Pul 8 - COPD and Asthma

Question 1

What is FEV1?

Answer 1

The amount of air that you can expire in one secound.

Question 2

What is the FEV1/FVC ratio in a normal lung?

Answer 2

It is around 80%.

Question 3

What is the FEV1/FVC ration in obstructive lung disease?

Answer 3

It is less than 80%; however, the absolute value is increased because the damaged lung cannot expel all that extra air inside.

Question 4

What is the FEV1/FVC ration in restrictive lung disease?

Answer 4

Ratio is normal or elevated; however, the absolute value for both are decreased.

Question 5

What is astham?

Answer 5

• Increase in sensitivity of the bronchioles that leads to bronchoconstriction (this is reversible). Beta-2 receptors dilate the bronchioles.

Question 6

What are some histological changes seen in asthma?

Answer 6

1. Smooth muscle hypertrophy.
2. Curschmann’s spirals: Spiral-shaped mucus plugs in disclimated epithelium.
3. Charcot-Leyden crystals: crystals associated with eosinophilic inflammation.

Question 7

What are some triggers for asthma?

Answer 7

1. Viral URI.
2. Allergens.
3. Stress.
4. Exercise.
5. Aspirin-induced asthma.

Question 8

What are the symptoms of asthma?

Answer 8

1. Cough.
2. Wheezing.
3. Dyspnea.
4. Tachypnea.
5. Hypoxia.
6. Decreased inspiratoty-to-expiratory ratio.
7. Pulsus paradoxus: Drop in systolic BP greater than 10mmHg during inspiration.
8. Mucus plugging.

Question 9

What is the pathophysiology of pulsus paradoxus?

Answer 9

When you take a deep breath, you decrease the inter-thoraxic pressure, causing increase blood flow into the right ventricle. Under some pathologies, that increase blood flow can cause the ventricular septum to push over into the left ventricle, decreasing blood felling into the left ventricle. This decreases left ventricular output, and a small drop in systolic pressure. If this drop of pressure is greater than 10 mmHg = Pulsus paradoxus.

Question 10

What are the differential diagnosis for eosinophilia?

Answer 10

[DNAAACP]
Drug.
Neoplasm.
Atopic disease (allergy, asthma, Churg-Strauss).
Addison disease.
Acute interstitial nephritis.
Collagen vascular disease.
Parasites (Ascaris lumbricoides, Strongyloides stercoralis, various hookworms).

Question 11

What is the main cause of chronic bronchitis?

Answer 11

Smoking.

Question 12

What is the Reid index and at what value is it important?

Answer 12

It is the gland depth divided by the total thickness of the bronchiole wall. If half of the bronchiole wall is comprised of mucus secreting glands, then there is chronic bronchitis (Reid index greater than 0.5).

Question 13

How is chronic bronchitis diagnosed?

Answer 13

Through clinical diagnosis:

• Daily productive cough for more than 3 months for at least 2 consecutive years.
• Symptoms: wheezing, crackles, cyanosis, dyspnea.
• “Blue boaters”

Question 14

What is the main cause of emphysema?

Answer 14

Smoking.

Question 15

What is the pathophysiology of emphysema?

Answer 15

Dilated alveoli, damaged alveolar walls and scepta = large alveolar spaces, decreased elastic recoil: air trapping.
-“barrel chest”: increase in anteroposterior diameter.

Question 16

What are changes seen in x-ray in patients with emphysema?

Answer 16

Wide and vacant:

• Hyperinflatted lungs with flatting of the diaphragm and blunting of the costophrenic angles.
• Increase in anteroposterior diameter.
• Prominent central pulmonary arteries.

Question 17

What are the different pathologic types of emphysema?

Answer 17

1. Centriacinar: Destruction of central portion of acini ( It mostly damages the respiratory bronchioles, sparing the alveolar duct and alveoli); most prominent in upper lobes and superior segments of lower lobes.
2. Panacinar: The whole acini is damaged, not sparing the alveolar ducts and alveoli. It is caused by alfa-1 antitrypsin deficiency. Most prominent in lower lungs.

Question 18

What are emphysema patients prone to?

Answer 18

Spontanous pnuemothorax.

Question 19

What are the symptoms of alpha-1 antitrypsin deficiency?

Answer 19

1. Early onset emphysema (around age 20-30)(alpha-1 antitrypsin protects against elastase, which is an enzyme that breaks down elastic fibers in the lungs).
2. Early-onset cirrhosis.

Question 20

What is bronchiectasis?

Answer 20

It is a congenital or acquired condition characterized by destruction and dilation of bronchial walls. Can be caused by chronic/recurrent infections.
-Copious amount of purulent sputum.

Question 21

What congenital problems are associated with bronchiectasis?

Answer 21

1. Cystic fibrosis (half of all cases).

2. Kartagener syndrome.

Question 22

What immunologic reaction is taking place in an asthma attack?

Answer 22

Antigen crosslinking IgE on pre-sensitized mast cells. Type I reaction.

Question 23

A patient has an extended expiratory phase. What is the disease it has?

Answer 23

Some time of obstructive lung disease.

Question 24

What is the hallmark sign of COPD?

Answer 24

-Decreased FEV1/FVC ratio.

Question 25

What is the hallmark of restrictive lung disease?

Answer 25

• Decrease of total lung capacity.

- Normal or elevated FEV1/FVC ratio.

Question 26

RFF: Blue bloater.

Answer 26

Hypoxemia, hypercapnia (chronic bronchitis).

Question 27

RFF: Pink puffer.

Answer 27

Dyspnea, hyperventilation (emphysema).

Question 28

RFF: Curschmann’s spirals.

Answer 28

Shed epithelium from mucus plugs (asthma).

Question 29

RFF: Most common cause of pulmonary hypertension.

Answer 29

COPD.

Question 30

What is the main difference between COPD vs asthma?

Answer 30

Both obstruct airway but asthma is temporary but COPD is permanent.