PFT - Bronchitis-emphysema COPD

Question 1

Be able to reproduce this chart.

Answer 1

Reproduce chart

Question 2

Why is the TLC increased in obstructive lung disease?

Answer 2

mainly due to increase in the residual volume

Question 3

What is the shift of the pressure-volume curve for restrictive lung disease?

Answer 3

Restrictive lung disease like pulmonary edema will show a shift to the right and is more flat due to reduced compliance

Question 4

What is the shift of the pressure-volume curve for those with obstructive lung disease?

Answer 4

Obstructive lung disease (i.e emphysema) would show a shift to the left and is more steep due to air trapping

Question 5

What are the obstructive lung disease we listed?

Answer 5

1. Chronic obstructive pulmonary disease (COPD)
   
   1. emphysema
   2. chronic bronchitis
2. asthma
3. bronchiectasis

Question 6

COPD includes what two conditions that typically occur together?

Answer 6

chronic bronchitis

emphysema

Question 7

What is the major pathogenetic mechanism by which COPD results?

Answer 7

cigarette smoking

Question 8

Emphysema is a disease restricted to what area?

Answer 8

acinus

Question 9

What is emphysema characterized by? What parts of the respiratory system involved? What does all this result in?

Answer 9

Abnormal Permanent Enlargement of the air spaces distal to the terminal bronchiole due to
destruction of their elastic tissue support (walls).

All or the part of the respiratory unit (respiratory bronchiole, alveolar ducts and alveoli) may be involved.

Results in: Loss of elastic recoil and enlarged air spaces.

Question 10

What is the acinus comprised of?

Answer 10

respiratory bronchiole
alveolar duct
alveoli

Question 11

What does this image depict?

Answer 11

lung with emphysema

centriacinar emphysema: central areas show marked emphysematous damage, surrounded by relatively spared alveolar spaces

Question 12

What are some mechanism or etiologies/pathogenesis by which emphysema comes about?

Answer 12

protease-antiprotease mechanism

Hereditary a1 antitrypsin deficiency

Question 13

Describe the protease mechanism of causing emphysema.

Answer 13

Protease (elastase) produced by Neutrophils and Macrophages

Antiprotease includes α 1 Antitrypsin

Imbalance between protease and antiprotease in lung.
Smoking attracts & stimulates release of elastase (protease) from neutrophil.
Oxidants in cigarette smoke and oxygen free radicals from neutrophils inhibit α 1 Antitrypsin (antiprotease).

Question 14

What is the mechanism by which Hereditary a1 antitrypsin deficiency produces emphysema?

Answer 14

pi gene on chromosome 14

piZ allele codes for structurally abnormal protein that accumulates in the liver.

piZZ homozygous state associated with panacinar emphysema and hepatic cirrhosis

Question 15

Neutrophil elastase is capable of digesting what organ?

Answer 15

human lung

Question 16

What can inhibit neutrophil protease from digesting the human lung?

Answer 16

alpha 1 antirtrypsin

Question 17

What are the 4 anatomical types of emphysema?

Answer 17

Centriacinar*
Panacinar*
Distal acinar
Irregular

Question 18

What is the most common type of emphysema?

Answer 18

centriacinar (centre-lobular) emphysema

Question 19

Where is the primary site of elastic tissue damage in centriacinar emphysema?

Answer 19

respiratory bronchioles

Question 20

What part of the lobes of the lung are typically associated with centriacinar emphysema?

Answer 20

upper lobes

Question 21

What part of the lobes do Panacinar emphysema usually affect?

Answer 21

lower lobes?

Question 22

Which emphysema is characterized by uniform destruction and enlargement of respiratory unit – whole acinus (respiratory bronchiole, alveolar duct and alveoli)?

Answer 22

Panacinar emphysema

Question 23

Which type of emphysema is usually associated with hereditary alpha 1 antitrypsin deficiency?

Answer 23

Panacinar emphysema - emphysema develops at in early age?

Question 24

Why is panacinar emphysema acquired in smokers?

Answer 24

chemicals in smoke inactivate alpha 1 antitrypsin

Question 25

What type of emphysema is depicted here?

Answer 25

centriacinar emphysema - central areas show marked emphysematous damage, surrounded by relatively spared alveolar spaces

Question 26

What type of emphysema is depicted here?

Answer 26

Panacinar emphysema - involving entire pulmonary architecture

Question 27

Which type of emphysema mainly involves the alveolar ducts and the alveoli sparing the proximal part of respiratory unit.

Answer 27

distal acing (paraseptal) emphysema

Question 28

Distal acing (paraseptal) emphysema appears as large air filled spaces found where?

Answer 28

located beneath the pleura

Question 29

If air filled spaces of distal acing emphysema are >1cm in diameter what are they called?

