Obstructive Lung Disease - Parks and Baker Flashcards
what values do full PFTs give you that spirometry doesn’t?
total lung capacity
residual volume
how do you measure residual volume?
TCL-FVC
Emphysema results in an (inc/dec) DLCO
decreased
what is DLCO?
measures the ability of the lungs to transfer gas from inhaled air to the red blood cells in pulmonary capillaries
Describe the changes in lab values for obstructive pulmonary dz: FEV1 FEV1/FVC FEF25-75 TLC RV
dec. FEV1 dec FEV1/FVC ratio dec FEF25-75 normal to inc. TLC inc. RV
why do you get an increased rv in OPD?
air trapping
what is the characteristic pattern of emphysema on flow-volume loops?
scooped-out
t/f: most patients are somewhere between emphysema and chronic bronchitis
true
what is the biggest risk factor for COPD?
smoking
only what percent of smokers develop COPD?
10-15%
do more men or women die of COPD?
women
What are the three leading causes of death?
- heart disease
- Cancer
- Chronnic lower resp. tract disorder
is emphysema defined clinically or anatomically?
anatomically
what are the two criteria for emphysema Dx?
- irreversible enlargemnt DISTAL to terminal bronchioles
2. airspace destruction WITHOUT fibrosis
What are the four types of emphysema?
Centriacinar
Panacinar
Paraseptal
Irregular
t/f: you tend to see a combo of types of emphysema
true
what is the most common type of emphysema?
centriacinar
centriacinar emph. has initial sparing of what structure?
distal acinus
which lobes of the lung are affected in centriacinar emph?
upper lobes and apical segments
centriacinar emph is assc’d wit….
heavy smoking; walls black with pigment
centriacinar emph is assc’d with what other diz?
chronic bronchitis
describe the histo of a slide for centriacinar emph
huge alveoli with dilated airspaces. Alveolar walls and capillaries have been destroyed
what are the anatomical boundaries of panacinar emph?
airspace enlargement from respiratory bronchiole to alveoli (NO SPARING)
which lobes of the lung are affected in panacinar emph?
lower lobes and anterior margins
which type of emph is assc’d with a1-antitrypsin def?
panacinar emph
t/f: nicotine indirectly causes inflammation via TLR on mac’s
false; DIRECTLY causes inflammation
Which three chemokines are released in response to ROS from tobacco smoke?
IL9
leukotriene B4
TNF-a
The release of IL9, LTB4, and TNF-a recruit neutrophils to the lung which then break down..
elastin
The tissue damage in the alveoli from smoke is due to a (blank-blank) imbalance
protease-antiprotease
A1-AT helps to reduce (blank) activity
elastase
t/f: A1-AT def can be congenital or acquired as a result of oxidative damage
true
A1-AT def is coded by the Pi gene on which csome?
14
what are the two alleles of Pi gene?
M and Z
What is the normal A1AT alleles?
2 copies of PiMM
What is the genotype for panacinar emph?
2 copies of PiZZ
What is the result of the PiMZ allelle combo?
reduced levels of A1AT in the lungs; but asymptomatic. adding smoke increases risk sig.
popping a bleb can lead to a….
pneumothorax
What are the two ways that airspace enlargement leads to pathophys?
- loss of elastic recoil
2. small airway inflammation
in small airway inflamm, goblet cell metaplasia leads to…
mucus plugging
in small airway inflamm, there is a (blank) infiltrate
inflamm cell
in small airway inflamm, there is smooth muscle hypertrophy and (blank) fibrosis
peribronchial
Is chronic bronchitis defined anatomically or clinically?
clinically
What are the criteria for chronic bronchitis Dx?
Persistent cough with sputum production for at least three months in at least two consecutive years.
What are the four ways that the body tries to protect itself in response to tobacco smoke?
- deploy inflamm cells (neutrophils, mac’s, lymphs)
- hypertrophy of submucosal glands in trachea/bronchi
- hypersecretion of mucus in large airways
- small airway obstruction
T/F: the causes of small airway obstruction are the same in emphysema and chronic bronchitis
true;
- increased goblet cellls
- increased mucus production
What is the Reid index?
thickness of bronchial glands:total bronchial wall thickness
abnl: submucosal glands are greater than 50% of the thickness
Who are the pink puffers?
emphysema
Describe the clinical presentation of emphysema?
dyspnea; slow decline in function cough not necessary wt. loss BARREL-CHESTED prolonged expiratory phase hunched over PURSED LIP BREATHING
who are the blue bloaters?
chronic bronchitis
After the chronic cough, what are the symptoms of chronic bronch?
Dyspnea on exertion
Hypercapnea
Hypoxemia
Mild cyanosis
how will exacerbations of COPD affect dz course?
they will ultimately increase the speed of disease progression
what are common exacerbations of COPD?
URI or smoke in the air. seen more in CB than in E
What are the GOLD criteria for COPD?
- preventable and treatable
- persistent airflow limitation
- enhanced chronic inflamm response to noxious particles/gas
- exacerbations and comorbidities contribute
t/f: spirometry is necessary for the Dx of COPD
true
What are the spirometer criteria for a dx of COPD?
Post-bronchodilator FEV1/FVC <0.70
is the FEV1/FVC ratio or FEV1 %predcited value determinant of the severity of COPD?
%predicted value FEV1
What % predicted is mild COPD?
> 80
What % predicted is moderat COPD?
