Okay, so let's look at smooth muscle and inflammation
with the picture because that is really helpful.
See the normal airway?
Look you got the smooth muscle
wrapped around it, everything's good,
the airway's big open, you can
take a big beautiful relaxing breath.
Now look over to the other side, we're in trouble.
That's an inflamed lung and airway.
Remember the inflammatory response is part
of the problem when people have bronchospasm.
Now look at this one, it's
gunked up and swollen up.
Look at those walls, they are thicker and the
opening is clearly smaller than in a normal muscle.
So someone with bronchospasm
likely has this going on.
This is what it looks like when the airways become inflamed and
it's got a much tighte, smaller area for air to pass through.
so it's clear which patient would
have a more difficult time breathing
and why patients have a difficult time
breathing, they just have less to work with.
Now let's look at the normal
alveoli versus a pneumonia one.
Look at the normal one, look how cute they
are, a bunch of blueberris or grapes all together,
these are normal bronchiole and alveoli.
Remember, bronchioles are the
little guys at the end of the bronchi
and you've got pneumonia,
yeah that's kind of gross, right?
You've got fluid accumulating in the
alveoli and filled with nastiness in it.
This means we've got an infection and
we're kind of in some big trouble because
infection means inflammatory response so that's
why when you have something like a pneumonia,
it's so difficult for the patient to breathe, their
airways are inflamed, their alveoli are filled with gunk
so they don't exchange O2 and CO2 very well.
Not like looking at the normal lung -
everything's open, alveoli need to be round
and covered in a surfactant in order to work
effectively, that is what's going down in a lung,
bronchiole and alveoli that
are filled with gunk of pneumonia.
So getting a feel for the difference between how it
normally works and what's gone wrong in a disease process,
that's the key to understanding how
to take the best care of your patients.
Now, I want you to practice
with me: breathe in, breathe out.
Do it again cause if you're studying, you're probably
stressed like the rest of us so breathe in, breathe out.
Okay, let's talk about what just happened in your body.
First of all, most all of us feel more relaxed when
you take a legit big breath in, big breath out.
I always recommend that you do that throughout your
day especially when it's feeling really stressful
kind of helps you refocus and become more calm.
Let's look at inhalation.
Now air comes into my nose or mouth
or both, whatever you're doing, right?
The diaphragm contracts.
Remember that's the layer of
skeletal muscle across your chest wall.
It divides my chest from my gut and when it
pulls down, this is when the action happens,
when it pulls down, creates a negative pressure.
Now I've got some other muscles, I need my abdominal muscles
and I also need the intercostal muscles in between my ribs.
What they do when I take a
deep breath in is my chest expands.
Well I use my abdominal muscles, which
I wish I had more of, maybe you do too.
I use my abdominal muscles and then the intercostal
muscles help pick my ribcage up and expand it
so I can let my lungs fill up with air.
That's why people when they're pregnant, when their
chest cavity is filled with this little person
that's growing in their bodies ,they
don't have much room to breathe.
But if you know currently not making
a human that's what should happen.
You should take a deep breath in, diaphragm goes down,
air goes in, chest wall expends, your lungs fill with air.
The inhalation doesn't take as much effort, right?
Because it's just kind of a relaxing of things.
Now if I focus on it, I can
do more forceful exhalation
We do that with patients who have COPD, we
do pursed lip breathing instead of... they do this.
So people that have COPD, that's
how pursed lip breathing helps him
because air gets stuck in there in chronic obstructive
pulmonary disease so if we take longer to exhale,
then that helps give the
lungs more time to empty
because that's one of the biggest
struggles with COPD is air trapping.
Okay, so you've got the basics, how
we breathe in, how we breathe out.
Now thankfully, we don't
have to think about this, right?z
the only time I think about is when I'm on
the stairmaster then I feel like I can't breathe
but normally, this just happen without me
remembering to breathe in and breathe out.
So back to bronchospasm and look we've got those
airways again and you've already seen them once
but I want you to look at it closely now.
Normal airway, asthmatic airway, and
an asthmatic airway during an attack,
Okay, normal airway look at that we've
got the bronchioles and the alveoli, right?
Remember, bronchioles and then the alveoli, those
little grape-like clusters we call them at the end.
They need to look around and keep their shape and be
free of gunk in order for them to exchange CO2 and O2.
So that's what a normal airway looks like.
Now an asthmatic airway is already kind
of inflamed, right, because of the asthma.
Remember that smooth muscle
around it is relaxed though.
So a normal airway and an asthmatic airway that's a little
thicker so I have a smaller airway just on a good day,
but the smooth muscle isn't clamped down.
Now when I have an asthma attack or an
exacerbation of asthma, look at that airway,
That's smooth muscles wrapped all around there again like
I showed you with that rubber band around my fingers
That is just squeezing the life out of it and the smooth
muscle that's in the wall is also squeezing that airway
so you have a tiny, tiny hole.
Normal - wide-open, asthmatic airway
not in an attack - still smaller than normal
asthmatic airway during an
attack - hoho, big-time trouble
Remember bronchospasms come on quick, it really
clamps down to usually inflammatory response.
It's either response to an allergy, ad
infection or some type of over-exertion.
Now you may have heard the term
exertional asthma or exercise-induced asthma
that's when sometimes when
somebody is like extremely overexerted
then they end up having this kind of feel like
bronchospasm when you really can't feel your breath,
can't catch your breath.
So that's when the patient will tell you, "Man, I just,
I feel this really intense tightening in my chest".
So back to the cause of this, it's
usually an inflammatory response,
maybe because you've been introduced to
something that you're allergic to - an allergen,
there's already infection in the lung,
or you completely overexert yourself
and it's, you have a really
hard time catching your breath.