EXAM 1 Flashcards
1
Q
Theophylline and Phosphodiesterase-4 inhibitors
Less?
Modest?
Options?
A
2
Q
- Volume of air inspired or expired during a normal inspiration or expiration.
- Amount of air inspired forcefully after inspiration of normal tidal volume.
- Amount of air forcefully expired after expiration of normal tidal volume.
- Volume of air remaining in lungs at the end of a maximal expiration.
- Maximal amount of air that can be inhaled from the end-expiratory level of a tidal volume (VT+IRV).
- Volume of air in the lung at the end of a normal expiration.
- Volume change that occurs between maximal inspiration and maximal expiration (IRV+VT+ERV).
- Volume of air in the lung at the end of a maximal inspiration (RV + VC or FRC + IC).
A
- Tidal Volume
- Inspiratory reserve volume
- Expiratory reserve volume
- Residual volume
- Inspiratory capacity
- Functional residual capacity
- Vital capacity
- Total lung capacity
3
Q
Leukotriene pathways in asthma
Leukotrienes are products of?
Potent?
Released by what type of cells?
Why does aspirin induce Asthma?
A-D
A
4
Q
Concetpts
A
5
Q
COPD classifications based on spiro
A
6
Q
Combo B2 and antiinflammatory
A
7
Q
Forced Expiration
Dynamic Compression
Increasing effort causes?
A
- Airway Ptm= 10-10 = 0 airway tends to collapse (equal pressure point)
- Driving force PA-Ppl
- Increasing effort causes similar increase of PA and Ppl
8
Q
Peripheral receptors
Located on?
Respond to fluctuations in?
Responsible for the increase of? Due to?
Response to ___ is less important than that of central chemoreceptors
Mainly respond to?
4 things
A
- Located in aortic bodies and carotid bodies.
- Respond to fluctuations in blood O2 levels very fast.
- Responsible for all the increase of ventilation due to arterial hypoxemia.
- Response to arterial PCO2 is less important than that of the central chemoreceptors
- Peripheral chemoreceptors are located in the carotid and aortic bodies. They mainly respond to decreased arterial PO2, but are also stimulated by increased PCO2 and H+ (rapidly responding).
9
Q
Hemoglobin synth
A
10
Q
Pulmonary and Bronchial Circulation
Bronchial circulation is part of the?
Pulmonary circulatoin receives?
Other notes about pulm
A
11
Q
Central Controller
Medullary respiratory center
DRG
VRG
2 parts
Apneaustic area in pons
Pneumotaxic center of pons
A
- Dorsal respiratory group (DRG): Cells have inherent rhythm that causes inspiratory cycles , controls diaphragm & external intercostals. Active for 2 sec during inspiration & quiet for 3 sec during expiration.
- Ventral respiratory group (VRG): Increased DRG activity stimulates the VRG which stimulates internal intercostals & abdominal muscle layers during forced expiration.
Apneustic: Stimulates DRG for normal inspiration (2 sec) or longer during forced inspiration (maximum inhalation)
Pneumo:
- Inhibits apneustic area to allow exhalation;
- Modifies the pace set by DRG and VRG;
- Its absence causes increase in depth of respiration and a decrease in respiratory rate.
12
Q
Partial Pressure
Definition
A
13
Q
Anti-inflammatory drugs Corticosteroids
MOA
Inhaled
Oral
A
14
Q
Gas-exchange airways
What are they made of?
Alveolar Sacs
A
- Alveoli make up the wall of the alveolar sac
15
Q
Ventilations perfusion matching
The alveolar pressure of both O2 and CO2 are determined by?
Two extreme? Results in?
A
16
Q
Long acting B2agonists
A
17
Q
Hemoglobin
Carries
Adults?
A
18
Q
COPD diagnosis
A
19
Q
Eosinophils
Stimulated by?
Secrete?
5 secretions
A
- • are stimulated by interleukin-3 (IL-3), IL-5, and granulocyte-macrophage colony-stimulating factor (GM-CSF) produced by TH2 lymphocytes and mast cells.
- adhesion molecules, particularly vascular cell adhesion molecule (VCAM-1), and by traveling along chemokine gradients to sites of inflammation.
- secrete cytotoxic granules that cause local tissue damage and induce airway remodeling, directly and indirectly to airway hyperresponsiveness
- major basic protein (MBP)
- matrix metalloproteinases
20
Q
Antimuscarinics
MOA
Used with?
used when? ABC
A
21
Q
Mechanics of Breathing: How the Lung is supported and Moved
A
- Respiration related pressures
- Muscles of respiration
- Elastic properties of the lung (compliance)
- Flow resistance properties (airway resistance)
- Dynamic Compression
- Work of Breathing
22
Q
Bronchi/ Bronchioles
Conducting: 1-16
Respiratory: 17-23
Cartilage?
