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Physiology and Pharmacology > Lecture 11 > Flashcards

Lecture 11 Flashcards

1
Q

What are the two categories of lung disease?

A
  1. Obstructive
    - reduction in flow through airways
  2. Restrictive
    - reduction in lung expansion
    Both reduce ventilation
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2
Q

If Forced expiratory volume in one second (FEV1) against vital capacity is under 80% …

A

Obstructive lung disease

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3
Q

When looking at Flow-Volume relationships, what would a linear decline imply?

A

Rapid increase of flow rate

Obstructive lung disease

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4
Q

What could the narrowing of the airways be due to?

A 
Excessive secretions
 - mucus narrows airways
Bronchoconstriction e.g. asthma
 - hypersensitivity triggers airways to constrict
Inflammation
 - In tissue around the airways
 - Swelling constricts airways
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5
Q

What happens to flow rate in obstructive lung disease?

A

Flow rate drops as there is an increased resistance to the flow of air

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6
Q

How would obstructive lung disease show in Volume-Time curves?

A

FVC is unaltered but FEV1 drops

Endpoint volume remains the same but the time taken to reach there is longer

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7
Q

How would obstructive lung disease show in Flow-Volume loops?

A

The initial flow and peak flow can be similar but there is a sharp fall in flow-rate giving a concave shape to the curve

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8
Q

What are examples of obstructive lung diseases?

A

Chronic bronchitis
- Persistent productive cough and excessive mucus secretion (3 consecutive months in last 2 years)
Asthma
- Inflammatory disease
Chronic obstructive pulmonary disease (COPD)
- Structural changes
- Lower airways swell
Emphysema
- Loss of elastin
- Can be classified as both obstructive and restrictive

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9
Q

What can happen in asthma patients?

A

The sufferer has hyperactive airways

Genetic mutations of increased ACh is possible

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10
Q

What can be a trigger for asthma patients?

A 
Atropic (extrinsic)
 - allergies, contact with allergens
e.g.hay fever, pollen, dust, particles
 leads to increased level of IGEs
 - has hereditary links

Non-atropic (intrinsic)

  • respiratory infections, cold air, stress, exercise, inhaled irritants, drugs
  • common in cyclists
  • irritants
    e. g. smoke
  • drugs
    e. g. aspirin
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11
Q

How does the immune system respond to triggers for asthma?

A

Movement of the inflammatory cells into the airways
Release of inflammatory mediators
such as histamine and subsequent bronchioconstriction

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12
Q

What kind of asthma treatment is there?

A

Short-acting beta-2 adrenoreceptor agonists
- salbutamol
- causes dilation of airways
Longer acting treatments:
Inhaled steroids
- Glucocorticoids such as beclometasome act to reduce the inflammatory responses
- Long-acting beta-2 adrenoreceptor agonists

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13
Q

What can be seen in restrictive lung disease?

A 
Reduced lung expansion
 - Chest wall abnormalities
 - Muscle contraction deficiencies
Loss of compliance (fibrosis)
 - Normal aging process
 - Increase in collagen
 - Exposure to environment factors
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14
Q

What happens to the vital capacity in restrictive lung disease?

A

It decreases

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15
Q

What can be seen in volume-time curves in restrictive lung disease?

A

Reduction in FVC, but FEV1 remains unaltered (or increases!)

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16
Q

What can be seen in Flow-Volume loops in restrictive lung disease?

A

The shape of the relationship tends to be normal, but there is a reduction in the volumes of air moved. There can be a reduction in the peak flow

17
Q

How is breathing regulated?

A

Automatic, rhythmical process

Basic respiratory rhythm is generated by centers in the medulla

18
Q

Inputs from where can modify the respiratory pattern?

A

Pons

Medulla

19
Q

How can the Pons regulate breathing?

A

Control changes in breathing pattern

20
Q

How can the Medulla regulate breathing?

A

Controls basic breathing

21
Q

Breathing is typically an involuntary process. But what are examples of it being controlled consciously?

A

Hyperventilation

Breath holding

22
Q

Are conscious modifications of breathing long-term?

A

It is temporary
Will be overridden if required
e.g. CO2 build up triggers breathing

23
Q

What are the two medullary centers that regulate breathing?

A

Dorsal Respiratory Group (DRG)

Ventral Respiratory Group (VRG)

24
Q

How does the DRG regulate inspiration?

A 
Sends signals to the inspiratory muscles
Spontaneously active
 - shows period of activity
 - shuts off
 - period of activity
25
Q

How does VRG regulate inspiration and expiration?

A

Inactive during quiet respiration

During activation, helps control forceful inspiration and expiration

26
Q

Which centers affect the Pre-Botzinger complex to control breathing? Where do they belong?

A

Pneumotaxic center
Apneustic center
Pons

27
Q

What does the pneumotaxic center do?

A

Increases the rate of breathing by shortening inspirations
Period of firing goes on for shorter period
Inhibitory effect on inhibitory center

28
Q

What does the apneustic center do?

A

Increases the depth and reduces the rate by prolonging stimulations
- Stimulates inhibitory center

29
Q

What reflex are stretch receptors involved in when controlling respiration?

A

Hering-Breuer reflex

30
Q

How does the Hering-Breuer reflex work?

A

Stretch receptors in the lung send signals back to the medulla to limit inspiration and prevent over-inflation of the lungs

31
Q

What are the steps in the Hering-Breuer reflex?

A
  1. Inspiratory center acts on Phrenic nerve
  2. Phrenic nerve stimulation contracts diaphram
  3. Stretch receptor in lung sends signals
  4. Vagus nerve stimulation
  5. Inhibits inspiratory center
32
Q

How are chemoreceptors involved in respiration?

A

Central chemoreceptors
- Monitors conditions in CSF
- Sensing CO2 and pH
- Buffering on pH is more sensitive in CSF than in
blood (acidification stimulates breathing)
- Indirect response to a rise in CO2
- Stimulation leads to an increase in ventilation

Peripheral chemoreceptors
- Located in the carotid body and aortic arch
- Respond to : Increase in CO2, Decrease in pH,
Decrease in O2
- Stimulation leads to an increase in ventilation

33
Q

Which gas is the primary driving force for respiration?

A

CO2

34
Q

What happens when patients become accustomed to living with elevated CO2?

A

CO2 loses driving effect / can stop breathing altogether

O2 becomes primary driving force for respiration

Physiology and Pharmacology (27 decks)

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