COPD Flashcards
COAD
Commonly used clinical term for a group of pathological conditions in which there is (acute or chronic?) partial or complete obstruction to air flow any level from _____ to ________ resulting in functional disability of the lungs
Chronic
trachea to smallest airways
COAD or COPD
⚫_________
⚫______________
⚫__________
⚫______________
Asthma
Chronic bronchitis
Emphysema
Bronchiectasis
ASTHMA
A chronic inflammatory disorder of the airways;
characterised by
⚫ widespread ________ of the airways, with
⚫ marked reduction in the __________________
⚫ Triggered by ________ stimuli.
⚫ Results in recurrent episodes of ________,________,__________ and __________.
⚫ May be ____________________, with or without
treatment
narrowing
inflow and outflow of air
a variety of
coughing, wheezing, breathlessness and chest tightness
reversed partly or completely
Classification of asthma Based on several factors including
A. Aetiology:
_________: ________ induced, Type 1 hypersensitivity
__________: induced by several ___________
Extrinsic; Allergen
Intrinsic; nonimmune factors
Classification of asthma Based on several factors including
Severity: _______,________, or ______
Frequency:_________ or _________
Clinical behaviour: i.e. brittle, difficult, ________ or ________
mild, moderate or severe
intermittent or persistent
steroid dependent or
resistant
Pollen concentrations are highest in the _______ or _________
Afternoon or midday
Pathophysiology
⚫ Asthma attacks are caused by airway
_________________
hyperresponsiveness
Pathophysiology
⚫ Asthma attacks are caused by airway
hyperresponsiveness—that is, an overreaction of the ________ and __________ to various environmental and
physiological stimuli, known as _______.
bronchi and bronchioles;
Pathophysiology
⚫ The most common causes of asthma attacks are extremely (small or large?) and (heavy or light?) weight particles transported through the ____ and inhaled into the lungs.
Small
Light ; air
Pathophysiology of asthma
⚫ When they enter the airways, these particles, known as
environmental triggers, cause ____________ in the airway walls, resulting in an asthma attack
An inflammatory response
Extrinsic/Environmental triggers
⚫ These are called __________.
allergens
ASTHMA: Extrinsic triggers
Allergens produce type ____ hypersensitivity reaction
1
Extrinsic triggers in asthma
⚫ They bind to _____ on the ____ cell in a previously sensitized individual
⚫______ cell _______ & releases inflammatory mediators & chemotactic
factors which cause
⚫ Increased ________ and ______
⚫ Broncho__________
⚫_______ hypersecretion
⚫
IgE; mast
Mast; degranulates
vascular permeability & oedema
constriction; Mucus
Asthma: Extrinsic triggers
These same allergens may cause little or no reaction in nonallergic people
T/F
T
10 Mediators
⚫ The _____ cells release ______ as a 10 mediator
⚫ ______ cells- secrete too much ______.
Mast; histamine
Goblet; mucus
10 Mediators
Histamine causes
⚫ increased ________ leading to ______ and ________
⚫ Broncho_____ - causing more _______
venular permeability
swelling and redness
spasms; narrowing
10 Mediators
Goblet cells- secrete too much mucus.
⚫ Mucus clogs the ________, resulting in _________ and ______
bronchioles
wheezing
Coughing
___________Triggers
These are refered to as intrinsic triggers.
Non-environmental
Non-environmental Triggers / intrinsic triggers. They include:
⚫_________ triggers
⚫ Physical exercise
⚫ Cold weather
⚫ Sometimes __________bring on attacks.
⚫ Chemicals found in _______ or _______
⚫ Intense ________
Physiological
substances in food or drink
food or medicine
emotion
Pathophysiology of asthma
⚫ Extrinsic triggers stimulate ______ nerves in ______ to discharge
⚫ These in turn stimulate the _____ nerve ( _______ nerve) to discharge
⚫ Cause release of inflammatory mediators & chemo tactic factors which
cause
⚫ Macrophage, eosinophil, basophil infiltration &________ activation
⚫ Broncho _______
⚫_______ hypersecretion
afferent
Tracheobronchial tree
vagal; efferent; mast cell
constriction
Mucus
Clinico-Pathologic correlation in asthma
⚫Bronchi and bronchioles become _______ resulting in _______ of airways
⚫_____eases work done to move air in and out of the lungs
⚫Mild chest _______ and _______ develop
⚫__________ starts and increases in pitch; dyspnoea sets in
oedematous; narrowing
Incr; pressure; dry cough
Wheezing
Clinico-Pathologic correlation in asthma
Cough _______ and becomes ______ of thick, stringy mucus.