SM?
Lining?
Elastic fibers?
Glands?
Cells unique in bronchioles
From larger to terminal bronchiole 6 things
A
- Cartilage decrease: Ring shaped cartilage gives way to cartilage plates and eventually disappear
- Smooth muscle increases: SM increases in proportion and continuity as the vessel decreases in size
- Lining: TRE to simple columnar epithelium, epithelial layering and thickness decreases, Cilia decreases
- Elastic fibers appearance
- Mucous glands decrease in size and number and fewer goblet cells
- Clara cells bein to appear, unique in bronchioles (clara cells can reduce inflammation)
23
Q
Dynamic Compression and pulmonary diseases
Factors that exagerate dynamic compression?
2
Dynamic compression in emphysema
2
A
- Resistance increase of the peripheral airways
- Low lung volume
- Driving pressure is reduced because of reduced recoil pressure
- Loss of radial traction on the airways makes them more compressible
24
Q
Alveolar capillary unit
Interface?
SA
Capillary covers?
If something increased thickness what would happen?
A
- The blood-gas interface is the alveolocapillary membrane very thin (0.2-0.3 micrometers)
- Surface area 100 m ^2
- Capillaries cover 90% of the surface
- Disorder that thickens the membrane impairs gas exchange.
25
Erythropoeisis
picture
26
IgE and Mast Cells in Asthma
\_\_\_\_ is the bodies response to allergic Rxn
\_\_\_\_ is produced by ____ cells
Allergen?
Minute concentrations
* IgE
* IgE is produced by B-cells, IgE is specific for one antigen
* An antigen that stimulates an IgE antibody response
27
Hypercapnia
Increase in?
Cause by?
Symptoms?
* Increase in PaCO2
* Caused by
* Depression of the respiratory center by drugs (narcotics)
* Disease of the medulla
* Airway obstruction (sleep apnea, severe asthma, chronic bronchitis)
* Increased physiological dead space (emphysema)
* Neuromuscular diseases (amyotrophic lateral sclerosis)
* Symptoms: HA, confusion, increase cardiac output, HTN, arrythmias due to E+ abnormalitities
28
Targeted therapy for Asthma Cytokines
29
Emphysema Contributing Factors
Genetic
* Alpha1-Antitrypsin def (Inhibits action of protease)
* Elastase breaks down elastic fibers, Destructive process increases in people with low
30
Mechanisms of Underlying airflow
Small Airway Disease
Parenchymal Destruction
31
Perfusion and its Matching with Ventilation
8 things
1. Pulmonary and bronchial circulation
2. Pulmonary vascular resistance
3. Distribution of blood flow (perfusion)
4. Ventilation-perfusion matching
5. Regional gas exchange in the lung
6. Mismatching in diseases
7. Hypoxemia
8. Hypoxic pulmonary vasoconstriction
32
Signs and Symptoms
Asthma
Cough, dyspnea, tight feeling in chest • Wheezing • Rapid, labored breathing • Thick, sticky mucus coughed up • Tachycardia • Hypoxia • Respiratory acidosis • Respiratory failure
33
Drugs
Source:
Pharmacological Effects
Stimulates 2 things
Induces release of?
Clinical uses: Pts with ____ \_\_\_\_ and ____ \_\_\_
Anemia associated with? 3 diseases
ARs
Rapid Increase in?
Erythropoeitin
34
Another picture
35
Antiinflammatory agents
By 2 actions
1.
36
Extraalveolar vessels
Resistance of both alveolar and extra-alveolar vessels are greatly affected by? WHy?
Decrease
37
* The _____ is a simple device for measuring lung volumes and functions (VT, FEV1, FVC, FEV1/FVC).
* ______ is the volume of lung that does not eliminate CO2. (anatomic vs. functional dead space)
* _____ of the normal lung do not have the same \_\_\_\_\_\_. The lower regions of the lung ventilate better than do the upper zones.
* ______ is regulated by CNS central pattern generator, areas in pons peripheral carotid, and aortic receptors.
* The\_\_\_\_\_of the blood is the most important factor controlling ventilation under normal conditions, and most of the control is via the \_\_\_\_\_\_\_\_\_.
* The spirometer is a simple device for measuring lung volumes and functions (VT, FEV1, FVC, FEV1/FVC).
* Dead space is the volume of lung that does not eliminate CO2. (anatomic vs. functional dead space)
* Regions of the normal lung do not have the same ventilation. The lower regions of the lung ventilate better than do the upper zones.
* Respiration is regulated by CNS central pattern generator, areas in pons peripheral carotid, and aortic receptors.