50-80
What % predicted is severe COPD?
30-50
What % predicted is very severe COPD?
<30
After smoking cessation, lung function decline is (worse than/equal to) non-smokers
equal to
what distinguishes asthma from other COPD?
reversible
are there more male or female kids with asthma?
2x more males
are there more men or women with asthma?
equal
when is the peak of asthma presentation?
3 years
t/f: some kids grow out of asthma
true
t/f; asthma is progressive
false
mild will be mild
severe will be severe
what are the Sx of acute asthma exacerbation
chest tightness
wheezing
dyspnea
cough w/wo sputum
What is status asthmaticus?
persistent Sx lasting days to weeks
can result in cyanosis and death
what changes do you see to peripheral blood in asthma?
eosinophilia
What do you see in asthma sputum?
- Curschmann spirals
(Whorls of shed epithelium forming spiral shaped mucous plugs) - Charcot-Leyden Crystals
What is the most common type of asthma?
atopic
what is the MOA of atopic asthma?
immediate type I hypesensitivty rxn
what will RAST show in atopic asthma?
positive skin tests for specific allergens
which type of asthma has a family history?
atopc
Non-atopic asthma is assciated with hyper-irritability of the…
bronchial tree
Which type asthma tends to be more severe?
non-atopic
which three chemokines are released 5-30 mins after beginning of asthma attack?
IL4
IL5
IL13
which cell mediates the type I rxn and release the chemokines in atopic asthma?
TH2 cells
What is the result of release of chemokines from Th2 cells?
- tissue inflammation
- IgE production
- Mast cell degranulation
What three things do mast cells release when stimulated by Th2 cells?
LT C4, D4, E4
What are the four changes to the respiratory structure during an asthma attack?
- bronchoconstriction
- increased mucus
- vasodilation
- increased vascular permeability
Mast cell degranulation leads to a loss of..
integrity of the mucus membranes (inc. vascular permeability)
T/F: asthma attacks can last for days without additional exposure
true
What are the changes that wee see in an asthma attack 2-24 hours after it begins?
- increased inflamm cells
- major basic protein
- continued airway constriction
- epithelial destruction
Which four inflammatory cells invade the airways 2-24 hours after the beginning of an asthma attack?
Eos
Basophils
neutrophils
lymphs
What is the best way to interrupt the continued asthma cascade?
inhaled corticosteroids
b2 agonists for SMC
If a pt is unresponsive to bronchiodilators or corticosteroids, what type of med should you give them?
mAb to IL4/5/13
Describe the bronchiole remodeling in chronic asthma
- goblet cell hyperplasia
- smooth muscle hypertrophy
- inflammation
- fibrosis
T/F: inflammation and fibrosis are the main causes of chronic asthma
false.
while present, they are secondary to smooth muscle hypertrophy and goblet cell hyperplasia in causing symptoms
what is another name for non-atopic asthma?
intrinsic asthma
When does intrinsic asthma begin?
adulthood
What is Samter’s triad?
Nasal polyps
asthma
Aspirin sensitivty
in which type of asthma do we see Samter’s triad?
intrinsic
Describe the spirometry values that confirm asthma
FEV1
FEV1/FVC
PEF
Decreased FEV1
dec. FEV1/FVC
Dec. PEF
The reversible nature of asthma is measured how?
> 12% AND 200mL improvement in FEV1 15 minutes post-inhaled beta-2 agonist
What med do you give people to trigger an asthma attack?
Methacholine;
PC20 = conc’n of methacholine reduceds FEV1 by 20%
can also have them exercise
what symptom is especially important in determining asthma severity?
night time symptoms
what is bronchiectasis?
Permanent dilation of the bronchi and bronchioles
Caused by destruction of the muscle and elastic tissue
bronchiectasis is assc’d with what type of infx?
necrotizing infx
What are the three things that can form an obstruction in the bronchiole?
mucus plug
tumor
foreign body
explain how blockage of a bronchiole leads to bronchiectasis
- secretions and bacteria are not cleared.
2. infection and infalmm leads to destruction of smooth muscle and elastic fibers
in what lobes of the lungs do you tend to see bronchiectasis?
lower lobes
in what genetic dz do you see bronchiectasis?
CF
what other dz will cause LOCALIZED bronchiectais
if there’s a tumor there!
Using pathology words, describe what you see in bronchiectasis destruction
cystic appearing with mucopurulent secretions
What is Kartagener syndrome and what is it assc’d with?
Primary ciliary dyskinesia
assc’d with bronchiectasis
What are the bacterial causes of necrotizing pneumonia asscciated with bronchiectasis?
TB
S. aurues
H. flu.
pseudomonas
What are the vira lcauses of necrotizing pneumonia asscciated with bronchiectasis?
adenovirus
influenza
HIV
What are the fungal causes of necrotizing pneumonia asscciated with bronchiectasis?
aspergillus
What are other dz states associated with bronchiectasis?
RA
SLE
IBD
post-transplant
What are the Sx of bronchiectasis?
- LOTSA COUGHING
- foul-smelling, bloody sputum
- worse in morning
- dyspnea and cyanosis
- severe hemoptysis
Describe the morphologic changes to the airways in bronchiectasis
- acute and chronic inflamm of the bronchiole walls
- desquamation of epithelium
- ulcerations
- fibrosis
- MULTIPLE POS. CULTURES
Which abx do you give prophylactically or chronically for bronchiectasis?
doxycycline
