Obstructive Lung Disease

Question 1

What are some causes of bronchiectasis?

Answer 1

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

Question 2

How does loss of elasticity lead to obstruction?

Answer 2

Positive pressure during expiration causes airways to close - like a balloon deflating

Question 3

What are some long term consequences of chronic asthma?

Answer 3

Chronic remodelling - fibrosis and irreversible obstruction

Chronic hypoxia - Pulmonary hypertension - Cor pulmonale

Question 4

What is the difference between obstructive and restrictive lung disease in their spirometry?

Answer 4

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

Question 5

What is the pathogenesis of bronchiectasis?

Answer 5

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

Question 6

What are some complications of emphysema?

Answer 6

Hypoxia due to airflow obstruction

Pulmonary hypertension due to loss of small vessels

Cor pulmonale

Pneumothorax

Question 6

What is the definition of chronic bronchitis?

Answer 6

Chronic cough with sputum production for 3 months within 2 years.

Question 7

Define emphysema

Answer 7

Abnormal, irreversible enlargement of airspaces distal to terminal bronchioles due to destruction of alveolar walls without fibrosis

Question 7

What are some complications of chronic bronchitis?

Answer 7

Chronic respiratory infections/superimposed infective exacerbations [most important]

Hypoxia, pulmonary hypertension, cor pulmonale

Squamous metaplasia > squamous dysplasia > premalignant

Question 7

What is small airways disease?

Answer 7

Chronic inflammation, fibrosis, obstruction of terminal bronchioles

Caused by cigarette smoke

Question 8

What are pink puffers and blue bloaters

Answer 8

Different clinical presentations of COPD

Question 10

What are some short term, serious consequences of asthma?

Answer 10

Death

Spontaneous pneumothorax/pneumomediastinum - due to air being trapped - lung segment popping

Atelectasis - collapse of the lung

Question 11

What causes alveolar wall destruction in emphysema?

Answer 11

Neutrophils release proteases and elastases

ROS from cigarettes cause this destruction and inactivate anti-proteases

Question 12

What are the types of obstructive diseases?

Answer 12

Asthma

COPD - emphysema, chronic bronchitis, small airways disease

Bronchiectasis

Question 13

Which two groups of people are more susceptible to emphysema?

Answer 13

Women and African Americans

Question 13

What lung diseases is smoking a risk factor for?

Answer 13

COPD

Respiratory bronchiolitis-associated interstitial lung disease

Exacerbation of asthma

Pneumonia

Lung Cancer

Acute bronchitis

Question 15

What is bullous emphysema?

Answer 15

Localised area of subpleural emphysema, they can burst and cause a pneumothorax

Question 15

What are features of chronic restrictive (interstitial) lung disease?

Answer 15

• chronic, diffuse, non-infectious
• Restrictive spirometry
• Inflammation and fibrosis of inter-alveolar septa
• Diffuse reticulo-nodular and/or ground-glass patterns on CXR

Question 16

Blue bloaters are characterised by …

Answer 16

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

Question 18

What is the pathogenesis of chronic bronchitis?

Answer 18

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)

Question 19

Why is bronchiectasis?

Answer 19

Irreversible, abnormal dilation of bronchi/bronchioles

Question 20

What is the most common form of interstitial lung disease?

Answer 20

Idiopathic pulmonary fibrosis - mean survival = 3 years!

Question 21

What does chronic bronchitis look like histologically?

Answer 21

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

Question 22

What are the features of Obstructive and Restrictive lung disease?

Answer 22

They are chronic, diffuse and non-infectious

Question 23

Provide a definition for asthma?

Answer 23

Airway hyperresponsiveness to various stimuli that causes sporadic bronchoconstriction which is at least partially reversible.

Question 25

True or false, diagnosis of asthma is made on histological evidence..

Answer 25

False - clinical and physiological evidence is required.

Question 26

Pink puffers are characterised by …

Answer 26

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

Question 27

What types are restrictive lung disease are there?

Answer 27

Honey comb lung Idiopathic pulmonary fibrosis Pneumoconiosis eg asbestosis Sarcoidosis

Question 29

What are clinical features of bronchiectasis?

Answer 29

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

Question 30

What is an important difference between asthma and COPD?

Answer 30

The obstruction is asthma is at least partially reversible.

Question 31

What are the acquired causes of disease? (I DIVINE TIME)

Answer 31

Infection Degenerative Inflammation Vasculature Iatrogenic Neoplastic Environmental Trauma Idiopathic Metabolic Endocrine