* The PCO2 of the blood is the most important factor controlling ventilation under normal conditions, and most of the control is via the central chemoreceptors.
38
Which one is normal?
Obstructive, Restrictive
N, R, O
39
Nerves
Autonomic affects ___ and depth
Parasympathetic tone-
Sympathetic tone-
* Respiratory centers control breath rate and depth
* Autonomic nervous system affects rate and depth through smooth muscle contraction/relaxation
* **Parasympathetic tone:** Vagus nerve connects smooth muscle cells, stimulation contricts airways by releasing acetylcholine
* **Sympathetic tone:** Stimulation causes release of catecholamine, which induces bronchodilation, (No innervation to smooth muscles but releases catecholamine)
40
Mononuclear phagocyte system
Consists of? That originate?
They are transported into the bloodstream, differentiate into?
Mature in the tissue as?
What do they do to microorganisms
Mostly accumulates in?
41
Regional differences in ventilation
Fact:
Regions of the normal ___ do not have the same \_\_\_\_\_.
The ___ regions of the lung ventilate better than?
Reason for this?
* Lung do not have the same ventilation
* Lower ventilates better than upper
* Intrapleural pressure is less negative at the bottom of the lung than at the top because of the weight of the lung and the configuration of the chest wall.
* The lower regions of the lung are better ventilated than the upper regions because of the effects of gravity on the lung.
42
Overall structure of
1. conducting airways
2. Gas exchange airways
* Upper- Nasal cavity, pharynx, larynx
* Lower - Trachea, Bronchi, bronchioles
* Gas exchange airways- Respiratory bronchioles, alveolar ducts, alveolar sacs
43
Short acting agonists
6 what are the SEs
44
Inspiration process (active)
5 steps
1. Inspiratory muscles contract (diaphragm descends and rib cage rises)
2. Thoracic cavity volume increases
3. Lungs stretch --\> Lung volume increase
4. Intrapulmonary pressure drops
5. Air flow down its gradient
45
Erythrocytes
46
Resistive Work
Work to overcome?
Major and Minor
* Work to overcome airway resistance MAJOR
* Work to overcome tissue resistance MINOR
47
Emphysema
Disease of the?
Characterized by?
48
Anti-IgE antibody
What pts should try this
49
Leukotriene Antagonists
5-lipoxygenase inhibitor:
Leukotriene Receptor Antagonists:
Therapeutic Uses:
Modest?
Good for someone with?
ASA
Not indicated for?
Advantages?
AEs
50
Anti Anemic Drugs
Due to oral
Due to injection
Iron
AEs
51
The respiratory defense system
Filtration
Cilia
Goblet cells and ____ glands
Alveolar macrophages
SA=?
Removes ___ and \_\_\_
* Particles and pathogens
* **Filtration** in nasal cavity removes large particles
* **Cilia -** Sweep debris trapped in mucus toward the pharynx (mucus escalator)
* **Goblet cells and mucous glands** - Produce mucus that bathes exposed surfaces
* **Alveolar macrophages** - Engulf small particles that reach lungs
* SA= 100 m^2
52
Signs symptoms and classifications of Anemia
5anemias
53
Leukocytes
54
Chest wall
Lungs are housed in?
Forces for lung inflation?
Pleura
Membrane?
Layers? 2
Pleural space?
* The lungs are housed in the thoracic cavity
* Forces for lung inflation is supplied by the muscle of respiration
Pleura
* Serous membrane
* Parietal and visceral layers
* Pleural space- Fluid, acts as lubricant, Pleuriisy inflammation, pneumothorax
55
Therapeutic options smoking
Nicotine ____ Therapy
Pharmacologic 2 options
56
Anti Anemic Drugs
What type of anemia?
Kinetics
Dynamic
AEs
Folic Acid
57
Activation of mucosal mast cells releases bronchoconstrictor mediators such as
Activation of mucosal mast cells releases bronchoconstrictor mediators such as histamine, cysteinyl-leukotrienes, prostaglandin D2.
58
Ventilation
How gas gets to the alveoli
6 things
1. Lung volumes
2. Measurements of lung volume
3. Total and alveoli ventilation
4. Anatomic and physiologic dead space
5. Regional difference in ventilation
6. Chemical control of ventilation
59
Gas-exchange airways
Alveolar Ducts
3 things
1. Passage of alveolar sacs (cluster to alveoli)
2. Lining: Mostly simple squamous epithelia
3. Thin-walled, fibro-elastic tubes, fewer smooth muscle spirals, many alveoli from walls
60
Asthma Pathophysiology
4 things
* Bronchoconstriction
* Airway edema
* Increased mucus
* Airway remodeling
The end result of this is narrowing of the airways and decrease in air flow and O2 supply
61
Sumamary
The primary and initial symptoms of most pts are seen due to?