Inflammation prevents ______________
Cells start to burn oxygen _________, increasing the body’s demand for oxygen.
________ develops. If untreated _____ occurs
intensifies; productive
insufficient oxygen-rich air from getting to the alveoli; at a higher rate
Hypoxaemia; cyanosis
Airway narrowing in asthma
⚫ Release of _______
⚫ Smooth muscle ______
⚫ Increased vascular _________/_______
⚫ Excessive mucous __________
chemical mediators
contraction
permeability/oedema
secretion
MORPHOLOGY of Asthma
Gross:
⚫ ________ lungs
⚫ (Thin or Thick?) , tenacious, adherent mucus in airway
Distended; thick
MORPHOLOGY of asthma
Microscopy:
⚫_________ crystals
⚫_________ spirals
⚫______ bodies
⚫ Hyperplastic bronchial _____________ & increase number of ______ cells
⚫_________ submucosa
Charcot-Leyden
Curschmann
Creola; mucosa and glands ; goblet
Oedematous
MORPHOLOGY of ASTHMA
Microscopy:
⚫ Charcot-Leyden crystals in _________,_______ , strips of _________
⚫ Curschmann spirals- _________ of airway
⚫ Creola bodies- compact clusters of _______ in sputum
mucus plugs, eosinophils
epithelium; mucus cast
epithelial cells
Genetics of asthma
⚫ Research suggests that genetic factors increase the risk of developing the disorder.
T/F
T
Genetics of asthma
Children with a family history of asthma are more likely to develop asthma than other children.
T/F
T
Emphysema
Is the ________ of airspaces (proximal or distal?) to __________
With __________
Without _______
Enlargement
Distal; terminal bronchioles
destruction of their walls
fibrosis
Emphysema occurs With fibrosis
T/F
F
Without fibrosis
Emphysema
A progressive respiratory disease
characterised by coughing, shortness of
breath & wheezing
T/F
T
Classification of Emphysema
Based on morphology
⚫___________
⚫_________
⚫___________
⚫__________
⚫ Mixed (Unclassified)
Panacinar
Centriacinar
Paraseptal
Irregular
Pathogenesis of emphysema
⚫ Cigerette smoking:__________ or _____ imbalance hypothesis
⚫_________ deficiency (genetic)
⚫ Air pollutants
⚫ Infection
Protease-Antiprotease or Proteolysis-Antiproteolysis
Alpha-1-antitrypsin
Smokers’ Emphysema
⚫ Increased number of _______
⚫ Contain __________ & other proteases
⚫ Reduced __________ activity due to
_____________________ enzyme
⚫ Increased activity of _______ & other
enzymes
neutrophils
serine elastase; α1-antitrypsin
oxidation of methionine
trypsin
Smokers’ Emphysema
Unopposed and increased ______ activity
destruction of _______ leads to loss of
___________
permanent ________ of alveoli
(Small or large?) volume of residual air trapped in the lungs
elastolytic; alveolar walls; elastic recoil
dilatation
Large
α1-antitrypsin
Produced in the _______
Is a Circulating ________
Major _______ of _______
liver; glycoprotein
Inhibitor ; proteases
α1-antitrypsin
⚫ In the lungs: inhibits _________
⚫ In the blood:_____% of all antiproteinase activity
neutrophil elastase
90
Molecular genetics of α1-antitrypsin
A1AT def caused by an abnormality of the ______ gene on chromosome ____ (14q32.1)
SERPINA1
14
Molecular genetics of α1-antitrypsin
Amount produced determined by genotype
⚫ Alleles:
⚫_____ , non-mutated
⚫______, glutamate to lysine mutation at position 342
⚫______ glutamate to valine mutation at position 264
PiM
PiZ
PiS
SERPINA1
(Serine Peptidase Inhibitor, Clade A, member 1)
Features of PANACINAR
The acinus is ____________
Destruction of _________
Associated with ___________
Tends to occur in ______ lobes
uniformly affected
alveolar septa
α1-AT deficiency
lower
Most frequently encountered pattern of emphysema is ???
