Obstructive and Restrictive Lung Disease

Question 1

What is the main spirometry change in obstructive lung disease and in restrictive lung disease?

Answer 1

Obstructive - FEV1.0 decrease

Restrictive - FVC decreased

Question 2

What are some types of obstructive lung disease?

Answer 2

Asthma, COPD (chronic bronchitis, emphysema, small airways disease), bronchiectasis

Question 3

What is emphysema?

Answer 3

Abnormal, permanent enlargement of air spaces distal to the terminal bronchiole
- from destruction of the alveolar wall WITHOUT fibrosis

Question 4

What is the pathophysiology of emphysema?

Answer 4

Imbalance between proteases and antiproteases in the lung - from smoking, secrete more proteases (particularly neutrophils)

Question 5

How does emphysema cause airway obstruction?

Answer 5

Loss of elastic recoil
- loss of supporting elastic tissue
- dynamic airway collapse during forced expiration
Complications - hypoxia, pulmonary hypertension, cor pulmonale, pneumothorax

Question 6

What is chronic bronchitis?

Answer 6

Persistent cough productive of sputum for at least 3 months in 2 consecutive years with no other cause

Question 7

What is the pathogenesis of chronic bronchitis?

Answer 7

• Chronic irritation by inhaled substances
• Increased mucus production
• Airway inflammation, scarring and permanent narrowing

Question 8

What is small airways disease?

Answer 8

• Affects the terminal bronchioles
• Caused by cigarette smoking
• Chronic inflammation, fibrosis, obstruction
• Important component of COPD

Question 9

How does smoking predispose to pulmonary infection?

Answer 9

• Inhibition of muco-ciliary escalator
• Increased mucus
• Inhibition of leukocyte function
• Direct damage to epithelial layer

Question 10

What is bronchiectasis?

What is its pathogenesis?

Answer 10

Irreversible, abnormal dilation of bronchi/bronchioles

Severe destructive inflammation of airways

• loss of surrounding elastic tissue and muscle
• clearance of organisms and fluid impaired

Question 11

What is the clinical course of bronchiectasis?

Answer 11

Dilated airways often full of pus, severe cough productive of lots of foul smelling sputum, episodic fever, SOB and cyanosis, cor pulmonale

Question 12

What is restrictive lung disease?

Answer 12

Share these features:

• chronic, diffuse, non-infectious
• restrictive spirometry
• inflammation and fibrosis of inter-alveolar septa
• specific diagnosis often not identified

Question 13

What is idiopathic pulmonary fibrosis?

Answer 13

Interstitial inflammation, fibrosis at varying stages of development
Cause unknown
Inevitable progression to end-stage lung