7. Airway Diseases: Obstructive and Restrictive Flashcards
OBSTRUCTIVE and RESTRICTIVE
OBSTRUCTIVE:
• Limitation of ____;
• Increased ____
• Due to ____ obstruction
RESTRICTIVE:
• Reduced ____ of lung parenchyma
• Decreased ____
• Reduced ____
ATELECTASIS:
• ____ of lung volume
• ____
• ____
The diseases that are obstructive are the ones that limit air flow
The obstructive diseases are the limitations of air flow, and as a result there is increased
resistance. this is due to partial or complete obstructions.
- 3 diseases related to obstruction in the ____.
- and one is related to pathology in the ____
What about restrictive diseases?
-These all result from a limitation of air flow,
-but restrictive diseases are due to reduced expansion of lung parenchyma.
example: If you have a lung and you stretch it to be the size of a football field, and that football field shrinks, because of ____, there is going to be a decrease in lung capacity.
One is going to have to work ____ to breathe and exchange gas.
finally will talk about atelectasis: collapse of lung resulting from loss of volume (result of of either obstructive or restrictive).
airflow resistance partial or complete expansion lung capacity compliance collapse/loss obstructive restrictive
bronchi
alveoli
fibrosis
harder
Lung volumes in Obstructive and Restrictive diseases • Tidal Volume (VT) • Inspiratory Reserve Volume(IRV) • Forced Vital Capacity (FVC) • Forced Expiratory Volume1 (FEV1) • Residual volume
- what is tidal volume of the lung?
-change in lung volume during ____ breathing. this is the volume you
are exchanging - what is inspiratory reserve volume?
-volume on top of the ____ on the graph. - forced vital capacity?
-the volume of air that you can breathe out ____. the max you can force out.
example: the capacity of your lung is about 6000mL
if you try as hard as you can, can you force out that much? no, bc if you do, your lung will collapse. the volume of air that you can force out is about ____. - Residual Volume: About ____ that you cannot breathe out no matter how hard
you try. - diference between FVC and FEV1?
what does the 1 signify? it is very important!
-its the volume of air that you can breathe out in ____.
example: so if you think about it, if someone has an obstructive disease (asthma) and the bronchioles are narrow, would they be able to breathe out? if they breathe in, they can breathe in ____ amount, but if they try to breathe out, they will breathe
out ____ than normal.
normal tidal volume forcibly 5L 1L
one second
full
less
Lung volumes in obstructive and restrictive diseases
Normal
• FEV1 ~ ____ L
• FVC~5.0 L
• FEV1/FVC ~ ____%
Obstructive
• FEV1 ~____L
• FVC~5.0L
• FEV1/FVC ~ ____%
Restrictive
• FEV1 ~____L
• FVC~3.1L
• FEV1/FVC ~ ____%
FVC: about 5L
FEV1: is about 4L
1. NORMAL
-difference between these two in a normal individual is about 8-%
- OBSTRUCTIVE
-in obstructive diseases, your ____ is the same because your lung is not undergoing
fibrosis.
-But your ____ is going to be less.
Ex: if you think about a kid with asthma, breathing when they whistle, its because their
airways are narrow so they’re breathings out less.
*their ratio will be much less around 26%. This number is going to be very low. but FVC
will be normal. * Compared to normal 80% this number is very low. - RESTRICTIVE
-If someone has a lung fibrosis, what will happen to total FVC? ____, because lung capacity is reduced.
-If they dont have obstruction in their airway, what will happen to the ratio? It will stay about the ____.
In restrictive, your ____ is less because, say you have fibrosis in lung, because there is no obstruction, the ratio is about the same, maybe a little bit ____.
4.0 80 1.3 26 2.8 90
FVC
FEV1
less
same
FVC
higher
OBSTRUCTIVE LUNG DISEASES: • Dyspnea/obstruction: • Emphysema (alveoli/acinus) • Chronic Bronchitis • Bronchiectasis • Bronchial asthma
But emphysema, is actually in acinus of ____.
- What is the mechanism of emphysema?
- In this situation, there is ____ in size of airspace distal to terminal bronchi.
alveoli
increase
Emphysema
• ____ increase in size of airspaces ____ to terminal bronchioles
• Destruction of ____.