Centrilobular
Centrilobular emphysema
Destruction of cluster of ____________ in the ______ part of the pulmonary lobule
Most severe in ______ zones
Damaged RBs separated from each other by _____________
terminal respiratory bronchioles (RB)
central; upper
normal alveolar ducts
Centrilobular emphysema
Proximal bronchioles are ______ and ———-
inflamed and narrow
___________ emphysema is Associated with smoking
Centrilobular
Localised Emphysema (________)
destruction of ______
Usually found at the _____ of the _____ lobe but may be anywhere
Usually ____pleural
paraseptal
alveoli; apex; upper
sub
Focal Dust Emphysema
⚫ Disease of __________
⚫ Similar to ______- but enlarged spaces are (smaller or larger?) and (more or less?) regular
coal miners
centrilobular
Smaller
More
_________ emphysema forms bullae which may rupture
Localized /paraseptal
Clinical features of emphysema
Patients usually about _____yrs or older
Symptoms usually start when _____ of lung tissue is damaged
Dyspnoea initially ______, progressively worsens
60; ⅓
mild
Clinical features of emphysema
Cough is (productive or non-productive?) , (minimal or maximal?) .
non-productive
Minimal
Cough in emphysema is productive when it is associated with _________
chronic bronchitis
Clinical features of emphysema
⚫__________ may be the chief complaint
⚫ _______pnoea (↑RR), (shortened or prolonged?) expiratory phase, _____eased minute volume
Cough or wheezing
Tachy; prolonged; incr
Clinical features of emphysema
⚫ Use of _______ muscles of respiration
⚫______ chest
⚫ _________ lungs on CXR
accessory; Barrel
Overinflated
Emphysema is easily confused with asthma
T/F
T
Emphysema patients are also called??
Chronic bronchitis patients are also called ???
Pink puffers
Blue bloaters
Chronic Bronchitis
Chronic (productive or non-productive ?) cough without a discernible cause for at least __________ of the year over a period of ________.
Productive
3 months
2yrs
Chronic Bronchitis
_____% of cases occur in smokers
Exposure to ETS & air pollution increases
risk of CB in non-smokers
90
Morphology
⚫ Gross
⚫ Thick, hyperaemic & oedematous bronchial wall
⚫ Suppurative exudate in lumina of bronchi and
bronchioles
⚫ + or – mucus plugs
Gross Morphology of CB
⚫ (Thin or Thick?) , hyperaemic & ________ bronchial wall
⚫_________ exudate in lumina of _______ and ______
Thick
oedematous
Suppurative
bronchi and bronchioles
CB patients must have mucus plugs
T/F
F
⚫ may or may not have mucus plugs
Morphology of CB
⚫ Hypertrophy of ________ & hyperplasia of ________ resulting in excess mucous in the airway
⚫ Thickened ______, _____ enlargement & oedema results in a narrower lumen
⚫___________ hyperplasia
⚫_____________ (in smokers)
submucous glands; goblet cells
bronchial wall; glandular
Smooth muscle
Squamous metaplasia
Morphology of CB
Ratio of wall thickness (distance between ____________ and ____________ ) to _________ = _____ index
epithelial basement membrane & the cartilage
thickness of gland layer
Reid
In CB, Reid index is > ____
Normal is ______
0.5
0.4
CB often accompanied by emphysema
T/F
T
CB often accompanied by _______
emphysema
Clinical Features of CB
⚫________ cough for years
⚫ ________ on exertion
⚫________ (Blue bloaters)
⚫ Cor pulmonale
⚫ _______________ predisposes to infections
Productive
Dyspnoea
Cyanosis
Retained mucous secretions
Cor pulmonale is frequent in emphysema
T/F
F
Cor pulmonale is frequent in CB
T/F
T
Bronchial infections is frequent in emphysema
T/F
F
Bronchial infections is frequent in CB
T/F
T
Age at diagnosis of CB
Age at diagnosis of emphysema
50
60
Dyspnea is a late manifestation in CB
T/F
T
Dyspnea is a late manifestation in emphysema
T/F
F
Early
Elastic recoil in CB is??
Elastic recoil in emphysema is ??
