15. Obstructive and Restrictive lung disease

Question 1

What is meant by obstructive disease?

Answer 1

Increase in resistance to airflow due to partial or complete obstruction of airways

Question 2

What is meant by restrictive disease?

Answer 2

Reduced expansion of lung parenchyma

Reduced total lung capacity

Question 3

What is the spirometry test?

Answer 3

A test can help diagnose various lung conditions

Question 4

What does the spirometer measure?

Answer 4

The amount and/or speed of air that can be inhaled and exhaled

Question 5

What is FEV1?

Answer 5

Forced expiratory volume in one second
The amount of air you can blow out within one second
Normal lungs and airways can normally blow out most of the air from your lungs within one second

Question 6

What is FVC?

Answer 6

Forced vital capacity

The total amount of air that you blow out in one breathe

Question 7

What does an obstructive pattern look like on spirometry?

Answer 7

FEV1 is reduced and the ratio of FEV1/FVC is lower than normal
Airway is narrowed so the amount of air can be blown out quickly is reduced

FVC is also reduced

Question 8

What does a restrictive pattern look like on spirometry?

Answer 8

FVC is less than the predicted value for your age, sex and size

FEV1 is also reduced

Ratio of FEV1/FVC is normal

Question 9

What are the clinical features of asthma?

Answer 9

A chronic disease characterised by recurrent attacks of breathlessness and wheezing

Question 10

What are the pathological features of asthma?

Answer 10

Reversible small airways obstruction characterised by bronchospasm, inflammation and oedema: paroxysmal

Question 11

What are causes of asthma?

Answer 11

Heat
Cold
Exogenous allergens
Chemicals eg. aspirin

Question 12

Describe the pathogenesis of asthma

Answer 12

Hypertrophy of peribronchial muscle
Increased mucus production by goblet cells
Eosinophils, Mast cells, Type II Helper T cells, neutrophils

Question 13

What does hypertrophy of the smooth muscle cause?

Answer 13

Narrowing of the airways
Increased reactivity to allergens, infecctions, irritants, parasympathetic stimulation
Triggering of bronchostriction

Question 14

What does COPD stand for?

Answer 14

Chronic Obstructive Pulmonary Disease

Question 15

What is COPD?

Answer 15

A lung disease characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible

Question 16

What is are the reasons for shortness of breathe?

Answer 16

Due to difficulty exhaling all the air from the lungs

Question 17

How is cigarette smoking a major cause of emphysema?

Answer 17

Activation of inflammatory pathways
Digestion of lung parenchyma by leukocyte metalloproteinases and elastases
Oxidants from cigarette smoke and inflammatory cells
IL-8 secretion recruits neutrophils that are primed by TNFalpha and cause damage to extracellular matrix

Question 18

What is alpha-1 antitrypsin deficiency?

Answer 18

Genetic abnormality of a protease inhibitor

If proteases are uninhibited - lead to the loss of lung tissue and to emphysema

Question 19

Define chronic bronchitis

Answer 19

A cough productive of sputum on most days for 3 months of the year for at least 2 successive years

Question 20

What are the histological changes in chronic bronchitis?

Answer 20

Chronic inflammatory cells infilatrate in walls of bronchi and bronchioles
Bronchial mucous gland hypertrophy

Question 21

What are restrictive disease caused by?

Answer 21

Caused by disease in the interstitium of the lung

Question 22

What do restrictive lung diseases involve?

Answer 22

An increase in the amount of fibrous tissue in the alveolar walls of the lungs
The lung will be stiff with reduced compliance

Question 23

What are examples of some conditions of restrictive lung disease?

Answer 23

Interstitial ling disease
Sarcoidosis
Obesity 
Scoliosis 
Neuromuscular disease

Question 24

What is asbestosis?

Answer 24

Interstitial fibrosis of lung die to asbestos exposure

Question 25

What is chronic obstructive lung disease diagnosis based on?

Answer 25

Clinical history
Signs and tests of respiratory function/radiology
little role for histopathology
Functional disorder primarily

Question 26

What are restrictive lung diseases diagnosis based on?

Answer 26

Clinical history

Signs and tests of respiratory function but radiology and biopsy has a role