Obstructive lung disease Flashcards
How does radius affect airway resistance?
resistance is inversely proportional to the r^4
How does radius affect airway resistance?
resistance is inversely proportional to the r^4
how does airflow obstruction lead to increased lung volumes?
incomplete emptying of alveoli (breath stacking and gas trapping)
What is a key word for airway hyper responsiveness?
asthma
What are the 2 types of asthma and what causes them?
Extrinsic = allergic IgE mediated Intrinsic = non-seasonal, non-allergenic, chronic and persistent
Is asthma a Th2 or Th1 mediated disease?
Th2
what is the DLCO in asthma?
nl to increased
What is inspiratory wheeze indicative of?
vocal cord dysfunction
what phase is wheezing heard in asthma?
expiratory
what is the pathophysiology of asthma?
airway inflammation, edema, and mucous plugging leading to gas trapping and airflow obstruction
what would the PV curve of asthma show?
increased volumes but normal slope because elastic recoil is normal
why are there increased lung volumes in asthma?
because there is air trapping
what is the long term treatment of vocal cord dysfunction?
speech therapy
on a methacholine challenge on vocal cord dysfunction what will be seen?
no change in FEV1 or PC20
What must the FEV1/FVC be in COPD?
if you have a 50 year smoking history what chance do you have to develop COPD?
20% chance
what are the characteristics of a blue bloater and what disease is this associated with?
hypoventilator hypoxic hypercapnic cor pulmonale CHRONIC BRONCHITIS
What are the characteristic of a pink puffer and what disease is this associated with?
hyperventilator
less hypoxic/hypercapnic than blue bloater
EMPHYSEMA
What is the pathogenesis of chronic bronchitis
glandular hypertrophy and over excretion of fluid mucous leading to impaired ventilation
What is the pathogenesis of chronic bronchitis
glandular hypertrophy and over excretion of fluid mucous leading to impaired ventilation
how does airflow obstruction lead to increased lung volumes?
incomplete emptying of alveoli (breath stacking and gas trapping)
What is a key word for airway hyper responsiveness?
asthma
What are the 2 types of asthma and what causes them?
Extrinsic = allergic IgE mediated Intrinsic = non-seasonal, non-allergenic, chronic and persistent
Is asthma a Th2 or Th1 mediated disease?
Th2
what is the DLCO in asthma?
nl to increased
What is inspiratory wheeze indicative of?
vocal cord dysfunction
what phase is wheezing heard in asthma?
expiratory
what is the pathophysiology of asthma?
airway inflammation, edema, and mucous plugging leading to gas trapping and airflow obstruction
what would the PV curve of asthma show?
increased volumes but normal slope because elastic recoil is normal
why are there increased lung volumes in asthma?
because there is air trapping
what is the long term treatment of vocal cord dysfunction?
speech therapy
on a methacholine challenge on vocal cord dysfunction what will be seen?
no change in FEV1 or PC20
What must the FEV1/FVC be in COPD?
if you have a 50 year smoking history what chance do you have to develop COPD?
20% chance
what are the characteristics of a blue bloater and what disease is this associated with?
hypoventilator hypoxic hypercapnic cor pulmonale CHRONIC BRONCHITIS
What are the characteristic of a pink puffer and what disease is this associated with?
hyperventilator
less hypoxic/hypercapnic than blue bloater
EMPHYSEMA
what are the historical requirements for diagnosis of chronic bronchitis?
cough > 3 months over the past 2 years without specific cause
What is the pathogenesis of chronic bronchitis
glandular hypertrophy and over excretion of fluid mucous leading to impaired ventilation
What is the pathogenesis of emphysema?
loss of normal alveolar space with enlargement of distal airspaces
what happens to compliance in emphysema?
it increases. The lungs are like a big floppy bag because of loss of elastic tissue and increased apoptosis of alveolar cells
What are the 2 types of emphysema?
Panacinar
Centriacinar
What location is panacinar emphysema located and which patients are more likely to have this type of emphysema?
involves the entire acinus
usually present in older patients or those with alpha 1 antitrypsin deficiency
What location is centriacinar emphysema located and which patients are more likely to have this type of emphysema?
involves the respiratory bronchiole
usually present in smokers
what is the PV curve of emphysema?
leftward shift and increased slope
what is the physical exam findings for chronic bronchitis?
cough
rhonchi
wheezing
what is the physical exam findings for emphysema?
diminished breath sounds
hyperresonant
What are common physical exam findings for both chronic bronchitis and emphysema?
prolonged expiratory phase
pursed lip breathing
tri-pod positionig
what is the best predictor for survival of COPD?
FEV1
what is the grading system for COPD?
GOLD 1-4 with 4 being the worst
what are the most common causes of death in COPD?
respiratory failure RV failure pneumonia spontaneous ptx PE
What are the distinguishable features of asthma compared to emphysema and bronchitis?
reversible, episodic
exacerbation with methacholine
normal and increased DLCO
what are the distinguishable features of chronic bronchitis compared to asthma and emphysema?
minimal reversibility (under stable conditions) normal to slightly increased DLCO
what are the distinguishable features of emphysema compared to asthma and emphysema?
marked hyperinflation
no reversibility to bronchodilation
decreased DLCO
shift in PV curve
What is key feature of bronchiectasis?
abnormal dilation of proximal bronchi
what is the physical exam finding of bronchiolitis?
inspiratory squeaks on exam