Normal
Low
Bronchiectasis is Chronic inflammatory disorder of the lung caused by _________ With destruction of _______ and _______, Resulting in __________ of bronchi and bronchioles
necrotizing inflammation
muscle and elastic
permanent dilatation
Bronchiectasis
This is clinically characterized by
⚫______
⚫________
⚫ Copious production of ______,_______ sputum
Fever
Cough
foul smelling, purulent
Asthma
CB
Emphysema
Bronchectasis
Productive cough
Productive cough
Non- Productive cough
Foul smelling sputum
Classification of bronchiectasis
⚫_________ bronchiectasis
⚫_________ bronchiectasis
Obstructive
Non-obstructive
Obstructive bronchiectasis
– may follow obstruction from ______ and is localised to _____________
any cause
the region distal to the obstruction
Non-obstructive bronchiectasis
– usually follows _________
infection
Predisposing factors of bronchiectasis
Congenital
⚫ Immunodeficiency States
⚫________
⚫_______ syndrome
⚫__________ sequestration of the lungs
⚫ Primary cilia dyskinesia
Acquired
⚫___________
⚫ Bronchial ______
Cystic fibrosis; Kartagener’s
Intralobar
Post-infectious; obstruction
Aetiopathogenesis of bronchiectasis
Obstruction
⚫ Foreign bodies
⚫ _____
⚫ Compression by enlarged ______
⚫ Post-inflammatory _______
Infection
⚫________________ e.g _______ or ______
Tumors; hilar lymph nodes; scarring
Necrotising pneumonia
post TB or staph
Morphology of bronchiectasis
⚫ Diffuse or segmental involvement of the (proximal or distal?) bronchi and bronchioles
⚫ Bilateral involvement of _____ lobes
⚫ Thickened fibrotic pleura with adhesions to the chest wall
Distal
lower
Morphology of bronchiectasis
Dilated bronchi &bronchioles appear
⚫___________
⚫________
⚫________
⚫__________
Cylindrical
Saccular
Varicose
Fusiform
Morphology of bronchiectasis
Dilated bronchi &bronchioles appear
⚫ Cylindrical –____ like dilatation
⚫ Saccular –_________-like distension
⚫ Varicose –________ enlargements
⚫ Fusiform –_____ shaped dilatation
tube
rounded sac
irregular
spindle
Morphology of bronchiectasis
Cut lung surface reveals
⚫ _______ appearance with fibrotic
intervening stroma
⚫ (thin or thick?) (constricted or dilated?) bronchial walls with ________ filled lumina.
⚫ Bronchioles can be easily followed by
dissection to the pleural surfaces
Honey comb
Thick; dilated ; mucus/pus
Morphology of bronchiectasis: Microscopy reveals
Bronchi & bronchioles
⚫ ___________________ epithelium
⚫ Acute & chronic inflammatory infiltrates
⚫ Tissue ________ and ______
Lung parenchyma
⚫ Fibrosis of _________
⚫__________ pneumonia in surrounding lung tissue
⚫ Suppuration
Normal, ulcerated or metaplastic
destruction and fibrosis
intervening stroma
Interstitial
In obstructive lung diseases
Volume of air that can be forcefully expired is _____eased (), especially during the first second of expiration (_____);
decr; FVC
FEV1
In obstructive lung diseases
FEV1:FVC is _____eased
Decr
In obstructive lung diseases , Total lung capacity (TLC) is usually ______eased due to ________
incr
air trapping
Emphysema is reversible
T/F
F
Emphysema is irreversible
Regions
Centrilobular-______ lobes. Especially the ____ segments
Panlobular-_______ lobes ; especially at the ———-
Paraseptal-_______ lobes
upper; apical
lower; bases
upper
Irregular (______ or ______) emphysema
Acinus is irregularly involved and may be asymptomatic.
scar or cicatricial
Irregular (scar or cicatricial) emphysema
Association: Occurs near the _____ and is commonly found around ______________ like tuberculous scars.
scar
old healed inflammatory process
In emphysema
Usually, the __________ of the lungs are more severely involved
______ are found in irregular and distal acinar emphysema
upper two-thirds
Bullae
Emphysema can easily be seen on the cut surface of formalin-inflated fixed lung.
T/F
T
Weight gain is seen in (CB or emphysema?)
Weight loss is seen in (CB or emphysema?)
CB
Emphysema
Pursed lip breathing is a clinical feature in patients with __________
Emphysema
Acute asthmatic attack usually lasts up to _______
several hours.
_________ is the most severe form of asthma in which the severe paroxysm persists for days and even weeks.
Status asthmaticus
In Status asthmaticus,
The bronchoconstriction responds to the drugs.
It may cause severe airflow obstruction
May lead to severe cyanosis and even death.
T/F
F
T
T
Genetic Causes of bronchiectasis
Kartagener or _______ syndrome (primary ______________)
________ syndrome
immotile cilia ; ciliary dyskinesia
Young’s
Cystic Fibrosis
Major respiratory diseases in cystic fibrosis (CF) are _________ and _________
sinusitis and bronchiectasis.