Answer 29

bullae

Question 30

Rupture of bull in distal acinar emphysema gives rise to what?

Answer 30

pneumothorax

Question 31

What does this image depict?

Answer 31

distal acing (paraseptal) emphysema - a more localized form of emphysema is known as paraseptal, or distal acing, emphysema, which can follow focal scarring Seen here are 2 small bull just beneath pleura

Question 32

What condition is show here and explain.

Answer 32

Emphysema Thinning and destruction of alveolar walls Adjacent alveoli fuse > large airspaces Loss of alveolar capillaries

Question 33

Because of loss of elastic recoil small airways will do what during expiration when a person has emphysema?

Answer 33

small airways collapse - trapping the air

Question 34

What are clinical finding os a person with emphysema?

Answer 34

Progressive Dyspnea and Hyperventilation Patients work hard at breathing against pursed lips: To prevent respiratory bronchioles from collapsing. Diminished breath sounds due to lung hyperinflation. Increased TLC Change in the shape of chest : Barrel chest Overventilation  Well oxygenated blood  pink puffers. Decreased FEV 1sec/FVC ratio

Question 35

What would a chest radiograph show of one with emphysema?

Answer 35

hyperluscent lung fields increased AP diameter depressed diaphragm

Question 36

Can corpulmonale develop in late stages of emphysema?

Answer 36

yes

Question 37

How will a typical patient with emphysema appear?

Answer 37

Barrel-chested and dyspneic with prolonged expiration. Sitting forward in a hunched over position Attempting to squeeze air out of the lungs with pursed lips . = Pink puffers

Question 38

What is the most common form of COPD?

Answer 38

chronic bronchitis

Question 39

Chronic bronchitis has a clinical definition requiring what?

Answer 39

1. persistent cough and sputum production 2. Present for at least 3 months 3. Present for at least 2 consecutive years

Question 40

What is the etiology of chronic bronchitis/ most important factors causing chronic bronchitis.

Answer 40

``` Strong association with cigarette smoking and Urban residence (air pollution). ``` Most important factors: chronic irritation by inhaled substance: cigarette smoke and air pollutants

Question 41

In pure chronic bronchitis what happens to the large airways?

Answer 41

Large airways (trachea,bronchi) Inflammation Mucus gland hyperplasia Mucus hypersecretion

Question 42

In pure chronic bronchitis what happens to the small airways?

Answer 42

``` Small airways (T.bronchioles) Inflammation Goblet cell metaplasia Mucus plugs SMC hypertrophy ```

Question 43

What are the effects of cigarette smoke and air pollutants when one has bronchitis?

Answer 43

Changes in Bronchi: Inflammation Mucous gland hypertrophy and hyperplasia which results in an increased Reid Index. Reid’s Index Ratio of the thickness of submucosal mucous glands to entire submucosa. Increased in CB Goblet cell hyperplasia. Result: excessive mucous production. ``` Changes in Terminal bronchioles: Inflammation and fibrosis Goblet cell metaplasia and Mucous plugs Smooth muscle hypertrophy Result: Narrowing  airflow obstruction. ```

Question 44

What are these 2 histological image showing?

Answer 44

mucous gland hyperplasia as seen in chronic bronchitis

Question 45

What is the pathogenesis of chronic bronchitis?

Answer 45

Chronic irritation by inhaled substances > - Hyperplasia of submucosal glands resulting in - Hypersecretion of mucus in bronchi. Obstruction to airflow in the terminal bronchioles.

Question 46

What are the C/F of chronic bronchitis ?

Answer 46

Persistent cough productive of copious sputum. Dyspnea Frequent infections Weight gain. Hypercarbia (CO2 retention)  Cyanosis (blue). Patients called as blue bloaters.

Question 47

Chronic bronchitis contributes to airway obstruction through what?

Answer 47

mucous hypersecretion leading to airway plugging airway edema and inflammation

Question 48

What is the net effect of COPD?

Answer 48

to make it difficult to get air out of lungs

Question 49

What does pulmonary hypertension is COPD result from?

Answer 49

Combination of: pulmonary vasoconstriction (induced by  hypoxia Loss of pulmonary vasculature surface area  and increased blood viscosity (due to polycythemia induced by chronic hypoxia)

Question 50

In COPD once the heart develops right ventricular hypertrophy what can occur?

Answer 50

right ventricular failure and for pumonale

Question 51

T/F. Pulmonary hypertension leads to damage to branches of the pulmonary vein with intimal and medial hypertrophy narrowing the lumen and further aggravating the problem.

Answer 51

False. Leads to damages of branches of pulmonary artery

Question 52

What term is used to describe this individual?

Answer 52

blue bloater