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Pulmonology > Obstructive Lung Disease > Flashcards

Obstructive Lung Disease Flashcards

1
Q

Extrinsic Asthma

A

Initiated by Type 1 hypersensitivity reaction induced by exposure to an outside agent

I.e. Allergic asthma, occupational asthma

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2
Q

Intrinsic Asthma

A

Initiated by non-immune mechanisms, i.e. inhaled irritants, exercise, etc.

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3
Q

Inflammatory cells present in asthma

A

Mast cells - activated by allergen via IgE receptors; release histamine

Eosinophils - release proteins that damage epithelial cells

Macrophages - activated by allergens to release cytokines

Neutrophils - present in airways and sputum

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4
Q

Structural changes in airways - asthma

A

Increased smooth muscle proliferation
Blood vessel proliferation
Mucus hyper-secretion

Final common pathway is airway narrowing

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5
Q

Asthma LFTs

A

Decreased FEV1/FVC - reversible or improved with a beta-adrenergic agonist, defined as improvement of > 12% or an absolute increase of > 200 mL

TLC, RV, FRC increased due to air-trapping

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6
Q

Methacholine challenge

A

Patient performs serial spirometry after inhaling progressively larger concentrations of bronchoconstrictor, stimulating airway obstruction

Asthmatics require less methacholine to reduce FEV1 by 20% (lower PC20)

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7
Q

Asthma treatments to reduce airway tone

A

Beta agonists - short acting (albuterol) vs. long acting

Anti-cholinergics (Ipratropium) - reduce vasoconstriction

Leukotriene inhibitors - reduce vasoconstriction

Phosphodiesterase inhibitors - increase intracellular cAMP

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8
Q

Asthma treatments to reduce inflammation

A

Corticosteroids - reduce # of inflammatory cells, decrease airway edema

Mast cell stabilizers

Anti-IgE therapy

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9
Q

Definition of COPD

A

Irreversible airflow limitation (FEV1/FVC < 0.70)

Includes elements of chronic bronchitis and emphysema

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10
Q

GOLD I

A

Mild COPD, defined as FEV1/FVC < 0.70

AND

FEV1 < 80% predicted

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11
Q

GOLD II

A

Moderate COPD, defined as FEV1/FVC < 0.70

AND

FEV1 50-70% predicted

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12
Q

GOLD III

A

Severe COPD, defined as FEV1/FEV < 0.70

AND

FEV1 30-50% predicted

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13
Q

Gold IV

A

Very severe COPD, defined as FEV1/FEV < 0.70

AND

FEV1 < 30% Predicted

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14
Q

Chronic Bronchitis - Definition

A

Productive cough present for 3 months/year over a 2-year period without another identified medical cause

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15
Q

Histologic changes in chronic bronchitis

A

Hypertrophy of submucosal glands
Increased number of goblet cells
Increase in size and number of smooth muscle cells
Squamous metaplasia

Final common pathway is narrowing of the airway lumen and obstruction by mucus with increased airflow resistance

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16
Q

Emphysema - Definition

A

Abnormal, permanent enlargement of alveoli with destruction of alveolar septa; leads to increased lung compliance with loss of elastic recoil

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17
Q

Centriacinar Emphysema

A

Scarring and dilation of the respiratory bronchioles and adjacent alveoli, resulting in the development of pathologically enlarged air spaces

Most often associated with smoking

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18
Q

Panacinar Emphysema

A

Scarring and dilation of the entire respiratory bronchiole + alveolar unit

More commonly seen in alpha-1-anti-trypsin deficiency

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19
Q

PFTs in COPD

A

Decreased FEV1/FVC (< 0.70)
Increased RV/FRC/TLC due to hyperinflation
Reduced DLCO due to destruction of the air-blood barrier (emphysema only)

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20
Q

Bronchiectasis

A

Abnormal dilation of the proximal, medium-sized bronchi due to destruction of the muscular and elastic components of their walls; requires infectious/inflammatory insult + impaired drainage leading to sustained tissue damage

Dilated airways are collapsible, resulting in obstruction

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21
Q

Cystic Fibrosis - Genetics & Clinical Characteristics

A

Autosomal recessive mutation in the CFTR gene, resulting in dysfunctional chloride secretion across epithelial surfaces

Major clinical complications: recurrent sinus and pulmonary infections with resultant bronchiectasis and airway obstruction; pancreatic insufficiency and pancreatitis, male infertility

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22
Q

Ivacaftor

A

Targeted genetic therapy for CF aptients with G551D mutation in the CFTR gene (4% of CF patients); restores function of the mutant CF protein

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23
Q

Treatment strategies for CF

A 
Antibiotics to treat recurrent infections
Bronchodilators
Nebulized hypertonic saline 
Chest physiotherapy
Lung transplantation
24
Q

Bronchiolitis obliterans - adults

A

Inflammation of the bronchioles (<2mm)

In adults, most commonly caused by inhalation of toxic gases, autoimmune pathology, or drugs in adults (rarely infectious)

25
Q

Bronchiolitis - Kids

A

Inflammation of the bronchioles (< 2mm) more often infectious in etiology (i.e. RSV)

26
Q

What is the characteristic physical exam finding of bronchiolitis?

