Obstructive Lung Disease Flashcards
What are some causes of bronchiectasis?
Severe necrotising infection - eg Staph aureus, influenza, aspergillus
Obstruction (+infection)
Cystic fibrosis
Cilia disorders
Non-infective inflammatory conditions - connective tissue disease, graph vs host disease
How does loss of elasticity lead to obstruction?
Positive pressure during expiration causes airways to close - like a balloon deflating
What are some long term consequences of chronic asthma?
Chronic remodelling - fibrosis and irreversible obstruction
Chronic hypoxia - Pulmonary hypertension - Cor pulmonale
What is the difference between obstructive and restrictive lung disease in their spirometry?
Obstructive have a lower FEV1 but the total expiratory volume is not significantly reduced Restrictive has a normal FEV1 but the total expiratory volume is decreased
What is the pathogenesis of bronchiectasis?
Severe destructive inflammatory of airways due to severe or chronic infection +/- obstruction
Loss of surrounding elastic tissue and muscle
Clearance of organisms and fluid is impaired
What are some complications of emphysema?
Hypoxia due to airflow obstruction
Pulmonary hypertension due to loss of small vessels
Cor pulmonale
Pneumothorax
What is the definition of chronic bronchitis?
Chronic cough with sputum production for 3 months within 2 years.
Define emphysema
Abnormal, irreversible enlargement of airspaces distal to terminal bronchioles due to destruction of alveolar walls without fibrosis
What are some complications of chronic bronchitis?
Chronic respiratory infections/superimposed infective exacerbations [most important]
Hypoxia, pulmonary hypertension, cor pulmonale
Squamous metaplasia > squamous dysplasia > premalignant
What is small airways disease?
Chronic inflammation, fibrosis, obstruction of terminal bronchioles
Caused by cigarette smoke
What are pink puffers and blue bloaters
Different clinical presentations of COPD
What are some short term, serious consequences of asthma?
Death
Spontaneous pneumothorax/pneumomediastinum - due to air being trapped - lung segment popping
Atelectasis - collapse of the lung
What causes alveolar wall destruction in emphysema?
Neutrophils release proteases and elastases
ROS from cigarettes cause this destruction and inactivate anti-proteases
What are the types of obstructive diseases?
Asthma
COPD - emphysema, chronic bronchitis, small airways disease
Bronchiectasis
Which two groups of people are more susceptible to emphysema?
Women and African Americans
What lung diseases is smoking a risk factor for?
COPD
Respiratory bronchiolitis-associated interstitial lung disease
Exacerbation of asthma
Pneumonia
Lung Cancer
Acute bronchitis
What is bullous emphysema?
Localised area of subpleural emphysema, they can burst and cause a pneumothorax
What are features of chronic restrictive (interstitial) lung disease?
- chronic, diffuse, non-infectious
- Restrictive spirometry
- Inflammation and fibrosis of inter-alveolar septa
- Diffuse reticulo-nodular and/or ground-glass patterns on CXR
Blue bloaters are characterised by …
COPD with predominant bronchitis
40-45 years old
Mild dyspnoea with later onset
Early onset cough with lots of sputum
Infections common
Repeated respiratory insufficiency
Common cor pulmonale
Increase airway resistance
Normal elastic recoil
Large heart and prominent vessels
Tolerant hypoxia better than pink puffers
What is the pathogenesis of chronic bronchitis?
Chronic irritation by inhaled substances - eg cigarette smoke or dust
Causes increased mucus production in large airways and
Chronic inflammation, scarring and narrowing in the small airways (permanent)
Why is bronchiectasis?
Irreversible, abnormal dilation of bronchi/bronchioles
What is the most common form of interstitial lung disease?
Idiopathic pulmonary fibrosis - mean survival = 3 years!
What does chronic bronchitis look like histologically?
Hypertrophy of the mucus secreting glands Increased goblet cells Mild increase in lymphocytes, macrophages and plasma cells, and oedema. Peribronchial fibrosis in small airways Maybe squamous metaplasia
What are the features of Obstructive and Restrictive lung disease?
They are chronic, diffuse and non-infectious
Provide a definition for asthma?
Airway hyperresponsiveness to various stimuli that causes sporadic bronchoconstriction which is at least partially reversible.
True or false, diagnosis of asthma is made on histological evidence..
False - clinical and physiological evidence is required.
Pink puffers are characterised by …
COPD with predominant emphysema 50-75 years old Severe dyspnoea early on Later cough with less sputum Occasional infections Respiratory insufficiency is fatal Rare Cor pulmonale Normal or slightly increase airway resistance Low elastic recoil Hyperinflation and small heart
What types are restrictive lung disease are there?
Honey comb lung Idiopathic pulmonary fibrosis Pneumoconiosis eg asbestosis Sarcoidosis
What are clinical features of bronchiectasis?
Dilated airways often full of pus - infections behind pus - severe productive cough with fowl smelling sputum - episodic fever - SOB and cyanosis - cor pulmonale - metastatic infection - amyloidosis
What is an important difference between asthma and COPD?
The obstruction is asthma is at least partially reversible.
What are the acquired causes of disease? (I DIVINE TIME)
Infection Degenerative Inflammation Vasculature Iatrogenic Neoplastic Environmental Trauma Idiopathic Metabolic Endocrine
