PFT - Bronchitis-emphysema COPD Flashcards
Be able to reproduce this chart.
Reproduce chart
Why is the TLC increased in obstructive lung disease?
mainly due to increase in the residual volume
What is the shift of the pressure-volume curve for restrictive lung disease?
Restrictive lung disease like pulmonary edema will show a shift to the right and is more flat due to reduced compliance
What is the shift of the pressure-volume curve for those with obstructive lung disease?
Obstructive lung disease (i.e emphysema) would show a shift to the left and is more steep due to air trapping
What are the obstructive lung disease we listed?
- Chronic obstructive pulmonary disease (COPD)
- emphysema
- chronic bronchitis
- asthma
- bronchiectasis
COPD includes what two conditions that typically occur together?
chronic bronchitis
emphysema
What is the major pathogenetic mechanism by which COPD results?
cigarette smoking
Emphysema is a disease restricted to what area?
acinus
What is emphysema characterized by? What parts of the respiratory system involved? What does all this result in?
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.
What is the acinus comprised of?
respiratory bronchiole
alveolar duct
alveoli
What does this image depict?
lung with emphysema
centriacinar emphysema: central areas show marked emphysematous damage, surrounded by relatively spared alveolar spaces
What are some mechanism or etiologies/pathogenesis by which emphysema comes about?
protease-antiprotease mechanism
Hereditary a1 antitrypsin deficiency
Describe the protease mechanism of causing emphysema.
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).
What is the mechanism by which Hereditary a1 antitrypsin deficiency produces emphysema?
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
Neutrophil elastase is capable of digesting what organ?
human lung
What can inhibit neutrophil protease from digesting the human lung?
alpha 1 antirtrypsin
What are the 4 anatomical types of emphysema?
Centriacinar*
Panacinar*
Distal acinar
Irregular
What is the most common type of emphysema?
centriacinar (centre-lobular) emphysema
Where is the primary site of elastic tissue damage in centriacinar emphysema?
respiratory bronchioles
What part of the lobes of the lung are typically associated with centriacinar emphysema?
upper lobes
What part of the lobes do Panacinar emphysema usually affect?
lower lobes?
Which emphysema is characterized by uniform destruction and enlargement of respiratory unit – whole acinus (respiratory bronchiole, alveolar duct and alveoli)?
Panacinar emphysema
Which type of emphysema is usually associated with hereditary alpha 1 antitrypsin deficiency?
Panacinar emphysema - emphysema develops at in early age?
Why is panacinar emphysema acquired in smokers?
chemicals in smoke inactivate alpha 1 antitrypsin
What type of emphysema is depicted here?
centriacinar emphysema - central areas show marked emphysematous damage, surrounded by relatively spared alveolar spaces
What type of emphysema is depicted here?
Panacinar emphysema - involving entire pulmonary architecture
Which type of emphysema mainly involves the alveolar ducts and the alveoli sparing the proximal part of respiratory unit.
distal acing (paraseptal) emphysema
Distal acing (paraseptal) emphysema appears as large air filled spaces found where?
located beneath the pleura
If air filled spaces of distal acing emphysema are >1cm in diameter what are they called?
bullae
Rupture of bull in distal acinar emphysema gives rise to what?
pneumothorax
What does this image depict?
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
What condition is show here and explain.
Emphysema
Thinning and destruction of alveolar walls
Adjacent alveoli fuse > large airspaces
Loss of alveolar capillaries
Because of loss of elastic recoil small airways will do what during expiration when a person has emphysema?
small airways collapse - trapping the air
What are clinical finding os a person with emphysema?
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
What would a chest radiograph show of one with emphysema?
hyperluscent lung fields
increased AP diameter
depressed diaphragm
Can corpulmonale develop in late stages of emphysema?
yes
How will a typical patient with emphysema appear?
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
What is the most common form of COPD?
chronic bronchitis
Chronic bronchitis has a clinical definition requiring what?
- persistent cough and sputum production
- Present for at least 3 months
- Present for at least 2 consecutive years
What is the etiology of chronic bronchitis/ most important factors causing chronic bronchitis.
Strong association with cigarette smoking and Urban residence (air pollution).
Most important factors:
chronic irritation by inhaled substance:
cigarette smoke and air pollutants
In pure chronic bronchitis what happens to the large airways?
Large airways (trachea,bronchi)
Inflammation
Mucus gland hyperplasia
Mucus hypersecretion
In pure chronic bronchitis what happens to the small airways?
Small airways (T.bronchioles) Inflammation Goblet cell metaplasia Mucus plugs SMC hypertrophy
What are the effects of cigarette smoke and air pollutants when one has bronchitis?
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.
What are these 2 histological image showing?
mucous gland hyperplasia as seen in chronic bronchitis
What is the pathogenesis of chronic bronchitis?
Chronic irritation by inhaled substances >
- Hyperplasia of submucosal glands resulting in - Hypersecretion of mucus in bronchi.
Obstruction to airflow in the terminal bronchioles.
What are the C/F of chronic bronchitis ?
Persistent cough productive of copious sputum.
Dyspnea
Frequent infections
Weight gain.
Hypercarbia (CO2 retention) Cyanosis (blue).
Patients called as blue bloaters.
Chronic bronchitis contributes to airway obstruction through what?
mucous hypersecretion leading to airway plugging
airway edema and inflammation
What is the net effect of COPD?
to make it difficult to get air out of lungs
What does pulmonary hypertension is COPD result from?
Combination of:
pulmonary vasoconstriction (induced by hypoxia
Loss of pulmonary vasculature surface area and
increased blood viscosity (due to polycythemia induced by chronic hypoxia)
In COPD once the heart develops right ventricular hypertrophy what can occur?
right ventricular failure and for pumonale
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.
False. Leads to damages of branches of pulmonary artery
What term is used to describe this individual?
blue bloater
