Obstructive pulmonary diseases

Question 1

What are two examples of obstructive pulmonary disease?

Answer 1

Asthma

COPD

Question 2

What kind of reaction typically causes asthma?

Answer 2

Hypersensitivity

Question 3

What is seen with 90% of asthma cases?

Answer 3

IgE mediated

Less severe than nonatopic asthma

Question 4

What causes symptoms of asthma?

Answer 4

Reversible airflow obstruction associated with bronchial inflammation or bronchoconstriction

Question 5

How is asthma diagnosed?

Answer 5

Symptoms based

Question 6

What is seen on PFT/spirometry with asthma?

Answer 6

Decreased FEV1

Decreased FEV1/FVC

Question 7

What is seen on PFT/spirometry with asthma after beta-1-agonist treatment?

Answer 7

> 12% increase in FEV1

Question 8

What are some histological findings of asthma?

Answer 8

Inflammation (Eosinophils/CD4+ T cells)
Mucosal edema
Mucus hypersecretion/plugging
hypertrophied bronchial smooth muscle

Question 9

What are some possible complications with asthma?

Answer 9

Status asthmaticus
Allergic bronchopulmonary aspergillosis
Chronic eosinohphilic pneumonia

Question 10

What is status asthmaticus? What can potentially happen if untreated?

Answer 10

Acute/severe bronchoconstriction

Death

Question 11

What causes allergic bronchopulmonary aspergillosis?

Answer 11

Allergic reaction to inhaled aspergillosis fumigatus spores

Question 12

What happens with allergic bronchopulmonary aspergillosis?

Answer 12

Lung infiltrates with eosinophils
Mucoid bronchial plugging

Can cause bronchietasis

Question 13

How is allergic bronchopulmonary aspergillosis treated?

Answer 13

Steroids and antifungals

Question 14

What are the two components of COPD?

Answer 14

Emphysema

Chronic bronchitis

Question 15

What seen with chronic bronchitis?

Answer 15

CD8+ T cells (asthma was CD4+…might come up)
macrophages
Neutrophils

Question 16

What is the usual cause to COPD?

Answer 16

SMOKING

Question 17

What are the symptoms of COPD?

Answer 17

NOT reversible, slowly progressive expiratory airflow obstruction
Asthma features (10%)
Death (4th leading cause of death in US)

Question 18

What are some histological findings of COPD in distal small airways?

Answer 18

Mucosal goblet cell hyperplasia

Bronchiolitis w/inflammation, increased mucus, edema, fibrosis

Question 19

What are some histological findings of COPD in alveoli?

Answer 19

Neutrophils/macrophages release elastolytic proteinases and degrade natural anti-proteinase protection

Emphysema

Question 20

What is emphysema?

Answer 20

Progressive acinar destruction with permanent air space enlargement

Question 21

What are three kinds of emphysema?

Answer 21

Centriacinar (centrilobular) emphysema…vast majority
Panacinar (panlobular) emphysema
Subpleural blebs

Question 22

Where does centricacinar emphysema occur?

Answer 22

Mostly upper lobes

Question 23

Where does panacinar emphysema occur?

Answer 23

Upper and lower lung fields are involved with equal severity

Question 24

What causes panlobular emphysema?

Answer 24

Advanced common emphysema

Alpha-1 antitrypsin deficiency

Question 25

What might be seen with alpha-1 antitrypsin deficiency?

Answer 25

Liver disease

Question 26

What can subpleural blebs cause?

Answer 26

PTX | Space-occupying mass effect

Question 27

How is airflow obstructed if bronchitis is the predominant component of COPD?

Answer 27

Mucus plugging

Question 28

How is airflow obstructed if emphysema is the predominant component of COPD?

Answer 28

Decreased elastic/alveolar "tethering" of respiratory bronchioles

Question 29

What happens because of decreased elastic/alveolar "tethering" of respiratory bronchioles?

Answer 29

Airway collapse during expiration with alveolar air trapping and loss of elastic recoil with hyperinflation Hypoxemia

Question 30

What are some typical clinical presentations of COPD?

Answer 30

Sedentary lifestyle (to avoid exertional dyspnea) Slowly progressive dyspnea on exertion Acute chest illness

Question 31

What are some PE findings with COPD?

Answer 31

Systemic wasting Hyper-inflated lungs w/barrel chest Decreased breath sounds

Question 32

How is COPD diagnosed?

Answer 32

``` Pulmonary function test (PFT)...key evaluation CXR...not sensitive CT/HRCT ABGs Hemogram ```

Question 33

What is found with PFT on COPD?

Answer 33

FEV1/FVC < 70% predicted value | VEV1 < 80% predicted value

Question 34

What is seen on CT/HRCT with COPD?

Answer 34

Air space destruction/enlargement/bleb formation NOT chronic bronchitis/asthma

Question 35

How do ABGs present with mild COPD?

Answer 35

Mild/moderate hypoxemia | NO hypercarbia

Question 36

How do ABGs present with severe COPD?

Answer 36

Worsening hypoxemia | Hypercarbia

Question 37

What can possibly happen because of worsening hypoxemia with severe COPD?

Answer 37

Pulmonary vasoconstriction/HTN-->cor pulmonale

Question 38

What can be detected via hemogram with COPD?

Answer 38

Polycythemia...chronic hypoxemia

Question 39

What are some common COPD treatment options?

Answer 39

``` Smoking cessation Bronchodilators Inhaled steroids Oxygen Pulmonary rehab ```

Question 40

What are some uncommon treatment options for COPD?

Answer 40

Lung volume reduction | Lung transplant