Emphysema and Chronic Bronchitis

Question 1

What is COPD?

Answer 1

A respiratory disorder characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations, and increasing frequency and severity of exacerbations.

Question 2

What are some comorbidities associated with COPD?

Answer 2

Ischemic heart disease, congestive heart failure, arrhythmias, pulmonary hypertension, lung cancer, osteoporosis, glaucoma and many more.

Question 3

What are the screening questions we ask to determine if someone may have COPD?

Answer 3

1. Do you cough regularly
2. Do you cough up phlegm regularly
3. Do simple chores make you out of breath
4. Do you wheeze when you exert yourself or at night
5. Do you get frequent colds that last longer than other people you know

Question 4

What is emphysema?

Answer 4

Permanent destruction of alveolar walls with a loss of elastic recoil.

Question 5

What are the two classifications of emphysema?

Answer 5

Panlobular and Centrilobular.

Question 6

What is panlobular (panacinar) emphysema?

Answer 6

Enlargement of all air spaces distal to the terminal bronchioles.

Question 7

What is centrilobular (centriacinar) emphysema?

Answer 7

Involves the central pulmonary lobule and not the distal lung units.

Question 8

Which type of emphysema is Alpha 1 Antitrypsin deficiency associated with?

Answer 8

Panlobular

Question 9

Which kind of emphysema is primarily caused by smoking?

Answer 9

Centrilobular

Question 10

Where is centrilobular emphysema typically found?

Answer 10

The upper lobes of the lungs.

Question 11

Where is panlobular emphysema typically found?

Answer 11

The lower lobes of the lungs.

Question 12

How does centrilobular emphysema affect the lungs?

Answer 12

Elevated proteases results in the destruction of elastic fibres, causing loss of elasticity resulting in flow limitations and abnormalities in gas exchange. Impairment in expiratory flow due to the loss of elastic recoil = DYNAMIC COMPRESSION

Question 13

How does emphysema change compliance?

Answer 13

Increases compliance, decreasing driving pressure of exhalation.

Question 14

What are the physical consequences of emphysema?

Answer 14

Air trapping, Increased FRC, RV, and TLC, destruction of alveolar capillary bed results in reduced surface area for gas diffusion.

Question 15

What causes increased airway resistance in emphysema?

Answer 15

Loss of elastance and collapse (dynamic compression) of the airways.

Question 16

Describe some clinical manifestations of emphysema.

Answer 16

Increased A-P diameter due to hyperinflation, accessory muscle usage, SOB, decreased breath sounds, hyperresonant on percussion, hyperlucent CXR.

Question 17

What are bulae and why are they bad?

Answer 17

Bubbles of overinflated lung tissue. If popped will cause a pneumothorax.

Question 18

What is a tell-tale indicator of emphysema on spirometry?

Answer 18

Obstructive pattern that is not responsive to B2 therapy with air trapping and reduced diffusion (DLCO).

Question 19

What is chronic bronchitis?

Answer 19

A pulmonary disease that causes a chronically productive cough due to bronchial inflammation.

Question 20

How do we specifically define chronic bronchitis?

Answer 20

When it lasts for at least 3 consecutive months of the year for 2 successive years.

Question 21

What are some of the net effects of smoking?

Answer 21

Increased airway resistance, increased carboxyhemoglobin, decreased repair abilities, decreased tracheal bronchial toilette, cardiac and cancer related concerns.

Question 22

What is occurring to cause chronic bronchitis?

Answer 22

Mucus glands enlarge (hypertrophy) and Goblet cells increase in number (hyperplasia); this creates an abnormal increase in mucus production.

Question 23

Why is mucus due to chronic bronchitis a problem?

Answer 23

It decreases airflow through the larger bronchi and can solidify in casts, completely blocking a bronchiole. The small airways are narrowed and V/Q mismatching is increased due to mucus plugging.

Question 24

Describe what happens at late stages of chronic bronchitis when hypoxemia sets in.

Answer 24

Hypoxemia constricts the pulmonary vasculature (hypoxic vasoconstriction), acidosis adds to the constriction of smooth muscles in the pulmonary blood vessels creating resistance, this resistance means the right side of the heart must work harder, eventually leading to cor pulmonale.

Question 25

What is cor pulmonale?

Answer 25

Right heart failure due hypertrophy as a result of having to pump against increased pressures.

Question 26

What clinical manifestations might you see with chronic bronchitis?

Answer 26

Sputum (thick and whitish or can also be purulent), hemoptysis, increased A-P diameter, accessory muscle use, clubbing and cyanosis, peripheral edema, crackles and wheezes on auscultation, dull percussion, polycythemia.

Question 27

How does chronic bronchitis affect lung compliance?

Answer 27

It decreases due to loss of volume from mucus production and plugging.

Question 28

What pattern may we see in an ABG on a patient with acute exacerbation of chronic bronchitis?

Answer 28

An ABG may read as metabolic alkalosis due to their high baseline CO2 levels, but due to hypoxemia they hyperventilate and bring their CO2 below baseline (but within a normal person’s range) causing alkalosis. If the patient is approaching respiratory failure, we will see pH fall and
CO2 rise because they can no longer maintain the RR that was causing the alkalosis.