Obstructive Lung Disease

Question 1

Which part of COPD can be partially reversible?

Answer 1

chronic bronchitis

Question 2

What are the 2 main types of obstructive lung disease?

Answer 2

asthma and COPD

Question 3

What is respiratory bronchiolitis?

Answer 3

small airway inflammation in COPD

Question 4

What occurs in chronic bronchitis?

Answer 4

Chronic irritation leads to defensive increase in mucus production with increase in numbers of epithelial cells (esp goblet cells)

Question 5

What may generate obstruction in small airway bronchiolitis?

Answer 5

Goblet cell metaplasia, macrophage accumulation and fibrosis around bronchioles

Question 6

What are the types of emphysema?

Answer 6

Centriacinar (centrilobular)
Panacinar
Others (e.g. localised around scars in the lung)

Question 7

In emphysema what is the dilation due to?

Answer 7

to loss of alveolar walls (tissue destruction)

Question 8

In what ways does emphysema impair respiratory function?

Answer 8

• Diminished alveolar surface area for gas exchange

- Loss of elastic recoil and support of small airways leading to tendency to collapse with obstruction

Question 9

What does PaO2 lead to in advancing emphysema?

Answer 9

Dyspnoea and increased respiratory rate
Pulmonary vasoconstriction (and pulmonary hypertension)

Question 10

In what rare genetic condition is there a high rate of emphysema and why?

Answer 10

alpha-1 antitrypsin deficiency, because elastic tissue is very sensitive to elastase, and antitrypsin is an anti-elastase

Question 11

How does tobacco smoke cause COPD?

Answer 11

Increases number of neutrophils and macrophages in lung
Slows transit of these cells
Promotes neutrophil degranulation
Inhibits alpha 1 antitrypsin