Underlying causes of asthma is an allergic ____ of the airways. _____ \_\_\_\_ ___ to the development and expression of asthma and its pathophysiology.
* Bronchoconstriction
* Inflammation
* Inflammation is central
62
Picture of regulation
63
Trachea- Structure, function, lining, divides into?, Carina?
* Windpipe, thinwalled rigid tube
* 4.5" long and 1" wide, 15-20 C-shaped cartilage rings
* Lining:TRE
* Cilia catches particles of dust
* Divides to form primary bronchi
* Carina= Cough reflex
64
Compostition of Plasma
What do transferritin and ferritin do?
65
Hemoglobin Picture
66
Bronchodilators Table
67
Mechanism of Smooth muscle relaxation by B2 agnosts
Activation of β2-adrenergic receptors leads to the activation of adenyl cyclase and to an increase in cAMP. This causes smooth muscle relaxation and bronchodilation in the combination of 2 factors:
* cAMP leads to the activation of Protein kinase A (PKA)
* cAMP lowers intracellular ionic concentrations
* Inactive myosin light chain kinase activate myosin light chain phophatase causes relaxations
68
Emphysema Contributing Factors
Smoking
* Decreases effects of Alpha1-antitrypsin
* Increases neutrophil number in alveoli and release elastase
69
Pulmonary Vascular Vessels
The behavior of the caps and the larger blood vessels in lungs is so different they are often called?
Alveolar vessels? 4 points
Lung volume increases ----\> chain of events
increase
70
Aging and Hemalogic system
71
Dynamic compression
End of quiet inspiration
* Flow = 0
* Airway Ptm= 0 - (-10) = 10
*
72
Airway resistance in Asthma
Airway conductance is ____ at a given recoil pressure due to _____ narrowing of ______ and ______ changes in the airways
What drug can be given to move the asthma line closer to normal?
* reduced, instrinsic narrowing, of the airways caused by contraction of smooth muscle
Bronchodilator (isoproterenol)
73
Therapy options meds
8 types
74
COPD Comorbidities
7
75
Lymphoid organs
Spleen
Splenic Pulp
Venous Sinuses?
76
Ventilations perfusion matching
77
Classifications of Asthma Severity
FEV1
- Persisitent has daily symptoms and at least 4 times per month
78
Asthma as an Inflammatory disease
WHat are the initial sympstoms of asthma?
What is the underlying cause of it though?
What is key in the expression of asthma?
How is airway inflammation characterized?
Increased number of?
* Although the primary and initial symptoms of asthma are due to bronchoconstriction, the underlying cause of asthma is inflammation of the airways
* Inflammation is central to the development and expression of asthma
* is characterized by an increased number of activated eosinophils, mast cells, macrophages and T-lymphocytes in the airway mucosa and lumen. There is also evidence that noninflammatory cells, including airway epithelial cells, contribute to the inflammation
79
Airway Closure
The volume of the lung at which airway closure begins is called?
When does it occur?
What increases this?
* Closing volume
* When the intra-Pleural pressure exceeds the airway pressure
* Airway diseases and aging increase the closing volume (earlier closure)
80
Lymphatic vessels
Main function which one keeps lungs free of fluid?
* The **deep lymphatic capillaries** begin at the level of the terminal bronchioles, there are no lymphatic structures in the acinus
* The **superficial lymphatic capillaries** drain the membrane that surrounds the lungs
* Main thing keep lungs free of fluid
81
Therapy options inhaled cortico
Regular Tx with inhaled corticosteroids improves?
Withdrawal from tx may lead to?
\_\_\_\_\_\_\_\_ _______ \_\_\_\_\_ ____ is more effective than an individual components in improving?
Addition of a \_\_\_\_/inhaled corticosteroid combination to an ______ apprears to provide additional benefits
Chronic Tx with _____ should be avoided because of poor?
82
Physiology of Airway smooth muscle contraction
Starts with ANS
83
Colony stimulating factors
84
Pulmonary Surfactant
Produced by?
Physiological importance?
Pathophysiology?
* Type II alveolar epithelial cells, line alveoli
* Physiological
* Decrease the surface tension of the alveolar lining layer
* Increase compliance
* Increase alveoli stability prevents small alveoli from collapsing, equalizes pressure between large and small alveoli
* Keep alveoli dry
* Patho- absence results in reduced lung compliance, alvealar atelectasis, and tendency for pulmonary edema
* IRDS
85
Anti Anemic Drugs
Vit B12 kinetics
86
3 functions of the Nasal Cavity and what is its lining made up of?
