Obstructive Lung Diseases Flashcards
what genetic factors are associated with obstructive lung diseases?
- α1 antitrypsin deficiency
- polymorphisms in TGFB (transforming growth factor B) gene which is important for immune cell activation
- polymorphism in matrix metalloproteinases (MMP)
obstructive diseases are a _______ disorder
airway: tracheal to terminal bronchiole
atelectasis is linked to _____ emphysema
septa/distal acinar emphysema
an ↑ in the Reid index is seen in _____
chronic bronchitis
a patient’s sputum analysis comes back with presence of Charcot Leyden crystals. What is this a result of?
Charcot Leyden crystals are breakdown products of eosinophils (can be seen in asthmatic patients)
smoking is associated with ______ type of emphysema
centrilobular (centriacinar) which affects the upper lung zones and the respiratory bronchioles are affected
viral infections can cause ______ asthma by ________
NON ATOPIC asthma;
the mucosal damage caused by the virus lowers the threshold of subepithelial vagal receptors to irritants
septal emphysema is found next to ______
atelectasis, along septa, margins of lobes and subplueral zones;
more common in upper lobes
what cytokine activates eosinophils?
IL-5
_______ is a common cause of drug induced asthma
aspirin
______ is a skin finding on atopic asthma
wheal and flare
describe the cough in chronic bronchitis
- PRODUCTIVE cough
- cough for at least 3 straight months for at least 2 years
in bronchiectasis, the airways are _____
dilated all the way to the pleura and filled with mucus and pus
virus induced mucosal damage lowers the threshold of _________
subepithelial vagal receptors to irritants in non atopic asthma
is there fibrosis associated with emphysema?
NO
_______ is a distinctive feature of chronic bronchitis
hyper secretion of mucus
patient has abnormal enlargement of the airspace proximal to the terminal bronchioles, what is this disease?
bronchiectasis;
if it was distal to the terminal bronchioles, it would be emphysema
what is the Reid index?
the ratio of the thickness of the mucous gland layer t the thickness of the entire bronchial wall (thickness of the all between the epithelium and cartilage)
define bronchiectasis
permanent dilation fo the bronchi/bronchioles PROXIMAL to the acinus secondary to destruction of supporting tissue
what are some causes of bronchiectasis?
- obstruction and chronic infection (tumor, foreign body)
- congenital/hereditary conditions (CF, immunodeficiency, Kartagener Syndrome)
- necrotizing/suppurative pneumonia
_____ emphysema is associated with alpha 1 anti trypsin deficiency
panlobular (panacinar); entire acinus and the lower lung zones are involved
what are some differences between atopic and non atopic asthma
non atopic:
- NO ↑ in serum IgE
- no skin wheal and flare reaction
- no family history (strong family history in atopic)
eosinophilic granuloma is a pulmonary disease almost exclusively in ______ and ______ is the culprit cell
smokers;
langerhans cells
Kartagener Syndrome is a AR disorder of ______
ciliary microtubules → persistent infection leadings to bronchiectasis
emphysema is characterized by abnormal permanent airspace enlargement ____ to the terminal bronchioles accompanied by destruction for airspace walls with/without fibrosis
DISTAL; WITHOUT fibrosis
pneumothorax is a complication of ______ emphysema
septal/ distal acinar emphysema;
can form bullae that can rupture into the pleural cavity
obstructive lung diseases is characterized by _____ resistance to air flow and _________
↑ resistance to air flow and limited expiratory rates on forced expiration
______ is pathognomonic for eosinophilic granulomas
Birbeck granules on EM
what are some obstructive lung diseases?
