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The Respiratory System > Pulmonary Airways Disease > Flashcards

Pulmonary Airways Disease Flashcards

1
Q

What are some examples of host defences to lung infection

A
  • Cough reflex
  • Cilia
  • Mucus
  • Antibodies, e.g. IgA
  • Macrophages
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2
Q

How does a dysfunctional cough reflex lead to increased pulmonary airways disease

A

The cough reflex may be lost. It can mean that things get stuck in the airways as they are unable to be removed and this increases the risk of infection.

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3
Q

What is the role of cilia

A

These line the cells of the respiratory tract and beat things upwards and out of the airways.

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4
Q

When may a cough reflex be lost

A

Following a stroke

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5
Q

How can the cilia become damaged

A

Due to genetics or smoking.

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6
Q

How may mucus be dysfunctional

A

The person may not be able to produce mucus or may not have enough mucus.

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7
Q

What is one condition in which mucus is dysfunctional

A

Cystic fibrosis. In CF, mucus is thick and cannot be moved up the ciliary escalators so becomes stuck.

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8
Q

How can drugs increase the risk of infection

A

Immunosuppressive drugs such as steroids or DMARDs can cause increased risk of infection.

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9
Q

Why may people with heart failure be at greater risk of lung infection

A

Due to the presence of pulmonary oedema.

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10
Q

What is the acinus

A

Everything beyond the terminal bronchiole to the alveoli of the lungs.

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11
Q

What is acute bronchitis

A

Inflammation of the bronchi - the large airways.

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12
Q

What usually causes acute bronchitis

A

A viral infection so it often cannot be treated with antibiotics.

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13
Q

If bacterial infection is the cause of acute bronchitis which organism may be to blame

A

H.influenzae

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14
Q

What is laryngotracheobrinchitis

A

This is acute bronchitis involving the larynx and the trachea as well as the bronchi.

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15
Q

What structures are included under the term “upper airway disease”

A

The larynx, the trachea and the bronchi.

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16
Q

What is bronchiolitis

A

Inflammation of the bronchioles - the small airways.

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17
Q

What condition is bronchiolitis often a feature of

A

Chronic bronchitis (a component of COPD)

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18
Q

What organism often causes bronchiolitis in children

A

Respiratory syncytial virus (RSV)

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19
Q

What are the presentations of bronchiolitis

A

Tachypnoea and dyspnoea.

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20
Q

In children most cases of bronchiolitis are associated with RSV. What is bronchiolitis normally associated with in adults

A

COPD.

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21
Q

What structures are included under the term “lower airway disease”

A

The bronchioles and the alveoli.

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22
Q

What are three ways in which airway obstruction can occur

A
  • A lesion outside the wall, for example a large lymph node
  • A lesion in the wall, for example a tumour
  • A lesion in the lumen, for example a foreign body
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23
Q

What is the most common lesion outside the wall of airways causing airway obstruction

A

Now the most common cause is malignancy (for which presentation can be recurrent pneumonia). In the past the most common cause was an enlarged lymph node due to TB.

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24
Q

In what two ways can airway obstruction present

A

It can be complete obstruction or the obstruction can act as a one way valve.

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25
Q

What can be the result of a complete airway obstruction

A

Distal collapse

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26
Q

What can be the result in the obstruction acts as a one way valve

A

Over-inflation.

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27
Q

What is diffuse obstructive airways disease

A

This affects both lungs and is diffuse as there are many airways involved.

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28
Q

What is often the result of pulmonary function tests for someone with disuse obstructive airways disease

A

Pulmonary function tests are often abnormal as it is difficult to blow air out of the lungs. The PFTs often have an obstructive pattern so there is reduced vital capacity, reduced FEV1/FVC ratio and reduced peak expiratory flow rate.