1. Removing particulate matter
2. Moisening air
3. Warming air
Lining: Typical respiratory epithelium (TRE)- ciliated pseudostratified columnar epithelium with goblet cells (release mucous)
87
Pharynx function, regoins, Lining
* Common opening for digestive and respiratory system
* 3 region- Nasopharynx (TRE), Oropharynx (Stratified squamous epithelium), Laryngopharnyx
88
COPD vs Asthma
89
Elastic work?
* Work to overcome the elastic recoil of the chest wall and the lung
* Work to overcome the surface tension of the alveoli
* Increased work in restrictive diseases (Fibrosis)
90
Muscles of Respiration
Inspiration
* Diaphragm:
* External intercostals:
* Accessory muscles:
1. The most important muscle of inspiration; supplied by phrenic nerves that originate high in the cervical region
2. When contract; move ribs upward and forward
3. Accessory muscles: Sternocleidomastoid, scalene muscles
91
Diffusion
5 things
* Partial pressure
* Laws of diffusion
* Diffusion and perfusion limitations
* Oxygen uptake along the pulmonary capillary
* Measurement of diffusing capacity
92
Anti Anemic Drugs
Iron
93
Diffusion and Perfusion limitations
What gases are each?!
94
Hypoxemia
Refers to?
Hypoventilation?
Limitation?
Refers to blood that enters the arterial system without going through ventilated areas of the lung
Primary cause of Hypoxemia?
95
Key concepts
96
Regulation of Erythropoiesis
97
Methylxanthines
98
99
Functions of the Respiratory System
Primary function?
Internal and External respiration
Other 5 functions
* Gas exchange, exchange of O2 and CO2
* Internal respiration- Capillary oxygenated blood within body
* External- Air exchange in lungs
1. Regulation of blood pH
2. Air-conditioning
3. Protection
4. Voice production
5. Olfaction
100
Surface tension
Property of?
LaPlace's Law
Evidence that surface tension plays a role in compliance:
* Of the surface of a liquid
* P=2T/r
* r=radius
* T=Tension
* P=transmural pressure
* Saline effects
* Saline increases lung compliance a lot
* Foam from lungs makes stable bubbles
101
beta adreno receptor s
102
Central chemoreceptors
4 things
What are they not sensitive to?
* Located near the ventral surface of the medulla
* Surrounded by brain extracellular fluid
* Respond to changes in its hydrogen ion (H+) concentration
* An increase in H+ concentration stimulates ventilation
* Central chemoreceptors are sensitive to the PcO2 but not PO2 of blood
103
Effort- independent flow rate phenomenon
Explain
* 3 tests are performed A (Hard exhale), B (slow then hard), C (least forceful)
* Moral the end of exhalation is all the same for each
* The reason for this is **compression** of the airways by intrathoracic pressure
104
Muscles of respiration
Expiration
* Normal expiration (passive)
* Relaxation of diaphragm and external intercostals
* Forced expiration (active)
* Abdominal wall: Rectus abdominis, oblique muscles, and trnasversus abdominis
* Internal intercostals: pulling the ribs downward and inward, thus decreasing thoracic volume
105
Objectives
Ficks law states?
Examples of Perfusion, Diffusion limited gases
What is Oxygen limited by?
How is the diffusing capacity measured?
106
Mismatching is diseased lungs
Normal, Emphysema, Chronic Bronchitis
107
Diffusing capacity test
What does it measure?
Single breath test what is the patient asked to do?
How is the transfer of CO limited?
Why does that matter?
108
Normal destruction of
109
Hypoxic pulmonary vasoconstriction
Benefitial
Deleterious
110
Begin quiet expiration
Dynamic compression
Ptm = 9
holding airways open
111
Mast cell stabilizer
112
Pulmonary resistance
Pressure volume curve
Hysteresis
Lung Compliance
Major contributing forces to compliance
5 things
If lung volume is small what happens to surface tension?
