2.3.1 Obstructive Pulmonary Disease

Question 1

What is obstructive pulmonary disease in its broadest sense?

Answer 1

An increase in resistance to airflow owing to partial or complete obstruction at any level

Question 2

What are measure on a PFT is reduced in obstructive pulmonary disease?

Answer 2

FEV1, decreased maximal airflow during forced expiration

FEV1/FVC is < 0.7 (Normal is ~0.75)

Question 3

What are four medical conditions that can be classified as obstructive pulmonary dz’s?

Answer 3

Emphysema, Chronic Bronchitis, Asthma, Bronchiestasis

Question 4

COPD is a clinical combination of which two medical conditions? Which third condition may be present?

Answer 4

Chronic Bronchitis and Emphysema

Asthma may or may not be present

Question 5

What % of smokers develop COPD? What % of COPD is a result of smoking?

Answer 5

35-50% of smokers develop COPD

80% of COPD is due to smoking

Question 6

Name the condition: abnormal permanent enlargement of the airspaces distal to the terminal bronchiole

Answer 6

Emphysema

Question 7

What are the two types of emphysema? What is generally the cause driving each type?

Answer 7

Centriacinar (smokers)

Panacinar (alpha 1 anti-trypsin deficiency)

Question 8

What type of emphysema are each of these slides?

Answer 8

Left: Centriacinar

Right: Panacinar

Question 9

When do patients begin to notice the effects of the emphysema?

Answer 9

Manifestations begin after 1/3 of the functioning lung parenchyma is impaired

Question 10

What is the pathogenesis of emphysema?

Answer 10

Question 11

Where is alpha 1 anti-trypsin typically produced within the body? What genotype of someone with a deficiency in this protein?

Answer 11

Liver

PiZZ (~1% of the population)

Question 12

The loss of what force causes emphysema to be an obstructive pulmonary disease?

Answer 12

Loss of elastic recoil due to the rupture of the alveolar septae (like a paper bag rather than a balloon)

Question 13

What is a unique complication of emphysema?

Answer 13

Pneumothorax (rupture of a bolus)

Question 14

Name that condition: productive cough of unknown cause, occuring for 3 or more months in at least two successive years

Answer 14

Chronic bronchitis

Question 15

Who typically get chronic bronchitis?

Answer 15

Men, age of 45(+)

Question 16

What is the pathogenesis of chronic bronchitis?

Answer 16

1. Inhalation of noxious substance (smoke or dust)
2. Mucus hypersecretion
3. Inflammation
4. Infection
5. Injury to epithelium -> chronic inflammation
6. Impaired ciliary action -> lack of mucus clearance -> infection

Question 17

What type of metaplasia occurs in chronic bronchitis?

Answer 17

Goblet cell. Results in mucus hyperproduction

Question 18

What is the Reid Index?

Answer 18

The reid index measures the ratio of the thickness of the mucous gland layer to the thickness of the bronchial wall b/t epithelium and cartilage

(Normal is < 0.4)

Question 19

Compare chronic bronchitis and emphysema in the following categories

Answer 19

Question 20

What is the nickname for patients with chronic bronchitis? emphysema?

Answer 20

Chronic bronchitis: blue bloaters

Emphysema: pink puffers

Question 21

Name the condition: episodic bronchoconstriction due to increased airway sensitivity to a variety of stimuli

Answer 21

Asthma

Question 22

During an asthmatic episode, what are some of the symptoms? When are they most likely to occur?

Answer 22

Coughing, wheezing, breathlessness, chest tightness

Temporality: night or early morning

Question 23

Asthma is most common in what patient population?

Answer 23

Children

Question 24

What is the term for continuous asthma attacks?

Answer 24

Status asthmaticus

Question 25

What are the two types of asthma?

Answer 25

Atopic - known allergen Non-atopic - no evidence of allergen

Question 26

What is the most common type of asthma?

Answer 26

Atopic

Question 27

Atopic asthma is what type of hypersensitivity reaction?

Answer 27

Type I (IgE mediated)

Question 28

What chromosome has been linked to asthma susceptibility?

Answer 28

5q

Question 29

What are some triggers for non-atopic asthma?

Answer 29

Viral infections, air pollutants, exercise, or cold

Question 30

What are some of the changes that occur when the airway gets remodeled in asthmatic patients?

Answer 30

Question 31

What are each of the symbols and arrows demarcating?

Answer 31

Bronchus from an asthmatic patient showing goblet cell hyperplasia (green arrowhead), subbasement membrane fibrosis (black arrowhead), eosinophilic inflammation (yellow arrowhead),and muscle hypertrophy (blue arrowhead)

Question 32

Name that condition: Typified by permanent dilation of bronchi and bronchioles caused by the destruction of the muscle and elastic tissue by chronic necrotizing infections.

Answer 32

Bronchiectasis

Question 33

What are some of the clinical features of bronchiectasis?

Answer 33

cough, fever, **copious of amounts of foul-smelling, purulent sputum**, hemoptysis

Question 34

What is the pathogenesis of bronchioectasis?

Answer 34

normal clearing mechanisms impaired -\> pooling of secretions distal to the obstruction -\> secondary infection and inflammation

Question 35

Name that condition

Answer 35

Bronchiectasis

Question 36

Fill in this chart with the **correct** answers

Answer 36