Emphysema

Question 1

What is Emphysema?

Answer 1

Smoke in the lungs activates a part of the immune system and your body releases neutrophils and macrophages as a response.

Question 2

What is Emphysema characterised for?

Answer 2

• The destruction of the alveoli leading to reduced surface area for gas exchange

Question 3

What is a result of Emphysema?

Answer 3

Difficult breathing and decreased O2 supply to the body

Question 4

What are Neutrophils?

Answer 4

First responders that arrive at the site of inflammation to engulf and destroy harmful substances

Question 5

What are Macrophages?

Answer 5

Larger immune cells that consume debris and pathogens and help initiate further immune response

Question 6

What does the continuous presence of smoke lead to?

Answer 6

• Chronic inflammation which causes damage to the lung tissue and the walls of the alveoli
• The breakdown of the alveoli walls leads to large less efficient air spaces and reducing the lungs ability to expel air

Question 7

What do Neutrophils secrete?

Answer 7

They secrete an enzyme called protease which breaks down proteins

Question 8

What is the name of the protease called?

Answer 8

Elastase

Question 9

What do Elastase target? And what does that do?

Answer 9

• Elastin
• Provides elasticity to tissues particularly in the lungs and blood vessels.

Question 10

What does Elastase help with?

Answer 10

By breaking down elastin, elastase can help combat infections by breaking down the structural components of pathogens

Question 11

What does the overactive elastase contribute to?

Answer 11

The destruction of alveolar walls, impairing lung functions and reducing the surface area available for gas exchange

Question 12

What is Alpha-1 Antitrypsin (A1AT)

Answer 12

Protein produced by the liver that serves as a protease inhibitor

Question 13

What do A1AT specifically inhibit?

Answer 13

Action of proteolytic enzymes, particularly neutrophil elastase which is secreted by neutrophils during inflammation.

Question 14

A1AT acts as a protective mechanism, what does this prevent and maintain?

Answer 14

Excessive tissue damage caused by neutrophil activity
Helps to maintain the integrity of luge tissue and other organs

Question 15

What can a deficiency of A1AT lead to?

Answer 15

Lead to unchecked activity of elastase resulting in tissue damage and an increase risk of developing emphysema

Question 16

What is Boyle’s Law?

Answer 16

As the volume of the thoracic cavity increases due to the contraction of these muscles, the pressure within the lung decrease relative to the outside atmospheric pressure

Question 17

What is elastic recoil?

Answer 17

The lung having a natural ability to return to original size after stretched or expanded

Question 18

What does effective elastic recoil ensure?

Answer 18

Ensure that air is expelled from the lungs helping to maintain normal breathing patterns and allowing for efficient gas exchange

Question 19

When we breathe out, what happens to the nerve innervation?

Answer 19

The nerve innervation to the intercostals and diaphragms stop as the lungs have a natural elastic recoil that allows them to deflate again

Question 20

Why is elastic recoil effective for breathing?

Answer 20

As it helps push air out of the lungs without requiring muscle contraction

Question 21

What does the destruction of elastin lead to?

Answer 21

Elastic recoil resulting in difficulty exhaling and trapping air in the lungs

Question 22

What happens to the Alveoli and Terminal Bronchioles?

Answer 22

As elastin is broken down, the alveoli and terminal bronchioles become saggy and lose their structure

Question 23

What is reduced elastic recoil?

Answer 23

Lung cannot efficiently deflate during exhalation making it harder to expel air

Question 24

There is a decrease in surface area, what does this cause?

Answer 24

Reduction available for gas exchange

Question 25

What does the loss of elastic recoil and reduce exchange area contribute to?

Answer 25

Hypoxemia and hypercapnia

Question 26

When there is such effort to breath out, what happens to the RV and the lungs?

Answer 26

RV increases
Leaves stale air in the bottom of the lungs unventilatable

Question 27

What does it mean when the pt gets a barrel chest?

Answer 27

Air still needs to breathed out in the same volume air, the chest expands and develops into a barrel chest

Question 28

What is Ventilation/Perfusion (V/Q)

Answer 28

A concept that describes the relationship between the amount of air reaching the alveoli (ventilation) and the flow of blood in the surrounding capillaries (perfusion)

Question 29

What is a normal V/Q?

Answer 29

0.8 - ventilation/perfusion are closely matched to optimise oxygen and the co2 exchange

Question 30

When there is a V/Q mismatch, what does this cause to the alveoli

Answer 30

Some of the areas of the lungs may receive adequate blood flow but not enough air
Other areas may receive air but lack sufficient blood flow

Question 31

What does a low V/Q ratio mean?

Answer 31

Decrease ventilation relative to perfusion

Question 32

What does high V/Q ration mean?

Answer 32

Ventilation is high but perfusion is low

Question 33

What condition could be in relation to high V/Q ratio?

Answer 33

PE where blood flow is obstructed

Question 34

What can mismatch usually lead to?

Answer 34

• Impaired O2 of blood
• Increased work of breathing
• Potential resp. distress
• Fatigue

Question 35

How can V/Q mismatch be assessed?

Answer 35

• Arterial blood gas analyse to measure O2 and CO2 levels

Question 36

What are some managements to improve ventilations and O2?

Answer 36

• Bronchodilators
• O2 therapy
• Pulmonary rehab