1. Pressure-volume curve of the lung
1. The expiratory curve does not follow inspiration
2. Hysteresis: Lung volume at a given transpulmonary pressure is higher during deflation then during inflation
3. Lung compliance (CL)
1. The slope of dV/dP is lung compliance, compliance decreases (the lungs become stiffer) at high lung volumes and very low lung volumes
4. Lung compliance and pulmonary diseases
1. Decreased compliance
1. Fibrosis: Increased fibrous tissue
2. Alveolar edema: prevents inflation of alveoli (surface tension change and lung volume decreases)
3. Atelectasis: Collapse of alveoli
2. Increased compliance
1. Emyphysema: loss of alveolar and elastic tissue
2. Aging lung: alteration of elastic tissue
3. Asthma Attach: unknown
5. Major forces contributing to lung compliance
1. Tissue elastic force
2. Surface tension forces
Increases surface tension
113
Emphysema contributing factors
114
Platelets
115
Objectives
116
Therapy at each stage
117
Hematopoiesis
Picture
118
A chronic\_\_\_\_\_\_\_ disorder of the\_\_\_\_, in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T-lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes\_\_\_\_\_ episodes of wheezing, restlessness, chest tightness, and coughing, particularly at night or early morning. These episodes are usually associated with widespread but variable ______ \_\_\_\_\_ that is often\_\_\_\_\_\_ either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial\_\_\_\_\_\_\_\_ to a variety of stimuli."--Expert Panel of the NIH National Asthma Education and Prevention Program (NAEPP)
* inflammatory
* airway
* recurrent
* airflow obstruction
* reversible
* hyperresponsive
* Asthma
119
Antiinflammatory Table
120
Definition of Anemia
121
122
Control of asthma during preganancy
123
Therapeutic options key points
5
124
Management of asthma chart
125
Anti Anemic Drugs
Vit B12
126
Law of Diffusion
The alveolar capillary membrane is the ideal medium for gas diffusion why?
CO2 diffuse ____ than 02
Rate of diffusion in relation to?
Ficks law
127
Partial pressure of gases in solution
Partial pressure doesnt equal?
How do gases dissolve in fluids?
128
Lung Receptors
Irritant receptors
Stretch Receptors
J Receptors
* Locate in the epithelium of the conducting airways.
* Proximal larger airways, absent in the distal airways.
* Sensitive to noxious gases, cigarette smoke, inhaled dusts, and cold air. Cause bronchoconstriction, may play a role in asthma
STRETCH
* Locate in airway smooth muscle.
* Sensitive to distension of the lungs.
* Slow ventilatory rate and volume due to an increase in expiratory time. (Herring-Breuer reflex)
J RECEPTORS
* Respond very quickly to increased pulmonary capillary pressure.
* Result in rapid, shallow breathing.
129
Lymphoid organs
nodes
130
Development of leukocytes
131
Oxygen uptake along the pulmonary capillary
Normal PaO2 of blood?
PAO2?
Time in capillary?
What happends during exercise?
* The PaO2 (blood) is normally 40 mm Hg; only 0.3 µm away, PAO2 (alveoli) is 100 mm Hg.
* At normal condition, blood spends about 0.75 second in the capillary. The PaO2 reaches that of the alveolar gas after about one-third of it.
* On exercise, the time is reduced to perhaps 0.25 second. Blood may not be fully oxygenated in disease state.
132
Pathway of air in gas-exchange airways
1. Surfactant, Alveolus
2. Pass through the epithelial cells
3. Interstitial
4. To endothelial cells
5. to Plasma
6. To RBC for distribution
133
Ventilation is defined?
The total volume of air taken into the lungs per minute is called?
The volume of the conducting airways outside of the alveoli. It does not participate in?
The amount of fresh gas getting to the alveoli that paricipates in gas exchange?
* The exchange of air between the atmosphere and the alveoli
* Minute ventilation (Ve)= total ventilation
* Anatomic deadspace, does not participate in ventilation
* Is the amount of fresh gas getting to the alveoli that participates in gas exchange
134
Mast cells
close to? Found where?
Express large number of a high affinity receptor for the ___ region of IgE
Binding to IgE is essentially?
When acitivated by interaction with antigen mast cells release?
* Closely related to Basophil granulocytes found in the blood
* Fc region of IgE Recptor is FceRI
* irreversible mast cells are coated with IgE
* a wide array of mediators to initiate an acute bronchospasm and also to release proinflammatory cytokines to perpetuate underlying airway inflammation
135
Compliance is the ability of the lungs to stretch during a change in volume relative to an applied change in pressure
What happens in Emphysema?
* Increase lung compliance and pulmonary fibrosis decreases lung compliance.
136
Other tx
Alpha Trypsin, recommended for?
Antitussive?
Vasodilators? What is contraindicated?
137
Recruitment and Distensibility
Pulmonary vascular resistance usually decreases with?
138
Iron cycle
139
Objectives
140
COPD risk factors
Particles
Gender
5 other things
141
COPD vs asthma
End result of both causing?
142
Tests of Lung Function
* The vital capacity measured with a forced expiration?
* The volume of gas exhaled in one second by a forced expiration from full inspiration
* The ration of FEV1 to FVC expressed as a percentage
* Majority of pts with lung disease have?
* Forced Vital Capacity (FVC)
* Forced Expiratory Volume (FEV1)
* FEV1/FVC
* FEV1
* Normal ratio is 80%
143
How does the carotid body send signals?
