Obstructive airway diseases

Question 1

What are Chronic Bronchitis and Emphysema better known as?

Answer 1

Chronic Obstructive Pulmonary Disease (COPD)

Question 2

What is the normal FEV1/FVC ratio?

Answer 2

0.7-0.8 ( 70-80%)

Question 3

What is predicted FVC based on?

Answer 3

Age, Sex and height

Question 4

What does PEFR stand for?

Answer 4

Peak Expiratory Flow rate

Question 5

What is the normal range for PEFR?
What % is considered a moderate fall?
What % is considered a marked fall?

Answer 5

400-600L/min
50-80% of best is moderate fall
less than 50% is marked fall

Question 6

Is FEV1 and FVC reduced in obstructive lung diseases?

Answer 6

FEV1 is REDUCED
FVC may be reduced
FEV1 is less than 70% of FVC

Question 7

Is Bronchial asthma considered a reversible airway obstruction?

Answer 7

Yes, spontanwously or as a result of medical intervention - Smooth muscle contraction and inflammation can be modified by drugs.

Question 8

What are the Aetiologies of Chronic Bronchitis and Emphysema?

Answer 8

SMOKING
Atmospheric Pollution
Occupation : dust

Alpha-1-antiprotease (antitrypsin) deficiency is an extremely rare cause of emphysema

Question 9

What else can affect the likelyhood of developing Chronic Bronchitis and Emphysema?

Answer 9

Effect of age and susceptibility
Prevalence
Men > Women but…
Increasing in developing countries

Question 10

Complicated Chronic Bronchitis is when sputum turns mucopurulent or FEV1 falls. What do these mean?

Answer 10

Mucopurulent = mucus and pus, due to acute infective exacerbation (there has been an infectionn and made it worse, now coughing up pus an dmucus).
FEV1 falls = patient can no longer breathe out as much air in 1 second as they could before.

Question 11

What are the Morphological changes in ‘Chronic Bronchitis’

Answer 11

Large Airways:

• Mucous gland hyperplasia
• Goblet cell hyperplasia
• Inflammation and fibrosis is a minor component

Small Airways:

• Goblet cells appear
• Inflammation and fibrosis in long standing disease

Question 12

Emphysema Pathological Definition:
Increase beyond the normal in the size of airspaces distal to the terminal bronchiole arising either from:
and without:

Answer 12

Increase beyond the normal in the size of airspaces distal to the terminal bronchiole arising either from:

dilatation or from destruction of their walls
and without obvious fibrosis.

Question 13

What are the 4 forms of Emphysema in order of most common to least common and what are the differences?

Answer 13

CENTRIACINAR:
Cigarette smoke, irritants only reach first alveoli so mainly only affects central part, distal parts of lungs often normal.

PANACINAR:
Often caused by Alpha-1-Antitrypsin deficiency, like centracinar except not just central, affercts whole lung/large section sof the lungs. Macrophages within alveoli produce proteases, to help mop up unwanted stuff. Proteases can damage cells is not cleared away by alpha-1-Antitrypsin.

PERIACINAR (‘Blebs of Bullous emphysema’) - tissue losss around the edges of acini - esp tissue loss from cells up against the pleura. Easily cause phneumothorax.

SCAR ‘ irregular’ - no clinical significance
‘Bullous emphysema’

Question 14

What type of disease is Bronchial Asthma. What happens?

Answer 14

Hypersensitivity disease-
degranlation of mast cells releases chemical factors:

induces inflammation - attracts inflammatory cell types - swelling and edema.

chemicals directly affecting the bronchiole smooth muscle and causing it to constrict

Question 15

What is the Acinus?

Answer 15

Everything beyond the terminal bronchiole, (gas exchange tissue part) inc. Alveoli, alveolar duct, respiratory bronchioles.
1-2cm accross, conducting airways

Question 16

What is a “Bulla”?

Answer 16

Emphysematous space greater than 1cm

Question 17

What is a “bleb”?

Answer 17

Bulla/emphysematous space just underneath the pleura

Question 18

What effect does smoking have on protease-antiprotease balance?

Answer 18

Smoking induces a protease-antiprotease imbalance?

Question 19

What is chronic (hypoxic) Cor Pulmonale?

Answer 19

Hypertrophy of the right ventricle as a result of hypertension in the pulmonary system due to systemic pulmonary vasoconstriction as a result of hypoxia (poor perfusion).

Question 20

What can Cor Pulmonale lead to?

Answer 20

Heart dilataation, Right heart failure,

Question 21

centri-acinar emphysema begins with dilatation of…?

Answer 21

entri-acinar emphysema begins with dilatation of the respiratory bronchiole, and then progresses to loss of alveolar tissue.

Question 22

asymmetrical chest expansion is suggestive of…?

Answer 22

asymmetrical chest expansion is suggestive of lobar collapse or pleural effusion

Question 23

What are the signs of respiratory distress in children as a result from trying to draw breath in through an obstructed airway?

Answer 23

tracheal tug, abdominal breathing, subcostal recession, intercostal recession and head bobbing

Question 24

Normal normal FEV1:FVC is about …?

Answer 24

0.7-0.8.

Question 25

What is The initial treatment for asthma in children over 5?

Answer 25

Very low dose inhaled steroids are the initial treatment for paediatric asthma

Question 26

is it likely that allergies cause the development of childhood asthma?

Answer 26

False – it is likely that an underlying abnormality in the epithelium leads to the development of both asthma and allergies.

Question 27

diagnosis of COPD requires what?

Answer 27

both typical symptoms and history AND typical spirometry showing airflow obstruction.

Question 28

Is Female sex is a risk factor for COPD?

Answer 28

Yes

Question 29

In an acute asthma attack, steroids should be given via...???

Answer 29

n an acute asthma attack, steroids should be given orally, or sometimes intravenously.