Emphysema

Question 1

what is emphysema ?

Answer 1

emphysema is characterized by the destruction of the alveoli leading to reduced surface area for gas exchange.

Question 2

how is emphysema is initiated?

Answer 2

it is often initiated by exposure to harmful substances particularly cigarette smoke which activates a part of these immune system

Question 3

what immune cells are activated in response to smoke in emphysema?

Answer 3

neutrophils: are the first responders the arrive at the site of inflammation to engulf and destroy harmful substances
macrophages: they are larger immune cells that also consume debris and pathogens they help initiate further immune response

Question 4

what is the consequence of an immune activation?

Answer 4

the continuous presence of smoke leads to chronic inflammation which leads to lung tissue and walls of alveoli damage

Question 5

what enzyme do neutrophils secrete and what do they do ?

Answer 5

they secrete an enzyme called protease specifically elastase which break down proteins and help eliminate pathogens and manage inflammation

Question 6

what does elastase target ?

Answer 6

elastase targets elastin a protein that provides elasticity to tissue particularly in the lungs and blood vessels by breaking it down. elastase helps combat infections by breaking down the structural components of pathogens

Question 7

what can an excessive amount of elastase cause?

Answer 7

an excessive amount of elastase can lead to tissue damage. In conditions like emphysema, the overactivity of elastase contributes to the destruction of alveolar walls, impairing lung function and reducing the surface area available for gas exchange

Question 8

what are alpha-1 antitrypsin and what do they do?

Answer 8

A1AT is a protein produced by the liver that serves as a protease inhibitor. it specifically inhibits the action of proteolytic enzymes, particularly neutrophil elastase

Question 9

what is the protective mechanism of A1AT?

Answer 9

it prevents excessive tissue damage caused by neutrophil activity, by inhibiting elastase A1At helps to maintain the integrity of lung tissue, by cleaving to elastin this reduces the potential damage to surrounding tissues. This balance between neutrophils and A1AT is essential for protecting lung function and preventing chronic conditions like emphysema.

Question 10

what can a deficiency of A1AT lead to?

Answer 10

it can lead to unchecked activity of elastase resulting in tissue damage and increased risk
of developing emphysema or liver disease. Individuals with A1AT deficiency may experience more rapid deterioration of lung function due to the lack of inhibition of elastase.

Question 11

what happens when you exhale in relation to nerve innervation?

Answer 11

when you exhale, the nervous system stops sending signals to the intercostal muscles and the diaphragm. This cessation of nerve innervation allows these muscles to relax.
As the muscles relax, the thoracic cavity decreases in size, and the lungs deflate. the protein that allows this elastic recoil is called elastin

Question 12

why is elastin and elastic recoil important and how does it affect patients with emphysema?

Answer 12

effective elastic recoil ensures that air is expelled from the lungs, helping to maintain normal breathing patterns and allowing for efficient gas exchange. In conditions like emphysema, the destruction of elastin leads to a loss of this elastic recoil, resulting in difficulty exhaling and trapping air in the lungs.

Question 13

why are saggy alveolis bad

Answer 13

-Reduced Elastic Recoil: The lungs cannot efficiently deflate during exhalation, making it harder to expel air.
-Decreased Surface Area: The destruction of alveoli leads to a significant reduction in the surface area available for gas exchange (the process of oxygen entering the blood and carbon dioxide being removed).
-This reduction in surface area severely impacts the lungs’ ability to oxygenate the blood, leading to symptoms like shortness of breath, chronic cough, and decreased exercise tolerance

Question 14

what clinical implications come with emphysema?

Answer 14

-hypoxemia
-hypercapnia

Question 16

how do patients with emphysema effectively exhale (what muscles do they use)?

Answer 16

-external intercostal muscles
-abdominal muscles

Question 17

why are patients with emphysema called pink puffers?

Answer 17

patients with emphysema adopt a technique called pursed lip breathing to help maintain a positive pressure in the airway, which can help prevent airway collapse.
-Pink: Indicates that they typically maintain a good oxygenation level, resulting in a pink complexion.
-Puffers: Refers to the effort they exert while breathing, often characterized by a pursed lip breathing technique that creates a puffing sound during exhalation

Question 18

what is residual volume

Answer 18

-Residual Volume (RV) is the amount of air that remains in the lungs after a complete exhalation. In emphysema, this residual volume increases
-The excess elastase activity leads to the destruction of alveolar walls, making it difficult to remove stale air trapped in the lungs

Question 19

why do patients with emphysema develop a barrel chest?

Answer 19

To accommodate the increased residual volume and to inhale adequate amounts of air, the chest expands over time.
This expansion leads to the characteristic “barrel chest” appearance:
The chest appears rounded and enlarged, resembling a barrel.
This change occurs as the rib cage adapts to allow for increased lung volume and air trapping

Question 20

what is v/q mismatch

Answer 20

The Ventilation/Perfusion (V/Q) ratio is a measure of the relationship between the amount of air reaching the alveoli (ventilation) and the blood flow in the pulmonary capillaries (perfusion).
-Ideally, for efficient gas exchange, the V/Q ratio should be balanced. A normal V/Q ratio is about 0.8, meaning that the ventilation and perfusion are closely matched to optimize oxygen and carbon dioxide exchange.