* Carotid body oxygen sensor releases neurotransmitter when detecting low PO2 .
* Information is transported to central controller by action potentials
144
Long acting bronchodilators have been associated with?
* Increased risk of worsening wheezing
145
Summary of MOA of Bronchodilators
146
Factors determining airway resistance
Airway Narrowing
* Dramatically ______ airway resistance what is an example of this?
* The ____ of the _____ \_\_\_\_\_ is controlled by?
* Stimulation of _____ receptors causes?
* ______ activity causes bronchoconstriction
* Increases, obstructive diseases
* Tone of the smooth muscle is controlled by the ANS
* B-adrenergic bronchodilation
* Parasympathetic activity
147
Hematopoiesis
148
Larynx function, structure, lining
* Maintain an open passageway for air movement
* Vocal cords- Are primary source of sound production
* Structure- Endolarynx and cartilage
* Epiglottis- Prevents swallowed material from moving into larynx
* Lining: TRE and stratified squamous epithelium in regoins of "wear and tear"
149
Antiasthma Drugs
Epinephrine
Selectivity
SEs? That are caused by its non selectivity
Isoproterenol
SEs
Selectivity
b2 agonists
150
Gas-exchange airways
Respiratory Bronchioles (17-23)
4 things
1. Transition from conducting to respiratory functions
2. Lining: Low columnar to low cuboidal, clara cells, larger tubes remain ciliated
3. No goblet cells, glands or cartilage
4. Supporting walls: SM and elastic fiebr networks
151
Iron cycle picture
152
Work of Breathing
Work =?
* Force x Distance
* Pressure change x volume change
153
Total pulomonary vascular resistance
* Decrease, Increase, Increase
* Increase increase, decrease
* Increased all around
154
Physiologic Deadspace
definition
Deadspace is the ____ that is ____ but not ____ with blood, so there is no ____ exchange and it does not eliminate what?
is the volume of (wasted ) air that does not eliminate CO2. Also called functional dead space. Not all of the alveoli are perfused with blood; air in these alveoli doesn't exchange with the blood and is part of the dead space.
Dead space is the volume of lung that is ventilated, but is not perfused with blood, so there is no gas exchange, and it does not eliminate CO2
155
Objectives
156
Composition of blood
Elements in blood
platelets in blank
157
Ventilations perfusion matching
In a normal lung
What kind of patern is seen?
Why is there a sharp increase?
Which zones are usually over or underventilated?
158
Alveoli
Primary?
25-??? amount
Alveolar septum comprised of 6 things
* Primary gas exchange unit
* 25-300 million
* Septum
1. Dense network of fibers
2. Dense network of capillaries
3. Type 1 pneumocytes - Simple squamous cells
4. Type 2 pneumocytes - Low cuboidal sype cells, act as a reserve cell, can replate type 1, source of surfactant
5. Macrophage- Remove foreign materials (Dust cells) smokers are pink
6. Pores of Kohn- Collateral ventilation, macrophage, distribution of air
159
Therapy options bronchodilators
* _____ medications are _____ to the _____ management of COPD
* Prescribed in 2 ways
* Principle bronchodilator txs are?
* Choice of treatment depends on?
* ___________ are convienient and more effective for symptom relief than _____ acting and reduce _____ and related hospitalizations
* ____________ Of different pharmacological class may improve?
160
T cells
Divided into?
One type causes a low level of IgG response
Other produces (IL4,5,6,9, and 13)
Asthma is cause by a cellular imbalance favoring\>
* T lymphocytes are divided into CD8+ TC (cytotoxic) cells and CD4+ TH (helper) cells. T helper cells are further divided into TH1 and TH2 cells based on the cytokines they produce.
* TH1 cells cause a low-level of IgG response.
* TH2 cells, which produce IL-4, IL- 5, IL-6, IL-9, and IL-13, guide the immune response toward a humoral response.
* Asthma is caused by a cellular imbalance favoring TH2 over TH1 and a humoral response involving strong IgE-mediated reactions rather than low-level IgG responses.
161
COPD definition
COPD, a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients.
