110714 copd and cases Flashcards
acinus
distal to terminal bronchiole
airways prxoimal to respiratory bronchioles are lined by what kind of epithelium
pseudostratified ciliated columnar epithelium
definition of COPD
diseases that cause obstruction to airflow out of lungs
types of obstructive lung disease
emphysema
chronic bronchitis
asthma
bronchiectasis
obstructive disease is located where
airway disorder–trachea to terminal bronchiole (although in emphysema you see changes with alveoli)
restrictive disease is located where
parenchymal disorder-respiratory bronchiole, alveoli and alveolar ducts
obstructive lung disease
increased resistance to air flow and limited expiratory rates on forced expiartion
restrictive lung disease
decreased expansion with reduced total lung capacity, O2 diffusing capacity, lung volumes and compliance
can have similar to normal or increased FEV1/FVC ratio
emphysema
permanent enlargement of all or part of the respiratory unit (respiratory bronchioles, alveolar ducts, alveoli) accompanied by wall destruction WITHOUT obvious fibrosis
causes of emphysema
smoking
air pollution
alpha1 antitrypsin deficiency
types of emphysema
centriacinar (centrilobular)-95% of cases–associated with smoking
panacinar-associated with alpha1 antitrypsin deficiency
pathogenesis of emphysema
increased numbers of macrophages, CD8 T cells and neutrophils
neutrophils and macrophages are activated by tissue damage from cigarette smoke
neutrophils make elastase
macrophages make free radicals
destruction of elastic tissue
increased compliance and decreased elasticity
elastic tissue normally keeps airway lumens open by applying traction. destruction of elastic tissue causes COLLAPSE of airways on expiration and prevention of air exit, causing trapped air distending repiratory unit and destruction of alveoli and alveolar ducts
panacinar emphysema
alpha1 antitrypsin deficiency that’s genetic or acquired (acquired from things like cigarette smoke)
lower lobes (as opposed to upper for centriacinar emphysema)
all parts of respiratory unit are affected by elastic tissue destruc
clinical findings of emphysema
severe and early onset of dyspnea
pink puffers
coexistence w chronic bronchitis (smokers’ emphysema)
cor pulmonale (less common)
diminished breath sounds due to hyperinflation
CXR of emphysema
increased AP diameter (barrel chest)
hyperlucent lung fields
vertical heart
depressed diaphragm
chronic bronchitis
productive cough for at least 3 months for 2 consecutive years
causes of chronic bronchitis
smoking
cystic fibrosis
pathogenesis of chronic bronchitis
inhaled smoke causes mucous hypersecretion in bronchi, leading to airflow osbruction in terminal bronchioles. in long standing cases, leads to irreversible fibrosis of terminal bronchioles
exacerbated by infection
another contributing factor is bronchospasm resulting in narrowed airway
clinical findings of chronic bronchitis
PRODUCTIVE COUGH (due to mucus secretion) cyanosis (due to decreased O2 saturation from hypoxemia)
blue bloaters
dyspnea
expiratory wheezing and rhonchi
cor pulmonale
CXR of chronic bronchitis
enlarged heart, horizontally oriented
increased bronchial markings
histology of chronic bronchitis
chronic inflam cells in airway wall
increased mucous glands-hyperplasia
thickening of walls (narrowing of bronchiolar lumen)
reid index
ratio of thickness of mucous gland layer to thickness of wall btwn epithelium and cartilage
compare emphysema and chronic bronchitis
see slide 35
bronchoectasis
permanent destruction and dilatation of bronchi and bronchioles
destruction involves cartilage and elastic tissue (entire wall)
causes of bronchiectasis
cystic fibrosis infections bronchial obstruction (tumor) primary ciliary dyskinesia allergic bronchopumonary aspergillosis
clinical findings of bronchiectasis
copious sputum
hemoptysis
digital clubbing
cor pulmonale
CXR of bronchiectasis
bronchial markings (from dilatation) extending to the periphery of lungs
gross findings of bronchiectasis
bilateral lower lobes distal bronchi and bronchioles
dilated airways
on cut surface dilated bronchi appear as cysts filled with mucopurulent secretions
history of SOB as child
asthma
what would productive cough mean?
chronic bronchitis
what causes decreased FEV1 in chronic bronchitis?
mucous secretion
what causes decreases FEV1 in emphysema
alveolar walls lost and elasticity lost
would beta agonist help for emphysema?
no, because beta agonist only works for sm musc contraction
clubbin is a sign of
chronic impaired air exchange, hypoxia
COPD
usually related to smoking
obstruction not reversible with beta agonist
reduced gas exchange
associated diseases of COPD
right heart failure
lung cancer
asthma
usually develops early in life (exacerbated by smoke but not caused by it)
associated with allergies
obstruction reversible with beta agonist
no defect in gas exchange
