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Pathophys II - Block 1 > COPD: Emphysema and Chronic bronchitis > Flashcards

COPD: Emphysema and Chronic bronchitis Flashcards

1
Q

characterized by an increase in resistance to airflow due to partial or complete obstruction at any bronchial level

A

obstructive airway disease

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2
Q

Can obstructive airway disease be partial or only complete?

A

partial or complete

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3
Q

What does FEV1 mean?

A

forced expiratory volume in 1 second

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4
Q

What happens to FEV1 with obstructive airway disease? What about FVC?

A

decreased FEV1

normal FVC

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5
Q

What does decreased FEV1 mean regarding air exiting the lungs?

A

Less air exits lungs per unit time

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6
Q

Major obstructive airway diseases

A
  • emphysema

- chronic bronchitis

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7
Q

Obstructive pulmonary disease causes chronic ________.

A

Obstructive pulmonary disease causes chronic inflammation.

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8
Q

Obstructive pulmonary diseases are chronic ___-_______ inflammatory disorders.

A

Obstructive pulmonary diseases are chronic cell-mediated inflammatory disorders.

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9
Q

What do these chronic cell-mediated inflammatory disorders activate and release?

A
  • activated T cell, macrophages, and neutrophils

- release cytokines

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10
Q

What are some examples of the cytokines released?

A
  • leukotriene B4

- TNF

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11
Q

What does the chronic inflammation cause variable degrees of?

A
  • Inflammatory mucous secretion

- Tissue remodeling and fibrosis

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12
Q

What is tissue remodeling and fibrosis due to?

A

due to cycles of phagocyte lysosomal protease release and subsequent tissue repair

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13
Q

With chronic inflammation, what do activated macrophages and neutrophils secrete?

A

lysosomal enzymes and oxygen free radicals

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14
Q

What are normally inhibited by circulating protease inhibitors, e.g., α1-antitrypsin?

A

lysosomal proteases

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15
Q

What happens when there are oxygen free radicals present from activated phagocytes or conditions of oxidant stress?

A

oxygen free radicals inactivate α1-antitrypsin

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16
Q

What effect does inactivating α1-antitrypsin inflammation and remodeling of alveolar walls have?

A

Inactivating α1-antitrypsin means that lysosomal proteases are not inhibited and therefore cause prolonged activation of lysozomal enzymes

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17
Q

What does prolonged activation of lysosomal enzymes result in?

A

inflammation and remodeling of alveolar walls

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18
Q

What are emphysema and chronic bronchitis also known as?

A

chronic COPD

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19
Q

What structures does emphysema affect?

A
  • alveoli

- terminal bronchioles

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20
Q

What structures does bronchiolitis affect?

A

-bronchioles

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21
Q

What structures does bronchitis affect?

A

-larger airways

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22
Q

What is the primary cause of chronic COPD?

A

cigarette smoking

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23
Q

What are some other causes of chronic COPD other than smoking?

A
  • environmental pollutants
  • related exposures
  • rare genetic cause
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24
Q

What is the name of the rare genetic cause for chronic COPD?

A

α1-antitrypsin deficiency

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25
What is another chronic obstructive inflammatory disease of the lungs affecting large airways?
asthma
26
What is asthma as known as?
reversible airway hyperreactivity
27
What are some characteristics of pure chronic bronchitis - large airways?
large airways - trachea, bronchi - mucus hypersecretion - inflammation
28
What are some characteristics of pure chronic bronchitis - small airways?
small airways - bronchioles - peribronchilar fibrosis - airway obstruction
29
What are some characteristics of pure emphysema?
acinus (respiratory bronchioles, alveolar ducts, alveoli) - loss of elastic recoil - loss of surface area
30
Characterized by permanent, abnormal enlargement of the alveoli (may include terminal bronchioles)
emphysema
31
How does emphysema affect alveolar walls?
Destruction of alveolar walls with or without fibrosis
32
Does emphysema tend affect upper or lower lobes more?
upper lobes more than lower lobes
33
What happens to surface area with emphysema?
Reduction in surface area that is needed for gas exchange
34
With emphysema, what happens to air in the alveoli and why?
Air becomes trapped due to obstruction and loss of alveolar recoil
35
With emphysema, what is the result of air being trapped in the alveoli?
results in air accumulation and overall hyperinflation
36
What does air accumulation and hyperinflation present as on physical exam?
increased AP chest diameter (“barrel chest”)
37
How is emphysema classified and what are those categories?
Classified by its anatomic location: - Centriacinar (centrilobar) - Panacinar (panlobular) - Distal acinar (paraseptal)
38
What are bullae and where do they usually form?
Bullae are large subpleural blebs, usually form near the apex
39
What does a rupture of a bullae result in?
pneumothorax
40
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.
41
What do patients with α1-antitrypsin deficiency markedly increased in developing?
COPD
42
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.
43
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°)
44
Is interstitial emphysema related to COPD or not?
NOT related to COPD
45
occurs when air is forced into soft tissue
interstitial emphysema
46
What are some examples of when interstitial emphysema occurs?
- trauma | - cough with obstruction
47
Inflammation of bronchi and trachea with hypersecretion of mucus
chronic bronchitis
48
What does mucus hypersecretion cause?
airway obstruction
49
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
50
What do people with chronic bronchitis have an increased risk of?
pneumonia
51
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).
52
What may chronic bronchitis lead to?
right heart failure (cor pulmonale)
53
What is chronic bronchitis a risk factor for?
lung cancer due to increase in dysplastic changes in bronchiole epithelial cells
54
What is chronic bronchitis sometimes associated with?
with intermittent bronchospasm and high pitched wheezing
55
What is another name for an intermittent bronchospasm and high pitched wheezing?
chronic asthmatic bronchitis
56
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
57
Can chronic bronchitis be diagnose radiologically?
YES
58
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)
59
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
60
What does spirometry usually show for COPD?
- reduced FEV1 | - +/- normal FVC
61
What does CBC usually show for COPD?
usually normal, may show polycythemia secondary to hypoxia
62
What population would you particularly consider assessing serum α1-antitrypsin activity?
nonsmokers < 40 years old, earlier for smokers

Pathophys II - Block 1 (8 decks)

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