COPD: Emphysema and Chronic bronchitis Flashcards
characterized by an increase in resistance to airflow due to partial or complete obstruction at any bronchial level
obstructive airway disease
Can obstructive airway disease be partial or only complete?
partial or complete
What does FEV1 mean?
forced expiratory volume in 1 second
What happens to FEV1 with obstructive airway disease? What about FVC?
decreased FEV1
normal FVC
What does decreased FEV1 mean regarding air exiting the lungs?
Less air exits lungs per unit time
Major obstructive airway diseases
- emphysema
- chronic bronchitis
Obstructive pulmonary disease causes chronic ________.
Obstructive pulmonary disease causes chronic inflammation.
Obstructive pulmonary diseases are chronic ___-_______ inflammatory disorders.
Obstructive pulmonary diseases are chronic cell-mediated inflammatory disorders.
What do these chronic cell-mediated inflammatory disorders activate and release?
- activated T cell, macrophages, and neutrophils
- release cytokines
What are some examples of the cytokines released?
- leukotriene B4
- TNF
What does the chronic inflammation cause variable degrees of?
- Inflammatory mucous secretion
- Tissue remodeling and fibrosis
What is tissue remodeling and fibrosis due to?
due to cycles of phagocyte lysosomal protease release and subsequent tissue repair
With chronic inflammation, what do activated macrophages and neutrophils secrete?
lysosomal enzymes and oxygen free radicals
What are normally inhibited by circulating protease inhibitors, e.g., α1-antitrypsin?
lysosomal proteases
What happens when there are oxygen free radicals present from activated phagocytes or conditions of oxidant stress?
oxygen free radicals inactivate α1-antitrypsin
What effect does inactivating α1-antitrypsin inflammation and remodeling of alveolar walls have?
Inactivating α1-antitrypsin means that lysosomal proteases are not inhibited and therefore cause prolonged activation of lysozomal enzymes
What does prolonged activation of lysosomal enzymes result in?
inflammation and remodeling of alveolar walls
What are emphysema and chronic bronchitis also known as?
chronic COPD
What structures does emphysema affect?
- alveoli
- terminal bronchioles
What structures does bronchiolitis affect?
-bronchioles
What structures does bronchitis affect?
-larger airways
What is the primary cause of chronic COPD?
cigarette smoking
What are some other causes of chronic COPD other than smoking?
- environmental pollutants
- related exposures
- rare genetic cause
What is the name of the rare genetic cause for chronic COPD?
α1-antitrypsin deficiency
What is another chronic obstructive inflammatory disease of the lungs affecting large airways?
asthma
What is asthma as known as?
reversible airway hyperreactivity
What are some characteristics of pure chronic bronchitis - large airways?
large airways - trachea, bronchi
- mucus hypersecretion
- inflammation
What are some characteristics of pure chronic bronchitis - small airways?
small airways - bronchioles
- peribronchilar fibrosis
- airway obstruction
What are some characteristics of pure emphysema?
acinus (respiratory bronchioles, alveolar ducts, alveoli)
- loss of elastic recoil
- loss of surface area
Characterized by permanent, abnormal enlargement of the alveoli (may include terminal bronchioles)
emphysema
How does emphysema affect alveolar walls?
Destruction of alveolar walls with or without fibrosis
Does emphysema tend affect upper or lower lobes more?
upper lobes more than lower lobes
What happens to surface area with emphysema?
Reduction in surface area that is needed for gas exchange
With emphysema, what happens to air in the alveoli and why?
Air becomes trapped due to obstruction and loss of alveolar recoil
With emphysema, what is the result of air being trapped in the alveoli?
results in air accumulation and overall hyperinflation
What does air accumulation and hyperinflation present as on physical exam?
increased AP chest diameter (“barrel chest”)
How is emphysema classified and what are those categories?
Classified by its anatomic location:
- Centriacinar (centrilobar)
- Panacinar (panlobular)
- Distal acinar (paraseptal)
What are bullae and where do they usually form?
Bullae are large subpleural blebs, usually form near the apex
What does a rupture of a bullae result in?
pneumothorax
Patients who are _________ for α1-antitrypsin deficiency mutation are unable to
_______ proteases, resulting in tissue _________.
Patients who are homozygous for α1-antitrypsin deficiency mutation are unable to inactivate proteases, resulting in tissue destruction.
What do patients with α1-antitrypsin deficiency markedly increased in developing?
COPD
Patient with α1-antitrypsin deficiency can have early onset _________ between ages _________, especially in the presence of ________.
Patient with α1-antitrypsin deficiency can have early onset emphysema between ages 18-31, especially in the presence of smoking.
What are some xray findings of emphysema? (7)
- Air trapping causing hyperinflation (count > 10 ribs)
- Hyperlucent lung fields (black, look “over-penetrated”)
- Increased retrosternal air
- Blebs
- Flattening of diaphragms
- Loss of peripheral vascular markings
- Vertical heart (QRS axis closer to 90°)
Is interstitial emphysema related to COPD or not?
NOT related to COPD
occurs when air is forced into soft tissue
interstitial emphysema
What are some examples of when interstitial emphysema occurs?
- trauma
- cough with obstruction
Inflammation of bronchi and trachea with hypersecretion of mucus
chronic bronchitis
What does mucus hypersecretion cause?
airway obstruction
What does inflammation of bronchi and trachea with hypersecretion of mucus result in? (3)
- mucous gland hypertrophy
- thickening of bronchiolar walls
- loss of respiratory cilia
What do people with chronic bronchitis have an increased risk of?
pneumonia
The clinical diagnosis for chronic bronchitis is: Persistent ____ with ______ production for at least __ months in at least __ consecutive years (without other cause).
The clinical diagnosis for chronic bronchitis is: Persistent cough with sputum production for at least 3 months in at least 2 consecutive years (without other cause).
What may chronic bronchitis lead to?
right heart failure (cor pulmonale)
What is chronic bronchitis a risk factor for?
lung cancer due to increase in dysplastic changes in bronchiole epithelial cells
What is chronic bronchitis sometimes associated with?
with intermittent bronchospasm and high pitched wheezing
What is another name for an intermittent bronchospasm and high pitched wheezing?
chronic asthmatic bronchitis
What are some xray findings for chronic bronchitis?
Nonspecific signs:
- Increased lung markings
- Kerley lines (type A, B, C; thin linear opacities caused by fluid infiltration into the lung interstitium)
- Bronchial wall cuffing
Can chronic bronchitis be diagnose radiologically?
YES
What can CXR be helpful in doing for chronic bronchitis?
CXR helpful to exclude other conditions which can clinically mimic the disease (e.g., bronchiectasis)
What are the components of evaluation of emphysema and chronic bronchitis?
- history and PE
- spirometry
- CXR, CT
- oximetry, arterial blood gas, acid-base assessment
- CBC
- serum α1-antitrypsin activity
What does spirometry usually show for COPD?
- reduced FEV1
- +/- normal FVC
What does CBC usually show for COPD?
usually normal, may show polycythemia secondary to hypoxia
What population would you particularly consider assessing serum α1-antitrypsin activity?
nonsmokers < 40 years old, earlier for smokers
