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Witrak's lungs > Obstructive pulmonary diseases > Flashcards

Obstructive pulmonary diseases Flashcards

1
Q

What are two examples of obstructive pulmonary disease?

A

Asthma

COPD

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2
Q

What kind of reaction typically causes asthma?

A

Hypersensitivity

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3
Q

What is seen with 90% of asthma cases?

A

IgE mediated

Less severe than nonatopic asthma

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4
Q

What causes symptoms of asthma?

A

Reversible airflow obstruction associated with bronchial inflammation or bronchoconstriction

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5
Q

How is asthma diagnosed?

A

Symptoms based

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6
Q

What is seen on PFT/spirometry with asthma?

A

Decreased FEV1

Decreased FEV1/FVC

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7
Q

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

A

> 12% increase in FEV1

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8
Q

What are some histological findings of asthma?

A

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

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9
Q

What are some possible complications with asthma?

A

Status asthmaticus
Allergic bronchopulmonary aspergillosis
Chronic eosinohphilic pneumonia

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10
Q

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

A

Acute/severe bronchoconstriction

Death

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11
Q

What causes allergic bronchopulmonary aspergillosis?

A

Allergic reaction to inhaled aspergillosis fumigatus spores

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12
Q

What happens with allergic bronchopulmonary aspergillosis?

A

Lung infiltrates with eosinophils
Mucoid bronchial plugging

Can cause bronchietasis

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13
Q

How is allergic bronchopulmonary aspergillosis treated?

A

Steroids and antifungals

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14
Q

What are the two components of COPD?

A

Emphysema

Chronic bronchitis

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15
Q

What seen with chronic bronchitis?

A

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

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16
Q

What is the usual cause to COPD?

A

SMOKING

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17
Q

What are the symptoms of COPD?

A 
NOT reversible, slowly progressive expiratory airflow obstruction
Asthma features (10%)
Death (4th leading cause of death in US)
18
Q

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

A

Mucosal goblet cell hyperplasia

Bronchiolitis w/inflammation, increased mucus, edema, fibrosis

19
Q

What are some histological findings of COPD in alveoli?

A

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

Emphysema

20
Q

What is emphysema?

A

Progressive acinar destruction with permanent air space enlargement

21
Q

What are three kinds of emphysema?

A

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

22
Q

Where does centricacinar emphysema occur?

A

Mostly upper lobes

23
Q

Where does panacinar emphysema occur?

A

Upper and lower lung fields are involved with equal severity

24
Q

What causes panlobular emphysema?

A

Advanced common emphysema

Alpha-1 antitrypsin deficiency

25
Q

What might be seen with alpha-1 antitrypsin deficiency?

A

Liver disease

26
Q

What can subpleural blebs cause?

A

PTX

Space-occupying mass effect

27
Q

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

A

Mucus plugging

28
Q

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

A

Decreased elastic/alveolar “tethering” of respiratory bronchioles

29
Q

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

A

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

Hypoxemia

30
Q

What are some typical clinical presentations of COPD?

A

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

31
Q

What are some PE findings with COPD?

A

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

32
Q

How is COPD diagnosed?

A 
Pulmonary function test (PFT)...key evaluation
CXR...not sensitive
CT/HRCT
ABGs
Hemogram
33
Q

What is found with PFT on COPD?

A

FEV1/FVC < 70% predicted value

VEV1 < 80% predicted value

34
Q

What is seen on CT/HRCT with COPD?

A

Air space destruction/enlargement/bleb formation

NOT chronic bronchitis/asthma

35
Q

How do ABGs present with mild COPD?

A

Mild/moderate hypoxemia

NO hypercarbia

36
Q

How do ABGs present with severe COPD?

A

Worsening hypoxemia

Hypercarbia

37
Q

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

A

Pulmonary vasoconstriction/HTN–>cor pulmonale

38
Q

What can be detected via hemogram with COPD?

A

Polycythemia…chronic hypoxemia

39
Q

What are some common COPD treatment options?

A 
Smoking cessation
Bronchodilators
Inhaled steroids
Oxygen
Pulmonary rehab
40
Q

What are some uncommon treatment options for COPD?

A

Lung volume reduction

Lung transplant

Witrak's lungs (5 decks)

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