Obstructive & Restrictive Lung Disease

Question 1

What are the shared characteristics of obstructive and restrictive lung diseases?

Answer 1

Not infectious, diffuse, chronic

Question 2

What are the obstructive lung diseases?

Answer 2

Asthma, COPD, bronchiectasis

Question 3

What is the obstructive pattern of spirometry?

Answer 3

Marked decrease in FEV1 and not much decrease in FVC

Question 4

What is the restrictive pattern of spirometry?

Answer 4

FEV1 is a bit low and FVC is markedly decreased

Question 5

What are the 3 aspects of COPD?

Answer 5

emphysema, chronic bronchitis and small airway disease

Question 6

What is asthma?

Answer 6

The increased responsiveness of airways to various stimuli which causes bronchoconstriction and is partly reversible

Question 7

What are the two types of asthma?

Answer 7

Allergic type (type 1 hypersensitvity) and non allergic

Question 8

What is the pathophysiological mechanism of asthma?

Answer 8

A trigger causes the release of inflammatory mediators from mast cells, there is an immediate response of oedema, mucous production and bronchospasm and a late phase of inflammation where the epithelium starts to become damaged

Question 9

What are the short term complications of asthma?

Answer 9

Death, collapse of lungs, rupture of lungs

Question 10

What are the long term complications of asthma?

Answer 10

airway remodelling, chronic hypoxia leading to cor pulmonale

Question 11

What is emphysema?

Answer 11

abnormal, permanent enlargement of air spaces distal to the terminal bronchiole from destruction of the alveolar wall without fibrosis

Question 12

What are the types of emphysema?

Answer 12

centriacinar, panacinar, distal acinar, irregular

Question 13

How does smoking cause emphysema?

Answer 13

Cigarette smoking attracts inflammatory cells, neutrophils release elastase, elastase damages elastic tissue. Cigarette smoking also impairs function of anti proteases

Question 14

How is emphysema inherited?

Answer 14

Through a deficiency in alpha-1 antitrypsin - an anti protease

Question 15

How does emphysema cause airway obstruction?

Answer 15

The loss of elastic tissue makes the airway floppy and so it is difficult to open

Question 16

Which is more important in emphysema - airway obstruction or loss of gas exchange?

Answer 16

Airway obstruction

Question 17

What are the complications of emphysema?

Answer 17

Hypoxia caused by airway obstruction and also loss of gas exchange surfaces, pulmonary hypertension leading to cor pulmonale, pneumothorax

Question 18

What is bullous emphysema?

Answer 18

A localised area of emphysema which is fragile and may lead to a pneumothorax

Question 19

What is chronic bronchitis?

Answer 19

A persistent cough with sputum for at least 3 months in 2 consecutive years

Question 20

What is the pathogenesis of chronic bronchitis?

Answer 20

Inhaled substance causes chronic irritation which leads to increased mucous procution in the larger airways and airway inflammation, scarring and narrowing in the smaller airways

Question 21

What happens at a cellular level in chronic bronchitis?

Answer 21

Hypetrophy of mucus secreting glands, increased goblet cells, increase in inflammatory cells, fibrosis around small airways, squamous metaplasia

Question 22

What causes lung cancer?

Answer 22

Squamous metaplasia

Question 23

What are the complications of chronic bronchitis?

Answer 23

Infections, hypoxia leading to cor pulmonale, lung cancer

Question 24

What is small airways disease?

Answer 24

Chronic inflammation, fibrosis and obstruction of terminal bronchioles

Question 25

How does smoking predispose to pulmonary infection?

Answer 25

inhibition of the much-cilary escalator, increased mucus, inhibition of leukocyte function, direct damage to epithelium

Question 26

What is bronchiecstasis?

Answer 26

An irreversible, abnormal dilation of bronchi/bronchioles

Question 27

What is idiopathic pulmonary fibrosis?

Answer 27

A common restrictive lung disease with unknown cause leading to interstitial fibrosis and inflammation