162
Expiration process (passive)
1. Inspiratory muscle relax (diapragm rises and rib cage decends)
2. Thoracic cavity volume decreases
3. Elastic lungs recoil passively --\> lung volume decreases
4. Pulmonary pressure increases
5. Air flows down its pressure gradient
163
Erythropoeisis
164
How to measure lung volume
* Spirometry
* Tidal and Vital capacity
* Also helium (FRC)
165
Vesicular Release of mast cells
Perfromed mediators (from the granules)
\_\_\_\_\_- has 3 effects
\_\_\_\_ has 2 effects
Newly formed lipid mediators (eicosanoids)
\_\_\_\_ D2 increases cytokine and induces bronchoconstriction
\_\_\_\_ (LTC4 and LTD4 and LTE4: central to the pathophysiology of asthma because they induce marked bronchoconstriction mucus hypersections and capillary leakagem vasegenic edemam recruit additional inflammatory cells
* Histamin
* Causes localized inflammatory immune response
* Increase blood vessel permeability and promotes leakage, leading to airwat EDEMA
* Tryptase
* Activates receptors on epithelia and endothelial cells, inducing the expression of adhesion molecules that attract eosinophils and basophils
* Causing hyperplasia of airway smooth muscle cells and contributing to aiway hyperresponsiveness
* Prostaglandins
* Leukotriene
166
Immune system in Asthma
Antibodies
Inflammatory cells:
Inflammatory mediators:
The antibody class of allergic disease is? Fundamental to?
* (IgM, IgG, IgA, IgD, and IgE) An antibody, or an immunoglobulin (Ig), is a small protein molecule created by the immune system to have a close structural "fit" to the surface of a foreign substance. The foreign substance is an antigen. Five classes of antibodies, namely IgM, IgG, IgA, IgD, and IgE, depending on their particular functions in the immune response
* Granulocytes: mast cells, eosinophils Agranulocytes: lymphocytes…
* Chemical substances that are secreted by immune cells to induce (or respond to) an ongoing immune response generated against a specific exposure to the body.
* IgE fundamental to the allergic response
167
* Inspiration is ____ but _____ during rest is passive. The most important muscle of respiration is the?
* The _____ curve is nonlinear and shows \_\_\_\_. The ____ pressure of the lung is attributable to both its ____ tissue and the _____ \_\_\_ of the alveolar linging layer
* Properties of ___ affect lung compliance and abnormal ____ production causes?
* ____ \_\_\_\_ of the airways during forced expiration results in flow that is ____ independent.
* Inspiration is active, but expiration during rest is passive. The most important muscle of respiration is the diaphragm.
* The pressure-volume curve of the lung is nonlinear and shows hysteresis. The recoil pressure of the lung is attributable to both its elastic tissue and the surface tension of the alveolar lining layer.
* Properties of surfactant affect lung compliance, and abnormal surfactant production causes IRDS.
* Dynamic compression of the airways during a forced expiration results in flow that is “effort independent”.
168
Summary of Agonists
SEs
169
Distribution of Perfusion
Zones
170
Airway cross sectional area
2 things,
end result
1. Individual airway diameter, decreases with branching
2. Overall or total cross-sectional diameter increases a lot
This results in a decreased airflow speed and a decrease in resistnance causing optimal diffusion.
171
Hematopoietic cells
172
Symptoms of COPD
173
Airway hyperresponsiveness
Hypersensitivity
Hyperreactivity
* the propensity of asthmatic airways to constrict in response to a wide variety of stimuli.
* a normal response at abnormally low levels of stimuli.
* an exaggerated response at normal to high levels of stimuli.
174
Chronic bronchitis
defined as?
for how long?
increase in?
175
Respiration related pressures
1. Alveolar Pressure (PA)
2. Intrapleural pressure (Ppl)
3. Airway pressure gradient (Patm-Pa)
4. Transpulmonary pressure (PA-Ppl)
5. Transchest wall pressure
* Relative Patm, remains negative throughout inspiration process
* Pressure in space between parietal and visceral pleura
* This is the pressure gradient driving airflow into the lungs
* Transmural pressure across the lungs; increases and decreases with lung volume
* Ppl-Patm
176
Distribution of perfusion
177
Neurochemical control of ventilation
The 3 basic eliments of the respiratory control system:
1. . Sensors that gather information and feed it to the central controller.
2. Central controller in the brain coordinates the information and, in turn, sends impulses to the effectors.
3. Effectors (respiratory muscles) cause ventilation
178
Emphysema Contributing Factors
Changes in lung tissue
two sub
* Breakdown of alveolar wall
* Decrease SA for gas exchange
* loss of elastic fibers
* loss of pulmonary capillaries
* Altered ventilation/perfusion ratio
* Decrease support for small bronchi
* Progressive difficulty with expiration
* Air trapping, increases residual volume
* Overinflation of lungs
179
Factors determining airway resistance
Lung Volume
Relation to resistance?
* Resistance decreases as lung volume increases because the airways are more open.
180
Regulation of erythro synthesis
181
Airway resistance
Laminar and Turbulent
* Laminar slow- determined by Poiseuilles law
* resistance at different divisions of the airway is different- resistance mainly ocurrs in larger airway where speed is higher and the radius is small in comparison to terminal bronchioles