• Increase in size • Doesn't occur because of fibrosis, but because of \_\_\_\_ of the alveoli wall • Centriacinar ○ Morphologically, affects the \_\_\_\_ part of the acinus § \_\_\_\_x more prevalent § Associated with \_\_\_\_ • Panacinar ○ \_\_\_\_ acinus ○ Not smoking associated ○ \_\_\_\_ basis • Diseases are common, but \_\_\_\_ > because you have to biopsy after you die • Alveoli has elastin fibers, if you think of millions of alveoli that are pumping out, when they pump out > push air through the bronchioles, and if these alveoli are not coming out > \_\_\_\_ can collapse ○ obstruction is not a direct obstruction, direct narrowing of the bronchiole, but is bc the alveoli are forcefully pumping air out and keeping bronchiole open and if they collapse theres no \_\_\_\_ and the bronchiole collapse.
permanent distal alveolar walls destruction central 20 smoking whole genetic
underdiagnosed
bronchioles
pumping action
- Blow up a balloon with air > let it go > flare out in the room until it deflates
- Millions of balloons, working at same time > all the air would go through this way
- What happens when expire: elastin fibers are ____, and as they contract they let the air ____
contracting
out
Emphysema
Destruction of ____
____
“Pink Puffer” • \_\_\_\_ • Normal \_\_\_\_ • Breathing through “\_\_\_\_” • Breathe more \_\_\_\_ • \_\_\_\_
• Emphysema > destruction of elastin > air is \_\_\_\_ inside the alveoli • The bronchioles are kept open by the pumping of the alveoli, initially, if you think of FVE1/FVEC ratio; the capacity of the lung stays about the \_\_\_\_, but because of obstruction > can get oxygen in, but cannot get the \_\_\_\_ out ○ Look at indiviudals > lung is \_\_\_\_ > barrel chest > because of expanded lung preventing chest from \_\_\_\_ ○ Pink Puffer § Pink - initial stages, no defect In oxygenation > normal O2 levels > breathe through pursed lips more frequently > hyperventilatew § Later stages: \_\_\_\_ position, trying to get last breahth out
elastin barrel chest dyspnea O2 pursed lips frequently hyperventilation
trapped same CO2 expanded contracting hunched over
Neutrophil Recruitment Elastase Release
• Neutrophil recruited in smokers > release \_\_\_\_ > destroys elastic fiber ○ If someone who smokes a lot, or a little > what's the difference? • Neutrophil release elastase, and tries to digest elastin > \_\_\_\_ ○ Counterbalanced by \_\_\_\_ (produced by \_\_\_\_) § Present in the \_\_\_\_ ○ Elastase that's prodcued because of smoke is trying to digest elastin, and then you have A1AT that is trying to put a break on this § If A1AT (antiprotease) wins > no emphysema • Genetic defect ○ Deficiency in producing \_\_\_\_ ○ Can develop emphysema even if they don't \_\_\_\_ • Reduced amount of AT in plasma > what happens if you start smoking > \_\_\_\_-effect of degrading elastin
elastase emphysema alpha1-antitrypsin liver plasma
A1AT
smoke
double
Emphysema
Centriacinar
Panacinar
• Centriacinar ○ Acini are \_\_\_\_ because of \_\_\_\_ of elastic fiber ○ Lower magnificiation > you see the holes • Panacinar ○ The whole lung is \_\_\_\_ ○ Anywhere you look you see these perforations • Lower power mag ○ Normal lung parenchyma up top ○ The spaces are because of elastin fibers that are destroyed because of the \_\_\_\_
larger
destruction
expanded
elastases
Clinical features of emphysema and treatment
• Clinical: • First symptom: \_\_\_\_ • \_\_\_\_/Barrel chest • \_\_\_\_ • Dyspnea, \_\_\_\_ Hb (Pink puffer) • Death due to: – \_\_\_\_ – \_\_\_\_
- Treatment:
- Stop ____
- ____ therapy
- ____
- ____ (see COPD)
- ____ (LVRS)• Clinical symptoms
○ Dyspnea - difficult to breathe
○ Weight loss/barrel chest
○ Pink puffers
○ Normal hemoglobin
○ Death: respiratory insufficiency, and RSHF (cor pulmonale)
• Treatment
○ Stop smoking - if disocvered early
○ Oxygen therapy
○ Broncholdilators
§ Main manifestation > ____ of bronchioles, bronchioles are not expanding
○ Antibiotics
○ LVRS
§ The lung volume is expanded > reduce it!
