obstructive lung disease: COPD + asthma Flashcards
easily collapsible airway (can be episodic or reversible)→ difficulty in removing air from lungs → ↑ lung volume
obstructive lung disease
types of obstructive lung disease
asthma copd chronic bronchitis emphysema bronchiectasis
↑ sensitivity of bronchioles → REVERSIBLE (with B2 agonist - FEV1/FVC ratio corrects) bronchoconstriction
bronchospasm → smooth muscle hypertrophy (↓ compliance of lung)
asthma
curschmann spiral: spiral shaped mucous plugs + desquamated epithelium in sputum
seen in obstructive lung disease
charcot-leyden crystal: associated with eosinophillic inflammation
asthma
asthma can be induced by
viral URI allergen stress exercise ASPIRIN (asthma exacerbated)
cough wheezing SOB tachypnea hypoxemia ↓ inspiratory: expiratory ratio pulsus paradoxus mucus plugging
asthma
inspiration: ↓intrathoracic pressure →↑ blood flow into right ventricle → can cause IV septum to push over into left ventricle →↓ blood flow into LV →↓ LV output → small drop in systolic bp: if >10 mmHg during inspiration =
pulsus paradoxus
not paradoxical - just exaggerated form of normal physiologic response
conditions with pulsus paradoxus
1) restrictive pericardial space - heart can't expand with RV full of blood → push IV septum into LV: cardiac tamponade pericarditis 2) lung conditions: pulmonary embolism asthma
airflow limitation
chronic inflammation in airways + lungs
COPD
primarily due to smoking
daily chronic productive cough for =>3 mo (not necessarily consecutive) for 2 consecutive years
other symptoms:
wheezing, crackles, cyanosis, late onset SOB
note: may proceed or follow the development of airflow limitation (like copd) but don’t need COPD for diagnosis
diagnosis of chronic bronchitis = clinical
permanent enlargement of airspaces distal to terminal bronchioles
emphysema
hyperplasia of goblet cells + submucosal glands
reid index >50%
chronic bronchitis
reid index
thickness of submucosal glands/thickness of bronchial wall (epithelium to right before cartilage)
“blue bloater”
chronic bronchitis
cyanosis + peripheral edema that can occur from poor oxygenation + pulmonary hypertension that can occur
primarily due to smoking dilated alveoli damaged alveolar walls + septa result: enlarged alveolar spaces ↓elastic recoil → air trapping
emphysema
FEV1/FVC ratio in obstructive lung disease
FEV1/FVC ratio in restrictive lung disease
equal or > 80%
“barrel chested”
emphysema
↑AP diameter
hyperinflated lungs flattening of diaphgragm blunting of costophrenic angle ↑AP diameter prominent central pulmonary arteries
emphysema on CXR
type of emphysema in which only central portion destroyed
associated with SMOKING
UPPER LOBES + SUPERIOR SEGMENTS OF LOWER LOBES
destruction of RESPIRATORY BRONCHIOLES in acinus ONLY
centriacinar emphysema
“pink puffers”
centriacinar emphysema
severe SOB
associated with pneumothorax (ACUTE SOB)
emphysema
α1antitrypsin deficiency: emphysema at early age (20-30 yo) + early-onset cirrhosis
causes panacinar emphysema: overactive elastase degrades elastic fibers of lung
LOWER LOBES
destruction of ENTIRE ACINUS
panacinar emphysema
permanent destruction + dilation of bronchial walls
COPIOUS PURULENT SPUTUM
recurrent infections → lung ABSCESSES
cause: chronic inflammation or infections of bronchi, CILIA disorders: CF, Kartagener syndrome
bronchiectasis
associated with CF or Kartagener syndrome
bronchiectasis
treatment of asthma
B2 agonist: smooth muscle relaxation in bronchi: albuterol, levalbuterol, salmeterol
methylaxthine
corticosteroids: ↓ inflammation: beclomethasone, fluticasone, budesonide
cromolyn
muscarinic antagonist: ipatriprium, tiotropium
antiluekotrienes: zilueton, zafirlukast, montelukast
theophylline
expectorants
gauifenesin
N-acetylcysteine
inhaled treatment of choice for chronic asthma
inhaled corticosteroid
inhaled treatment of choice for acute asthma exacerbation
albuterol
