First Aid, Chapter 5, Anatomy, Physiology, and Pathology, Remodeling of the lower airway

Question 1

What causes airway thickening in asthma and COPD?

Answer 1

With remodeling, the airway wall is thickened by cellular infiltration, extracellular matrix deposition, and expansion of airways smooth muscle. There is also pronounced neovascularization.

Question 2

What is present in sputum of asthmatics?

Answer 2

• Curschmann’s spirals: Corkscrew-shaped twists of condensed mucus (Figure 5-9)
• Creola bodies: Clusters of surface epithelial cells (Figure 5-9)
• Charcot-Leyden crystals: Eosinophil cell and granule membrane lysophospholipase (Figure 5-9)
• Eosinophils
• Metachromatic cells

Question 3

What is present in the sputum of COPD patients?

Answer 3

• Though eosinophils may be present, eosinophilia is NOT predominant in sputum of patients with COPD.
• Sputum macrophages and neutrophils during exacerbations are caused by infections.

Question 4

What is the surface epithelium like in asthma? COPD?

Answer 4

Asthma: fragile or denuded
COPD: usually not fragile

Question 5

What is the reticular basement membrane like in asthma? COPD?

Answer 5

Asthma: Thickened and hyaline
COPD: variable or normal

Question 6

What are the bronciolar mucous cells like in asthma? COPD?

Answer 6

Asthma: possible mucous metaplasia

COPD: metaplasia or hyperplasia

Question 7

What is bronchial smooth muscle like in asthma? COPD?

Answer 7

Asthma: Enlarge in large airways.

COPD: Enlarged in small airways

Question 8

What is mucus histochemistry characterized by in asthma? COPD?

Answer 8

Asthma: no change
COPD: Increased acidic glycoprotein

Question 9

What is the cellular infiltrate like in asthma? COPD?

Answer 9

Asthma: Predominantly CD3, CD4, CD25 (IL-2R) positive, marked eosinophilia, and increase in mast cells

COPD:
Predominantly CD3, CD8, CD68, CD25, VLA-1 positive, HLA-DR positive, mild eosinophilia, and mast cell increas

Question 10

What cytokines are increased in asthma? COPD?

Answer 10

Asthma: Increase in IL-4 and IL-5 gene expression

COPD: GM-CSF protein, ±IL-4; No increase in IL-5

Question 11

What is the airflow obstruction like in asthma? COPD?

Answer 11

Asthma: Variable, reversible; Nonreversible after remodeling

COPD: Usually progressive deterioration of lung function

Question 12

What are the postmortem findings in asthma? COPD?

Answer 12

Asthma: Hyperinflation, airway plugs; Usually no emphysema

COPD: Excessive mucus, more small airway involvement; Emphysema prominent

Question 13

What are the pathologic features of airway remodeling?

Answer 13

Airway wall thickening with increased collagen deposition and airway smooth muscle, goblet cell hyperplasia, subepithelial fibrosis, and angiogenesis