Obstructive Airway Diseases

Question 1

What is chronic bronchitis and emphysema better now as?

Answer 1

COPD (COAD or COLD)

Question 2

What factors determine predicted FVC?

Answer 2

Sex, age and height

Question 3

Besides FEV1/FVC - how else may obstructive lung disease be demonstrated?

Answer 3

Peak Expiratory Flow Rate (PEFR)

Question 4

What is the normal value of PEFR?

Answer 4

400-600litres/min

Question 5

What is considered a marked fall in PEFR value?

Answer 5

<50% of best

Question 6

How can FEV1/FVC demonstrate obstructive lung disease?

Answer 6

FEV1/FVC value < 0.7

Question 7

What are the common aetiologies of chronic bronchitis and emphysema?

Answer 7

SMOKING (just don’t do it kids - not cool)
Atmospheric pollution

Rarely: Alpha-1 antiprotease (antitrypsin) deficiency is a rare cause of emphysema (not CB)

Question 8

What is the clinical definition of chronic bronchitis?

Answer 8

Cough productive of sputum most days in at least 3 consecutive months for 2 or more consecutive years

Question 9

Why the complicated time constraints of the clinical definition of chronic bronchitis?

Answer 9

It excludes other lung diseases such as TB, Bronchiectasis and chronic bronchial asthma

Question 10

What qualifies complicated chronic bronchitis?

Answer 10

When mucopurulent (acute infective exacerbation) occurs or when FEV1 falls

Question 11

What are the morphological changes that occur in the large airways with chronic bronchitis?

Answer 11

Mucous gland hyperplasia
Goblet cell hyperplasia
(Inflammation and fibrosis to small extent)

Question 12

What are the morphological changes that occur in the small airways with chronic bronchitis?

Answer 12

Goblet cells appear

Inflammation and fibrosis in long standing disease

Question 13

What the pathological definition of emphysema?

Answer 13

Increase beyond the normal size of airspaces distal to the terminal bronchiole arising either from dilatation or or destruction of their walls without obvious fibrosis

Question 14

What are the five forms of emphysema?

Answer 14

Centriacinar 
Panacinar
Periacinar
Scar/Irregular 
Bullous emphysema

Question 15

What are the clinical features of centriacinar emphysema?

Answer 15

Emphysematous tissue around the terminal bronchiole

Question 16

How is panacinar emphysema characterised?

Answer 16

Dilatation of alveoli - massively destructive

Question 17

What are the clinical features of periacinar emphysema?

Answer 17

Emphysematous tissue just under pleural membrane

Question 18

What is a bulla?

Answer 18

An emphysematous space greater than 1 cm

Question 19

Bulla are not much to worry about - what happens when they burst though?

Answer 19

Spontaneous pneumothorax

Question 20

Describe the common pathogenesis of emphysema?

Answer 20

Smoking leads to an Alpha-1 antiprotenase (antitrypsin) deficiency - this upsets the elastin framework in alveolar tissue

Question 21

What do pharmacological treatments for COPD tackle?

Answer 21

Smooth muscle tone and inflammation in the small airways

Question 22

What effect does a reduction in the elastin framework of the alveoli have?

Answer 22

Loss of alveolar attachments responsible for keeping bronchioles open

Question 23

What is chronic (hypoxic) cor pulmonale?

Answer 23

Hypertrophy of the right ventricle resulting from disease affecting the function and/or the structure of the lung

Question 24

What factors contribute to pulmonary hypertension?

Answer 24

Pulmonary vasoconstriction 
Pulmonary arterioles - muscular hypertrophy and intimal fibrosis (fibrosis of inner most endothelium) 
Loss of capillary bed
Secondary polycythaemia (increased [RBC] leads to increased blood viscosity)