Lecture 17

Question 1

COPD presents as a mix of two conditions, what are they ?

Answer 1

1. Chronic bronchitis (excess mucus production + inflammatory reaction)
2. Emphysema (destruction of lung tissue forming big gaps in alveoli, alveolar ducts and respiratory bronchioles)

Question 2

What are the risk factors of COPD ?

Answer 2

1. Infection.
2. Age.
3. Environment (Chemicals, Pollution, Cigarette Smoke)
4. Genetic (AAT deficiency, AAT usually inhibits NE which is an enzyme that destroys lung architecture)

Question 3

How is diagnosis of COPD achieved ?

Answer 3

Through spirometry to assess airflow limitation (if FEV/FVC <0.7 then there is airflow limitation)

Question 4

What is the classification system for COPD?

Answer 4

GOLD 1 to 4

Question 5

True or false : treatment for COPD includes anti-inflammatory medication such as corticosteroids .

Answer 5

FALSE. Don’t work.

Question 6

True or false: Asthma is mostly prevalent in underdeveloped countries.

Answer 6

FALSE. Mostly in developed countries. BUT the death rate is higher in underdeveloped countries.

Question 7

What characterizes asthma ?

Answer 7

Chronic inflammation.
Shortness of breath
Chest tightness
Wheezing.
Variable respiratory airflow limitation.

Question 8

What is atopic asthma ?

Answer 8

Asthma caused by an allergen. Most common.

Question 9

What is non-atopic asthma ?

Answer 9

Asthma not caused by an allergen. Usually by a pollutant or a virus.

Question 10

What is airway hyper responsiveness (AHR) ?

Answer 10

It is a clinical presentation of asthma, whereby the airways have an exacerbated response to bronchoconstrictors.
PC(20) is the amount of bronchoconstrictor needed to cause a 20% decrease in FEV.
PC(20) = 8-16 mg -> Asthma
PC(20) >16 mg -> Normal.

Question 11

What type of Th reactions are seen in COPD and Asthma ?

Answer 11

COPD has a th1 reaction with cigarette smoke.

Asthma has a th2 reaction with allergens.

Question 12

What is the pathogenesis of Asthma?

Answer 12

1. Airway remodelling (persistent effect) ->increased vasculature, thickened airways, hyperplasia/hypertrophy of smooth muscle.
2. Inflammation (variable effect) -> th2 response
3. Bronchoconstriction

Question 13

True or false : both airway remodelling and inflammation contribute to AHR.

Answer 13

TRUE.

Question 14

True or false : treatments of COPD and Asthma are the same.

Answer 14

TRUE. Both use bronchodilators + spirometer.

Question 15

In terms of pathology, what differs in a smoking vs a non-smoking asthmatic ?

Answer 15

They have different mechanisms of inflammation.
Non-smoking asthmatic: eosinophils.
Smoking asthmatic : IL8 + neutrophils.

Question 16

True or False : COPD considered non-reversible, while asthma is considered reversible.

Answer 16

TRUE.

Question 17

What is the progression of cystic fibrosis ?

Answer 17

Genetic mutation in CF gene -> decreased chloride secretion -> abnormal composition of mucus -> obstruction of bronchi -> bacterial infections -> inflammation -> lung insufficiency.

Question 18

Digital clubbing occurs in what respiratory diseases ?

Answer 18

COPD and Idiopathic Pulmonary Fibrosis.

Question 19

What is the pathogenesis of Idiopathic pulmonary fibrosis ?

Answer 19

There is an ongoing injury to the epithelial cells that increases TFF-B secretion, which triggers fibrosis (scarring) that is excessive.

Question 20

What are the risk factors of idiopathic pulmonary fibrosis ?

Answer 20

Smoking (main one!)
Genetic
Antibiotics
Radiation

Question 21

What is the histology of idiopathic pulmonary fibrosis?

Answer 21

Fibroblastic foci : aggregates of myofibroblasts.

Honeycombing.

Question 22

What are the treatments of idiopathic pulmonary fibrosis?

Answer 22

1. Lung transplant.

2. Drugs : Ofev/Profenedone , which are tyrosine kinase inhibitors so the drugs stop the production of growth factors.