Obstructive And Restrictive Lung Diseases Flashcards
What is the difference between an obstructive lung disease and a restrictive lung disease?
Obstructive lung diseases are characterized by an obstruction to air flow anywhere from the trachea down the respiratory tree. A restrictive lung disease is the lungs not able to expand fully so total lung capacity has decreased.
What is going on with the FEV/FVC ratio in obstruction and restrictive lung diseases?
Restrictive normal and obstructive lower.
What are the 4 most common obstructive lung diseases?
Emphysema, chronic bronchitis, asthma and bronchiectasis.
Emphysema and chronic bronchitis are categorized as what condition and what is the most often cause?
COPD. Smoking.
What is the requirement for diagnosis chronic bronchitis?
Persistent cough with sputum production for at least 3 months over a 2 year period.
What is the predominant pathophysiologic mechanism of Chronic Bronchitis?
Mucous gland hyperplasia with associated thickening of the smooth muscle
Besides tons of mucus secretion, what 2 other things characterize Chronic Bronchitis?
Inflammation and infection
What 2 inflammatory cytokines do we see in chronic bronchitis?
IL 13 and histamine
hallmark histo feature of chronic bronchitis?
Increased size of mucus glands
What is the Reid index and what does it have to do with chronic bronchitis?
Ratio of the thickness of the mucus gland vs. the thickness of the whole wall that the gland sits in. Normal is usually .4 but increases over .5 with chronic bronchitis.
What is the cardinal symptom of chronic bronchitis?
Persistent, productive cough of sputum
How do we characterize emphysema?
Irreversible enlargement of the airspace distal to the terminal bronchiole with destruction of their walls.
What are the 4 types of emphysema, which two cause clinically significant obstruction and which one is most common?
Centriacinar, panacinar, paraseptal, and irregular. First two are clinically significant. Centriacinar is most common.
Which alveoli are involved in centriacinar, what part of the lung, and what condition is it associated with?
Proximal and central alveolar are affected, distal are spared. Upper lobes usually. COPD.
What alveoli are involved in panacinar emphysema, what part of the lung and what condition is it associated with?
Whole acinus or basically all the alveoli in the unit. Lower lobes. Alpha 1 antitrypsin deficiency.
What does alpha 1 antitrypsin usually do?
Coats the lungs and protects it from neutrophil elastase damaging the lungs.
What part of the acinus is damaged in paraseptal emphysema, where in the lung and what condition does this type of emphysema underlie?
Distal is affected. Upper lobe near the septa of the lobules. This type underlies spontaneous pneumothorax.
Irregular emphysema is associated with what in the acinus?
Scarring.
3 Mechanisms of alveolar damage in emphysema?
Inflammatory mediators, proteases, and oxidative stress leading to cell death.
What is the genotype of these patients with panacinar emphysema and what is the chromosome association?
homozygous PiZZ from chromosome 14.
What is the histo hallmark for emphysema and even though there are several different types, generally where will we find the lungs most commonly affected?
Abnormally large alveoli separated by thing septa.
Upper two thirds fo the lungs.
What is the first symptom appearing first with emphysema?
What are 5 other symptoms that come later?
Dyspnea is first.
Cough, wheezing, weight loss, barrel chested, and breath through pursed lips.
What is key to diagnosing emphysema?
Impaired expiratory airflow via a spirometry.
What are the 4 complications of emphysema?
Respiratory failure, CAD, right heart failure and pneumothorax with lung collapse
What 3 things are going on with asthma?
Muscle constriction, lots of mucus, and inflammation.
What are the two types of asthma and which one is most common? what is the main difference between the two?
Atopic asthma (most common) and non atopic asthma. the difference is that atopic is IgE mediated, type 1 hypersensitivity.
What are the triggers in atopic asthma and what are the triggers in non atopic?
Allergens in atopic and exercise, cold and infection.
What are the 3 main inflammatory cells in atopic asthma and what are the 2 main ones in non atopic?
Eosinophils, mast cells, and lymphocytes
T lymphocytes and neutrophils
What are the 3 contributing factors for a person having atopic asthma?
Immunity, environmental, and genetics
What is the big picture pathogenesis for atopic asthma?
Th2 and IgE response to environmental allergens in genetically predisposed individuals
What is the fundamental problem in atopic asthma?
The fact that there is a severe th2 response to normally harmless environmental antigens
Early asthmatic reaction is characterized by 4 physiological actions?
Bronchoconstriction, increased mucus production, VD, and increased vascular permeability.
What are the 4 inflammatory cells causing bronchoconstriction?
Leukotrienes c4 d4 and e4, histamine, prostaglandin d2, and acetylcholine
What inflammatory cell increases mucus secretion?
Leukotrienes c4, d4, and e4
What inflammatory cell increases vascular permeability?
Leukotrienes c4 d4 e4
What chromosome and which cytokines from the gene on that chromosome do they think is mostly associated with asthma?
5q. 3,4,5,9,13.
What is the characteristic histological finding of asthma, 5 things?
Thickening of the airway wall Fibrosis Increased vascularity Increased goblet cells and submucosal glands Smooth muscle hypertrophy
What is status asthmaticus and how is it characterized?
Severe acute asthma.
Characterized by this mucus plugs occluding the bronchials. These mucus plugs are called curshmann spirals.
What is histo feature that tells us we have tons of eosinophils?
Charcot Leyden crystals
what drug did she mention can caused drug induced asthma and what is the MOA?
Aspirin. Inhibits cox 1 and 2, leads to a decrease in PGE2, which increases pro inflammatory cells
What’s going on with bronchiectasis?
There is destruction of smooth muscle and elastic tissue by chronic necrotizing infections leading to permanent dilation of bronchi and bronchioles.
What are the two major conditions associated with bronchiectasis?
Obstruction and infection
What is one specific obstructive condition and one specific infection she mentioned?
Cystic fibrosis and allergic bronchopulmonary aspergillosis
What is the big picture problem with cystic fibrosis?
Defect in chloride transport which leads to thick secretions that obstruct
What is the problem with primary ciliary dyskinesia and what is the clinical triad?
Defect in ciliary motor proteins leading to ciliary dysfunction. Sinusitis, bronciectasis, and situs inversus
What is a big time adverse effect of primary ciliary dyskinesia?
Male infertility
What is going on with allergic bronchopulmonary aspergillosis?
Hypersensitivity response to Aspergillus infection overlying a chronic lung disease.
What two conditions underly ABPA?
Asthma and cystic fibrosis.
What 3 things help diagnose ABPA?
IGE, serum antibodies to Aspergillus, and positive skin test
What is the histo marker for ABPA?
Fungal hyphae of Aspergillus
What stain allows us to see ABPA?
Silver stain
