B4-057 Obstructive Lung Disease Flashcards
increase in resistance to airflow due to diffuse airway disease
obstructive
reduced expansion of lung parenchyma and decreased TLC
restrictive lung disease
obstructive lung disease: FEV1/FVC is
less than 0.7
restrictive lung disease: FEV1/FVC is
normal
2 diseases under COPD
- emphysema
- chronic bronchitis
if theres a reversible component, patient may have COPD and
asthma
primary risk factor for COPD
smoking
- affects proximal acinus
- respiratory bronchioles are enlarged, distal alveoli are spared
- upper lobe predominant
centriacinar
- affects entire acinus
- uniform enlargement from respiratory bronchiole to alveoli
- lower lobe predominant
panacinar
what type of emphysema is associated with heavy smoking?
centriacinar
what type of empysema is associated with alpha1-antitrypsin deficiency?
panacinar
centriacinar emphysema
panacinar emphysema
emphysema
an increase in […] damages the elastic fibers of the alveoli septa, causing emphysema
neutrophil elastase
loss of […] in the alveolar walls allows the respiratory bronchioles to collapse during expiration
elastic tissue
in emphysema, hyperinflation is caused by
air being trapped in alveoli and dilation of distal airspaces
A1AT deficiency + smoking causes
increased severity and earlier age of onset of emphysema
A1AT deficiency can also cause
liver cirrhosis
- increased bronchovascular markings with bronchial cuffing
- cardiomegaly
chronic bronchitis
hyperinflation
* low diaphragm
* dark lung fields with reduced vascular markings
emphysema
caused by exposure to noxious inhaled substances
chronic bronchitis
smoke, grain/cotton/silica dust
mucus hypersecretion in airway
chronic bronchitis
acquired CTFR dysfunction from smoking
chronic bronchitis
- goblet cell hyperplasia
- basement membrane thickening
- smooth muscle hyperplasia
chronic bronchitis
complications of COPD
3
- pneumothorax
- pneumonia
- pulmonary hypertension
due to increased airway sensitivity to a variety of stimuli
episodic bronchoconstriction
asthma
wheezing, dyspnea, chest tightness, cough
asthma
- triggered by exposure to allergens
- associated with rhinitis, eczema, urticaria, family hx
atopic asthma
chronic airway inflammation and hyperreactivity but no evidence of sensitization to allergen
non-atopic asthma
an exaggerated Th2-mediated IgE response to enviornmental allergens in genetically predisposed individuals
atopic asthma
stimulates B cells to produce IgE
IL4
activates eosinophils
IL5
stimulates mucus secretion and increases IgE
IL13
binds Fc receptors on mast cells
IgE
re-exposure to antigen results in
immediate IgE cross-linking on mast cells
immediate hypersensitivity reaction
cause bronchoconstriction, vascular permeability, and mucus production
leukotrienes
cause bronchoconstriction via muscarinic receptors
acetylcholine
forms charcot-leyden crystals, inflammation and mucus production
galectin-10
young children who develop lower respiratory tract infections have increased risk of developing
severe/persistent asthma
charcot leyden crystals
tons of eosinophils
destruction of smooth muscle and elastic tissue causing irreversible dilation of bronchi and bronchioles
bronchiectasis
bronchiectasis
bronchiolectasis
- severe, persistent, productive cough
- purulent, foul smelling sputum
- dyspnea
- hemoptysis
bronchiectasis
- impaired mucociliary clearance
- organ laterality defects
primary ciliary dyskinesia
defect in dynein
primary ciliary dyskinesia
situs inversus, sinusitis, bronchiectasis
kartagener syndrome
primary ciliary dyskinesia
caused by aspergillus
ABPA
- high serum IgE
- Charcot-Leyden crytals
- IgG to aspergillus
ABPA
treatment bronchiectasis
- antibiotics
- chest physical therapy
- barrel shaped chest
- prolonged expiration
- pursed lips breathing
emphysema
CXR
* increased AP diameter
* flattened diaphragm
* increased field lucency
emphysema
- wheezing, crackles
- cyanosis
- dyspnea
- CO2 retention
chronic bronchitis
hypertrophy and hyperplasia of mucus secreting glands in bronchi
chronic bronchitis
productive cough > 3months in two years
chronic bronchitis
this is from FA, not sure she mentioned it
- asymptomatic baseline
- intermittent coughing, wheezing, dyspnea, hypoxemia
- mucus plugging
asthma
- hyperresponsive bronchi
- reversible bronchoconstriction
- smooth muscle hypertrophy and hyperplasia
asthma
- daily purulent sputum
- recurrent infections (P. aeruginosa)
- hemoptysis
- digital clubbing
bronchiectasis
chronic necrotizing infection of bronchi or obstruction leading to permanently dilated airways
bronchiectasis