2.3.1 Obstructive Pulmonary Disease Flashcards
What is obstructive pulmonary disease in its broadest sense?
An increase in resistance to airflow owing to partial or complete obstruction at any level
What are measure on a PFT is reduced in obstructive pulmonary disease?
FEV1, decreased maximal airflow during forced expiration
FEV1/FVC is < 0.7 (Normal is ~0.75)
What are four medical conditions that can be classified as obstructive pulmonary dz’s?
Emphysema, Chronic Bronchitis, Asthma, Bronchiestasis
COPD is a clinical combination of which two medical conditions? Which third condition may be present?
Chronic Bronchitis and Emphysema
Asthma may or may not be present
What % of smokers develop COPD? What % of COPD is a result of smoking?
35-50% of smokers develop COPD
80% of COPD is due to smoking
Name the condition: abnormal permanent enlargement of the airspaces distal to the terminal bronchiole
Emphysema
What are the two types of emphysema? What is generally the cause driving each type?
Centriacinar (smokers)
Panacinar (alpha 1 anti-trypsin deficiency)
What type of emphysema are each of these slides?
Left: Centriacinar
Right: Panacinar
When do patients begin to notice the effects of the emphysema?
Manifestations begin after 1/3 of the functioning lung parenchyma is impaired
What is the pathogenesis of emphysema?
Where is alpha 1 anti-trypsin typically produced within the body? What genotype of someone with a deficiency in this protein?
Liver
PiZZ (~1% of the population)
The loss of what force causes emphysema to be an obstructive pulmonary disease?
Loss of elastic recoil due to the rupture of the alveolar septae (like a paper bag rather than a balloon)
What is a unique complication of emphysema?
Pneumothorax (rupture of a bolus)
Name that condition: productive cough of unknown cause, occuring for 3 or more months in at least two successive years
Chronic bronchitis
Who typically get chronic bronchitis?
Men, age of 45(+)
What is the pathogenesis of chronic bronchitis?
- Inhalation of noxious substance (smoke or dust)
- Mucus hypersecretion
- Inflammation
- Infection
- Injury to epithelium -> chronic inflammation
- Impaired ciliary action -> lack of mucus clearance -> infection
What type of metaplasia occurs in chronic bronchitis?
Goblet cell. Results in mucus hyperproduction
What is the Reid Index?
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)
Compare chronic bronchitis and emphysema in the following categories
What is the nickname for patients with chronic bronchitis? emphysema?
Chronic bronchitis: blue bloaters
Emphysema: pink puffers
Name the condition: episodic bronchoconstriction due to increased airway sensitivity to a variety of stimuli
Asthma
During an asthmatic episode, what are some of the symptoms? When are they most likely to occur?
Coughing, wheezing, breathlessness, chest tightness
Temporality: night or early morning
Asthma is most common in what patient population?
Children
What is the term for continuous asthma attacks?
Status asthmaticus
What are the two types of asthma?
Atopic - known allergen
Non-atopic - no evidence of allergen
What is the most common type of asthma?
Atopic
Atopic asthma is what type of hypersensitivity reaction?
Type I (IgE mediated)
What chromosome has been linked to asthma susceptibility?
5q
What are some triggers for non-atopic asthma?
Viral infections, air pollutants, exercise, or cold
What are some of the changes that occur when the airway gets remodeled in asthmatic patients?
What are each of the symbols and arrows demarcating?
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)
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.
Bronchiectasis
What are some of the clinical features of bronchiectasis?
cough, fever, copious of amounts of foul-smelling, purulent sputum, hemoptysis
What is the pathogenesis of bronchioectasis?
normal clearing mechanisms impaired -> pooling of secretions distal to the obstruction -> secondary infection and inflammation
Name that condition
Bronchiectasis
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