Chapter 5. MEDICAL REHABILITATION OF PATIENTS WITH DISEASES OF RESPIRATORY ORGANS

5.1. CLINICAL MEDICAL SUBSTANTIATION

OF REHABILITATION FACILITIES IN DISEASES OF RESPIRATORY ORGAN

5.1.1. Anatomic physiological make-up of the respiratory system

The use of rehabilitation facilities requires certain knowledge of the anatomic and functional features of the respiratory system, main pathophysiolog-ical syndromes of dysfunction of the pulmonary function, pathogenesis, and clinical physiological features of various nosological forms of pathology of the respiratory organs.

Lungs are of segmental-lobular structure: in the right-hand lung, three lobes are distinguished (upper, medium, and lower), in the left-hand lung - two lobes (upper and lower). Each lung lobe, in turn, is subdivided into segments that match the motion of vascular-bronchial fascicles represented by a bronchus of certain order and caliber, the pulmonary artery and vein, nerves, and lymphatic vessels (Fig. 5.1). Anatomic specific features of respiratory passages have to be taken into account while administering the therapeutic exercise facilities, selection of breathing exercises, especially drainage exercises, and starting positions for running the postural drainage procedure.

A structurally functional unit of a lung relating to the respiratory parenchyma - pulmonary acinus (alveolar tree), which forms respiratory bronchioles departing from the terminal bronchiole, and alveolar ducts, alveolar sacs, and alveoli. Alveoli are constantly in a somehow stretched state due to some amount of air in lungs remaining after exhalation - the residual volume. The stretched condition of alveoli is also supported by the surfactant covering the alveoli from inside - a pulmonary surfactant.

Fig. 5.1. Segments of lungs (according to E.R. Weibel): a, b - right-hand lung; c, d - left-hand lung (figures designate segments of lungs)