overview of respiratory pathologies: Part 2 Flashcards
Chronic Obstructive lung diseases (COPD)
what is COPD
- a chronic inflammatory lung disease that causes obstructed airflow from distal respiratory tree
what 2 diseases in COPD usually co exist
- chronic bronchitis
- emphysema
True or false, COPD is reversible
false, COPD is NOT reversible
chronic bronchitis
define chronic bronchitis clinically
persistent productive cough for at least 3 consecutive months in at least 2 consecutive years
which 2 places can there be mucus hyper-secretion in chronic bronchitis and what is it called if it is found in one of the places
Mucus hyper secretion in:
- large airways (trachea and bronchi) [bronchitis]
- small airways ( called bronchiolitis)
pathogenesis of chronic bronchitis
what are 4 features (the ā3 Hs and Iā) of the pathogenesis of chronic bronchitis and what is effected in each feature?
- hypertrophy and hyperplasia of the mucous glands
- hypersecretion of mucus due to increase in goblet cells in epithelium of the airways
- inflammation of airways due to more T cells, neutrophils and macrophages
what is chronic bronchitis in the smaller airways called
chronic bronchiolitis
what are 5 features of chronic bronchiolitis
- goblet cell metaplasia
- mucus plugs bronchiolar lumen
- inflammation
- bronchiolar wall fibrosis
- luminal narrowing and airway obstruction
emphysema
define emphysema
a chronic lung condition in which the alveoli may be destroyed or narrowed
what 2 ways does emphysema manifest physiologically
1) permanent dilation of respiratory bronchioles and alveoli
2) destruction of elastic wall tissue without signifcant fibrosis
what does the loss of elasticity of the alveoli in emphysema lead to
leads to difficulty in expiration and loss of surface area
types of emphysema
what are the types of emphysema based on and what are the 3 types
Types of emphysema are based on the anatomical location of the emphysema
3 types of emphysema:
- centrilobular/centriacinar emphysema
- panlobular/panacinar emphysema
- paraseptal/ distal acinar/ peripheral emphysema
what happens in centri-acinar/centrilobular emphysema and which lobes is it more common in and what is the main cause
- dilated respiratory bronchioles
- more common in upper lobes
- smoking-related things are the main cause
what happens in panacinar/panlobular emphysema, what is the main cause and which lobes is it most common in
- dilated alveoli
- hereditary
- more common in lower lobes
emphysema: clinical picture
what 3 symptoms are observed when someone has emphysema WITHOUT bronchitis
- dyspnoea (shortness of breath) with prolonged expiration
- barrel chest due to use of accessory muscle for breathing
- pursed lips breathing
what are 3 symptoms are observed when someone has emphysema with bronchitis
- shortness of breath but less prominent than without bronchitis
- patients retain CO2 so are hypoxic and cyanotic
- blue-bloater- cyanotic and obese
what 2 symptoms are observed when someone has emphysema WITH bronchitis
- shortness of breath is less prominent
- patient will retain CO2 more (hypoxic and cyanotic)
pathogenesis of alveolar damage
what causes emphysema
imbalance of proteases and anti-proteases resulting in lung parenchymal destruction
Asthma
what triad physiologically characterises asthma
- intermittent and reversible airway obstruction
- chronic bronchial inflammation with eosinophils
- bronchial smooth muscle hypertrophy and hyper-reactivity
what 2 ways can asthma be classified and give 1 example for each
- atopic/extrinsic (e.g asthma caused by seasonal allergens)
- non-atopic/intrinsic (e.g: asthma caused by infection, exercise or drugs)
what 4 symptoms does asthma clinically manifest as due to reversible airway narrowing
- shortness of breath
- wheezing
- chest tightness
- cough
asthma: morphological changes
what are 3 morphological changes that occur in asthma
- excess mucus production by goblet cells and glandular hypertrophy
- bronchial wall oedema due to inflammatory exudate which is eosinophil and mast cell accumulation
- smooth muscle hypertrophy and fibrosis with lumen narrowing
outline the early/immediate reaction in asthma
- Eliciting agent (allergen or non-specific stimulus) stimulates mast cells leading to 2 outcomes:
- production of different mediators like spasmogens, promoting bronchospasm and bronconstriction
- production of chemotaxins, which initiate the late phase
outline what happens in the late reaction of asthma
- activation of eosinophils and other leukocytes causes inflammation
2.mucosal oedema and muscle hypertrophy occurs, narrowing the lumen
- epithelial cells produce chemokines to attract more Th2 cells and eosinophils
- repeated inflammation leads to airway remodelling
bronchiectasis
define bronchiectasis
permanent dilation of main bromchi and bronchioles
what are 5 symptoms of bronchiectasis
- chronic cough
- dyspnoea
- large amounts of foul-smelling sputum
- haemoptysis
- clubbing of fingers
causes of bronchiectasis
what are 3 causes of bronchiectasis and give examples for each
obstruction
- tumours/foreign bodies/impaction of mucus
infection
- (especially with virulent organisms) like TB and necrotising pneumonia
congenital/hereditary
- cystic fibrosis
- immunodeficiency
- kartagener syndrome
what 2 main factors predipose/make someone liable to getting bronchiectasis?
- interference with drainage of bronchial secretions
- recurrent and persistent infection that weakens the bronchial walls
pathogenesis of bronchiectasis
what 3 ways can interference with drainage increase chance of someone getting bronchiectasis
Causes:
- obstruction of proximal airway (eg: tumour, foreign body)
- abnormality in the viscosity of bronchial mucus ( cystic fibrosis)
- immotile cilia syndrome, in which cilia are abnormal
what 2 ways can recurrent and persistent infection that weakening the bronchial walls increase chance of someone getting bronchiectasis
- predisposed to retention of secretions like mucus
- increase in immunodeficiency states (hypogammaglobulinemia)