○ These treatments only work if disease has only progressed so far, if alveoli are ____, nothing you can do to get them ____
dyspnea weight loss hyperventilation normal respiratory insufficiency cor pulmonale
smoking oxygen therapy bronchodilators antibiotic lung volume reduction surgery
contraction
destroyed
back
CHRONIC BRONCHITIS
Clinical condition; excessive ____ secretion in the bronchial tree
• Persistent and productive cough:
– At least ____ consecutive months in ____ consecutive years.
- ____, urban dwellers and ____ cities.
- ____
- 20-25% ____ (40-60 years) in smog- ridden cities• So much mucus coming out of bronchioles > figure out why they have obstructive disease
• Clinical condition
○ Excessive mucus secretion from bronchial tree
• Major diff bt emphysema and CB
○ Emphysema is morphologicla defintion, here it’s a ____ definition
• If someone has a productive cough for 3 months in 1 year, followed by the same thing the following year
○ Doesn’t develop overnight, takes time for someone to develop
○ Initially, may be acute
• ____ is the same in both cases
mucus 3 2 cigarette smokers smog-ridden middle-aged men men
clinical
etiology
CHRONIC BRONCHITIS
Clinical condition; excessive mucus secretion in the bronchial tree
• L: normal bronchiole wall, and passage for airway to travel • M: mucus blocking the airway ○ Reduced \_\_\_\_ ratio • R: shows the lumen of normal bronchiole; mucus, cilia, and goblet cells ○ Also have mucus gland ○ CB: excessive mucus retention, \_\_\_\_ can get trapped in there § If bacteria is trapped, and \_\_\_\_ is damaged > defense mechanism of the lung will be compromised > develop \_\_\_\_ of the lung
FEV1/FVC
bacteria
cilia
infection
Pathogenesis
Cigarette smoking/Irritant:
- Hypertrophy of ____ glands in ____ and main bronchi
- Hyperplasia of ____ in ____
- Mucus plug of ____ lumen
- Airway ____.
- Poorly functioning ____
- Cough
- Goblet cell ____ in ____ airways.
- Inflammation of ____ walls/fibrosis
- Airway obstruction• As undergo hypertrophy, prodcue more mucus
• As a result of hypertrophy and hyperplasia > produce more mucus > plugs lumen of bronchiole > lung obstruction, poorly functioning cilia (if cilia is covered it will suck)
• The obstruction mainly happens in the ____ and bronchioles, but what happens in small bronchioles:
○ Goblet cell metaplasia, and inflammation of bronchiole walls/fibrosis
○ Obstruction occurs because of two things:
§ ____ that is produced in bronchioles/trachea
§ ____ and fibrosis of the smaller airway
□ Add together to give obstruction
mucus trachea goblet cells bronchi/bronchioles bronchial obstruction cilia
metaplasia
small airways
bronchiole
trachea
mucus secretion
inflammation
REID INDEX
• Ratio of thickness of ____ wall
• Normal: ____ or less
• Chronic Bronchitis: ____ or more
• IF someone had died from CB > the mucus gland is going to be \_\_\_\_ than in a normal individual • Ratio of thickness of gland/bronchial wall ○ Red - total bronchole wall; balck is mucus gland § Normal is 0.4 or less ○ In CB > more mcuus gland > take up a larger space > 0.5+ • Abnormal ○ Black arrows > mucus gland, and red > wall of bronchiole ○ Compared ot normal, the mucus gland is much larger > \_\_\_\_ of CB
0.4
0.5
larger
diagnostic
CHRONIC BRONCHITIS
• ____ in the large airways and ____ in the small airways.
• Inflammation: ____/____
• Small airway (lower) > inflammation/fibrosis ○ Seeing inflammaiton ○ Blue dots > inflam cells; depending on timing of inflammatino, either \_\_\_\_, or neutrophils and \_\_\_\_ • Larger airway (upper) > \_\_\_\_ of mucous gland
mucus hyper-secretion
contraction
neutrophils and macrophages/fibrosis
neutrophils
macrophages
thickening