- emPhysema (Pink Puffer)
- chronic Bronchitis (Blue Bloater)
- bronchiectasis
- asthma (only one that is reversible)
what are some histological findings in someone with obstructive lung diseases
- hyper inflated lungs with or without bullae
- moth eaten appearance of lung parenchyma
- destruction of alveolar septa WITHOUT fibrosis → enlarged airspaces
- destruction of elastin in small airways
what are Curschmann spirals?
found in patients with asthma. they are mucous that have shed epithelial cells in them
what are some similarities between atopic and non atopic asthma?
same treatment and same inflammatory mediators
binding of the inhaled antigen (on second exposure) to ______ on mast cells will cause degranulation of mast cells
IgE antibodies
in ____ lung diseases the respiratory bronchiole, alveoli and alveolar ducts are affected
restrictive lung disease
restrictive is due to a lung parenchymal disorder
_________ of the seromucinous glands and _______ of the goblet cells is seen in chronic bronchitis
hypertrophy of seromucinous glands and hyperplasia of the goblet cells
bronchoconstriction in drug induced asthma (due to aspirin) is caused by _____
leukotrienes because aspirin inhibits COX pathway which then ↑ the activity of lipoxygenase pathway → ↑ leukotrienes
↓ production of prostaglandins
↑ production of leukotrienes
what clinical presentation is required to diagnose someone with chronic bronchitis?
cough that occurs for at least 3 consecutive months in at least 2 consecutive years
small airways disease, which causes the airflow obstruction in chronic bronchitis, is characterized by: goblet cell metaplasia, ______, and ________
- smooth muscle hyperplasia
- peribronchiolar fibrosis
what are the types of emphysema?
- centrilobular (centriacinar)
- panlobular (panacinar)
- septal (distal acinar)
- irregular (paracicatricial)
wheezing is very apparent in ________ because FEV1 <30%
asthma
the respiratory drive in chronic bronchitis is driven by ____
low pO2
what is the TLC, FEV1, FVC, and the FEV1:FVC ratio of obstructive lung diseases?
TLC is ↑ (obstructive lung diseases have issue with expiration)
FEV1 is ↓
FVC: ↓ or normal
FEV1:FVC: reduced
chronic bronchitis is an example of a _____ lung disease
obstructive
basement membrane thickening, bronchiole smooth muscle hypertrophy, goblet cell hyperplasia, edema with patchy epithelial necrosis and Cruschmann spirals and Charcot Layden crystals are histological findings in what disease
asthma
_______ metaplasia of the bronchial epithelium is a microscopic finding in bronchiectasis
squamous
goblet cell metaplasia at the level of _____ is seen in _________
bronchioles (they normally do not have goblet cells);
chronic bronchitis
____ zone of the lung and the _____ are affected in centrilobular emphysema
upper zone; respiratory bronchioles
acinus includes: respiratory bronchiole, alveolar duct and alveoli (all are distal to terminal bronchiole)
respiratory bronchiole is the most proximal/central part of the acinus
In asthma, ____ cells are inappropriately activated by the inhaled antigens
TH2 cells; which release cytokines: IL-4, IL-5 and IL-13
what cytokine stimulates IgE production?
IL-4
describe the mutation and the chromosome involved in the alpha 1 antitrypsin deficiency; what is an AE of this disease?
- gene point mutation on chromosome 14 that result in abnormal protein folding
- can lead to chronic liver disease because the abnormal protein accumulates in the liver
what do you see in the early phase of the mast cell degranulation in atopic asthma?
- bronchoconstriction (due to direct vagal stimulation)
- increased mucous production
- vasodilation
polymorphism in TGFB signaling leads to ____
inadequate repair of elastin injury
airway disorder is _____ lung disease
obstructive
what are some changes in the lungs in response to the inhaled irritants in chronic bronchitis
- hypertrophy of seromucinous glands
- ↑ goblet cells in surface epithelium
why is inspiration/expiration the issue in obstructive lung diseases
expiration;
inspiration is an active process so you can overcome the obstruction but expiration is passive you cannot overcome it
what is the pathogenesis of obstructive lung diseases such as emphysema
- imbalance of proteases and antiproteases coupled with inadequate repair mechanisms
FEV1: FVC ratio is ↑ , what type of lung disease is this?
restrictive
what inflammatory cells do you expect to see in the late phase of atopic asthma
activation of eosinophils, PMN’s and T cell and will get activation of epithelial cells which recruit more TH2 cells and eosinophils
what is status asthmaticus?
asthma that does not respond to therapy such as from bronchodilators
