronic bronchitis and emphysema – in other words, most people have both airway disease and alveolar disease•COPD affects as many as 30 million Americans•COPD is the fifth leading cause of death in the US and a major source of morbidityChronic Obstructive Pulmonary Disease (COPD)•Several factors are involved in the pathogenesis of COPD, but smoking is the most important–Other factors include occupational exposure to dust and fumes and air pollution•In addition to these factors, the development and progression of COPD is largely related to genetic predispositionChronic Obstructive Pulmonary Disease (COPD)•Two categories of COPD:–Type A: “pink puffer” – considered to have predominantly emphysema–Type B: “blue bloater” – considered to have predominantly chronic bronchitisFunctional Disability and COPD•The earliest manifestations of COPD may be relatively mild, but as time goes on, dyspnea becomes the most important limiting factor–Years may pass before the degree of dyspnea is severe enough to limit routine daily activities such as walking–As time progresses, activities such as dressing, bathing, speech, and even eating cannot be accomplished without severe shortness of breathFunctional Disability and COPD•Until the disease is extremely far advanced, relatively sedentary activities may be accomplished without too much difficulty•Driving may be possible, but walking even limited distances may not be, particularly if an incline or stairs are involved•Assessment of a given person’s functional capability may be difficult to determine based solely on pulmonary function studies and blood gasesFunctional Disability and COPD•Depression, fear, and anxiety are potent factors that may further exacerbate the person’s physical limitations•Preparation for a sedentary occupation may be wise even at the time of relatively mild disease because the rate of progression is variableTreatment of COPD•Many people with COPD may have a potential for some reversibility, which can be achieved with proper medical management•Adequate fluid intake and the use of expectorants helps to facilitate the clearance of respiratory tract secretions•Oxygen therapyTreatment of COPD•Chest PT and pulmonary rehabilitation programs are very useful in a variety of ways:–Learn to expel mucus from the respiratory tract–Learn breathing exercises and relaxation techniques that may help in ADLs–Do exercise reconditioning that can help increase endurance and improve work capacityVocational Implications of COPD•People may have to change their employment goals•The American Thoracic Society divides the degree of impairment by pulmonary function testing into mild, moderate, and severe–Mild impairment is usually not correlated with diminished ability to perform most jobs–Moderate impairment is correlated with a decreased ability to meet the demand of many jobs–Severe impairment prevents the person from meeting the demands of most jobsAsthma•Asthma is now regarded as an inflammatory disease of the airways that is characterized by reversible airway obstruction and bronchial hyperreactivity•The frequency, duration, and severity of the asthmatic attack varies markedly from person to person•Although there are differences from person to person, the asthma attack is typically characterized by shortness of breath and wheezingAsthma•During an asthma attack, the person is totally disabled–Even speech may be impossible–The person may be totally consumed by the effort to breathe and unable to eat or dress–The person is restless and unable to lie flat–Severe cough may produce musculoskeletal pain that aggravates the conditionAsthma•Depending on the severity, the attack may be totally or partially reversible, allowing the person to assume normal activities between episodes•People with severe asthma remain symptomatic at all times and resemble people with chronic bronchitis and emphysema with similar levels of disabilityTreatment of Asthma•Current medical therapy is focused on both the treatment and prevention of an asthma attack–Asthma medications are divided into "controllers" (anti-inflammatory agents or long-acting bronchodilator spray) taken on a regular basis and "relievers" (short-acting bronchodilator spray) used as needed•Severe asthma attacks often require hospitalizationVocational Implications of Asthma•In general, a person with asthma should avoid adverse environmental conditions such as outdoor work, temperature changes, heavy particulates, fumes, cigarette smoke, and the like•Physical labor is not contraindicated but should be limited to people with mild disease who are well controlled on medication and under medical supervision•The counselor should interact with the employers to attempt to ensure the avoidance of environmental irritants and to achieve recognition of the person's illness and potential for absenteeismInterstitial Lung Disease (ILD)•A large number of lung diseases involve the supporting structure (interstitium) of the gas-exchanging units (alveoli) of the lung and are termed interstitial lung disease (ILD)•One striking common feature among the heterogeneous group of diseases that make up ILD is the loss of lung volume•Often described as "restrictive" lung