Obstructive Disease Flashcards
Obstructive disease parameters are:
FEV1 is reduced,
FEV1/FVC is reduced
TLC is increased due to increase in the trapped air
FVC is also reduced or normal
What is vital capacity?
The Inspiratory capacity + tidal volume + expiratory capacity
What does obstructive disease affect?
It affects the airways (partial or extensive obstruction).
Can be partial obstruction vs complete obstruction.
What happens to parameters in restrictive diseases?
TLC is reduced due to decreased capacity in inhalation
FEV1 is reduced or normal
FEV1/FVC is usually increased or normal. (>80%)
Forced Vital Capacity is reduced due to the reduction in inspiration.
What do restrictive diseases affect and what do they involve?
It affects parenchyma, difficulty exapanding, most often caused by ARDS
What is COPD?
It is chronic bronchitis and emphysema together. Early symptoms aren’t present. Not fully reversible
Describe bronchitis
There is the hyper-secretion of goblet cells in the bronchial wall. Hypertrophy of the submucosal mucous secreting cells. Causes there to be obstruction in the airways
In the small airways there is increased goblet cells in the smaller airways
Airflow obstruction or increased obstruction in the airways due to the increased mucous glands.
Small airway fibrosis basically.
Airflow obstruction.
There is also inflammatory response which is CD8+ response–>airflow obstruction. Damage to the airway.
Reid Index > 0.5 (50%)
What are the clinical features of Bronchitis?
Blue bloaters ( mucus traps CO2)
causes Pa Co2 to increase, and PaO2 to decrease
Productive cough for more than 3 months in 2 years
can be cor pulmonale
What is emphysema
Emphysema is due to basically there being destruction of alveolar sacs. Results in excessive air trapping and causes there to be loss of elastic recoils.
What are the 4 different causes of emphysema?
Due to imbalance and of proteases and anti-proteases, smoking, AIAT deficiency.
What happens in imbalance of proteases and antiproteases?
Inflammation causes there to be protease release by the neutrophils and macrophages. A1AT causes neutralization. Lack of the enzyme causes there to be increased neutrophils.
Smoking is the most common cause of emphysema –> centri-acinar (upper lobes)
Hereditary AIAT Deficiency: pan-acinar.
AIAT effects on the liver:
the mis-folded proteins cause them to be stuck in the liver, causing them to be struck in the ER of hepatocytes
What are the clinical features of emphysema?
They are pink puffers, barrel chest, loss of alveoli. Dyspnea and cough with minimal sputum
What is the definition and pathogenesis of asthma
Asthma is reversible bronchoconstriction, and is caused by type 1 hypersensitivity.
Allergens induce there to be Th2 cells in CD4+ cells. These release release IL-4 and IL-5. IL-4 causes IgE switching. IL-5 is causes eosinophil attraction and IL-10 (attracts TH2 and inhibits TH1).
The second time there is a IgE induced reaction–> causes there to be leukotrienes (CDE4 release) and histamine release.
What are the clinical aspects of asthma?
They are dyspnea, productive cough and dyspnea. Productive cough can cause there to be wither Curschmann Spirals, or there can be Eosinophilic crystals ( Charcot-Leyden Crystals)
What can asthma be caused by?
Allergic rhinitis, Eczema, an a family history of Atopy.
What happens in early phase asthma?
Vascular permeability, edema, and bronchoconstriction and mucus production.
What happens in late phase of the asthma reaction?
What happens in the late phase is that major basic protein from the Eosinophils damages cells and causes bronhoconstritcion
What is severe non-responsive asthma called?
Status asthmaticus
What is the cause of bronchiectasis?
It is basically when there is permanent dilation of bronchi and bronchioles due to several reasons:
Can be because of
- CF
- Ciliary dyskinesea
- Necrotizing pneumonia
- local obstruction
How can CF cause there to bronchiectasis?
CF can cause bronchiectasis as the impaired chloride channels can cause an increase in mucus production, causing there to be more infections ==> increased destruction of the bronchial tissue.