A

Inspiratory squeaks

27
Q

Well-controlled asthma

A 
Symptoms no more than 2x/week
Nighttime symptoms no more than 2x/month
SABA used < 2x/week
Oral steroid use no more than 1x/year
Urgent care visit no more than 1x/year
28
Q

Inhaled glucocorticoids

A

Preferred long-term control medication for persistent asthma

Dose should be reduced 20-50% every 3 months to achieve lowest dose possible while maintaining contol

29
Q

Short-acting Beta-2 agonist

A

Smooth muscle relaxation via stimulation of B-2 receptors causes bronchodilation

Rapid onset of action within minutes; lasts 4-6 hours

30
Q

Long-acting Beta-2 agonists

A

Used prophylactically to prevent symptoms; effect lasts 12 hours

Black box warning - observed increase in asthma-related deaths; should not be used as monotherapy

31
Q

Leukotriene modifers

A

Direct leukotriene antagonist OR 5-lipoxygenase inhibitor

Causes bronchodilation and reduces inflammation

Administered orally

32
Q

Anti-IgE therapy

A

Binds to IgE, inhibiting its binding to mast cells

Parenteral administratio (IV, SC)

Adverse effects: Anaphylaxis

For treatment of allergic asthma

33
Q

Anticholinergics

A

Ex: Tiotroprium, Atropine

Inhibit bronchoconstricting effects of ACh on muscarinic receptors on bronchial smooth muscle

Long acting anti-cholinergics are approved for COPD (not asthma)

34
Q

Therapeutic options for COPD

A 
Beta agonists (short or long acting)
Anti-cholinergics (short or long acting)
Inhaled corticosteroids
35
Q

Pathology - Acute vs. Chronic Bronchitis

A

Acute bronchitis - neutrophils & mucous in the airway lumen and infiltrating vessel wall; usually infectious

Chronic bronchitis - mostly lymphocytes infiltrating airway wall; may be accompanied by squamous metaplasia of the epithelium and mucous gland hypertrophy

36
Q

Bronchiectasis - Pathology

A

Dilation of the medium-sized airway compared to the neighboring vessel

Leads to mucus plugging & recurrent infectious because airways cannot clear mucous effectively

37
Q

Follicular bronchiolitis - Pathology

A

Characterized by the presence of ectopic germinal center comprised mostly of B-cells within the bronchiole

Associated with CVD, immunodeficiency

38
Q

Constrictive and Obltierative Bronchiolitis (Bronchiolitis Obliterans) - Pathology

A

Inflammation and fibrosis of the bronchioles resulting in scarring of the bronchiole airway closed

Lesions are focal, blocking off one airway so that the lobule of lung distal to that airway becomes “air trapped”

39
Q

Granulomatous bronchiolitis - Pathology

A

Presence of multinucleated giant cells & activated macrophages

May be infectious (TB, fungal) or non-necrotizing (sarcoid, beryllium)

40
Q

Main histologic changes associated with asthma (4)

A
  1. Thickening of the basal lamina underlying the epithelium
  2. Eosinophilic inflammation
  3. Mucus hypersecretion
  4. Smooth muscle hyperplasia surrounding the airway
41
Q

Emphysema - Pathology

A

Broken alveolar septa - air spaces enlarge and form “cysts”

“Flag sign” refers to the “rolled up” appearance of broken septae

Subpleural blebs - may cause pneumothorax if ruptured

42
Q

Smoking vs. anti-trypsin emphysema - Pathology

A

Smoking-related emphysema is worse in the upper lobes and around airways (centrilobular)

Alpha-1-antitrypsin deficiency-related emphysema is worse in the lower lobes and involves the entire gas exchange unit (panlobular)

43
Q

3 major determinants of site and severity of occupational lung disease

A

Dose of chemical ( = duration of exposure x concentration)

Solubility of chemical - more water-soluble agents deposit in the upper airway; less water-soluble agents affect the distal airways/bronchioles

Particle size - > 10 microns are filtered in the upper airway; < 10 microns are “respirable” and penetrate more deeply into the lung

44
Q

Occupational (Immunologic) asthma - Definition & Prevalence

A

Characterized by variable airflow obstruction, airway hyperresponsiveness, and airway inflammation attributable to a particular occupational exposure which triggers an IgE-mediated immunologic reaction

Presents with latency - months to years after initial exposure; often displays a temporal pattern of symptosm

Accounts for up to 15% of adult asthma

45
Q

Irritant Asthma (Reactive airways dysfunction syndrome, RADS)

A

Direct airway epithelial injury caused by inhalation of substances with irritant properties, leading to persistent hyperresponsiveness and airflow obstruction

Presents without latency - symptom onset is clasically 24-48 hours after exposure

46
Q

Occupational COPD

A

Accounts for 15% of COPD

Most often associated with coal mine dust, respirable silica, and biomass combustion

47
Q

Constrictive / Obliterative Bronchiolitis

A

Injury of the small airways with resultant scarring and fibrosis of the airways closed

Often associated with toxic exposure, i.e. diacetyl flavoring on buttered popcorn

48
Q

4 airway diseases associated with environmental exposures

A

Occupational (Immunologic) asthma

Irritant asthma (Reactive Airways Dysfunction Syndrome )

Chronic Obstructive Pulmonary Disease

Constrictive / Obliterative Bronchiolitis

49
Q

Triggers of occupational asthma

A

HMW compounds - animal proteins, baking flours

LMW compouns - isosianaids, epoxy resins

50
Q

Triggers of irritant asthma / RADS

A

Noxious irritant gas/vapor/dust

Think 9/11

51
Q

LABA - Example & Uses

A

Salmeterol

Used in asthma & COPD

Never used as monotherapy; combination therapy only!

52
Q

Anti-cholinergics - Examples & Uses

A

Atropine, Tiotropium, Ipratropium

Approved for COPD but not asthma

53
Q

Systemic corticosteroids - examples & uses

A

Prednisone - oral or IV

Used to treat acute exacerbations of asthma

54
Q

Inhaled corticosteroids - examples & uses

A

Beclomethasone diproprionate, triamcinolone, acetonide

Preferred long-acting control agent to treat asthma and COPD

55
Q

Immunomodulation therapy for asthma

A

Omalizumab - SC

Anti-IgE approve for allergic asthma

Pulmonology (15 decks)

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