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29
Q

What are four pathological conditions which come under the umbrella of “diffuse obstructive airways disease”

A
  • Chronic bronchitis
  • Emphysema
  • Asthma

(COPD is a combination of chronic bronchitis and emphysema)

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30
Q

What are the symptoms of chronic bronchitis

A

Cough and sputum for three months of the year in two consecutive years (winter coughing two years in a row)

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31
Q

What is chronic bronchitis caused by

A

Pollution and smoking which act as irritants to the airways and cause inflammation.

32
Q

What organisms do exacerbations of chronic bronchitis tend to be a result of

A
  • H.influenzae
  • S.pneumoniae
  • Viruses.
33
Q

How does chronic bronchitis progress

A
  • Hypercapnia (due to under ventilation)
  • Hypoxia
  • Pulmonary hypertension
  • Right ventricular failure
    (cor pulmonale).
34
Q

Why are people with chronic bronchitis referred to as “blue bloaters”

A

Due to their presentation - there is decreased oxygen so more deoxyhaemoglobin which is more blue in colour.

35
Q

If CO2 is affected, which part of the airway does this tend to be a result of

A

This tends to be due to a problem with the upper airways. Problems with lower airways tend not to affect CO2.

36
Q

What happens in chronic bronchitis

A

There is mucus hyper-secretion due to increased goblet cells. If infected the mucus will change colour. There is chronic bronchial inflammation with squamous metaplasia.

37
Q

What is used to treat chronic bronchitis

A

Anti-cholinergic drugs to reduce mucus secretion and sometimes also steroids.

38
Q

What tend to be the result of pulmonary function tests for someone with localised airway obstruction

A

They tend to be normal

39
Q

In what two ways can diffuse obstructive airways disease present

A
  • Reversible and intermittent (asthma)

- Irreversible and persistent (COPD)

40
Q

What is emphysema

A

Emphysema has an anatomical definition - it arises due to structural changes within the lungs. There is irreversible dilatation of alveolar spaces with destruction of alveolar walls.

41
Q

What is associated with dilated alveolar spaces and destruction of alveolar walls in emphysema

A

Reduced surface area for gas exchange.

42
Q

What are the two main presentations of emphysema

A
  • Panlobular emphysema

- Centrilobular emphysema.

43
Q

What is centri-lobular emphysema strongly associated with

A

Smoking

44
Q

Where does centri-lobular emphysema normally occur

A

The upper lobes of the lungs

45
Q

Where does pan-lobular emphysema normally occur

A

The lower lobes of the lungs.

46
Q

How do the lungs present in pan-lobular emphysema

A

They are over distended.

47
Q

What is associated with pan-lobular emphysema

A

Alpha-1-antitrypsin deficiency.

48
Q

How does alpha-1-antitrypsin deficiency cause emphysema

A

Alpha-1-antitrypsin is responsible for protecting the lungs from neutrophil elastase which disrupts connective tissue. With a genetic disorder of defective alpha-1-antitrypsin there is no longer this effective protection against connective tissue destruction and this leads to emphysema.

49
Q

How is pan-lobular emphysema accelerated in those with alpha-1-antitrypsin disorder

A

Smoking.

50
Q

What are the clinical features of emphysema

A
  • Hyperventilation
  • Normal pO2 and pCO2
  • Weight loss
  • Right ventricular failure
  • Often co-existing with chronic bronchitis
51
Q

What is the way used to refer to people with emphysema due to their clinical presentation

A

Pink puffer

52
Q

What is asthma defined as

A

Reversible wheezy dyspnoea

53
Q

What are the 5 categories of asthma

A
  • Atopic (the majority of cases)
  • Non-atopic
  • Aspirin-induced
  • Occupational
  • Allergic bronchopulmonary aspergilosis.
54
Q

How could asthma cause death

A

Due to mucus plugging. There can be an outpouring of mucus which blocks the airway leading to trouble breathing in and out.

55
Q

What is the key in treating asthma

A

To prevent acute episodes.

56
Q

What Is atopic asthma

A

This is asthma associated with allergy.

57
Q

What conditions are normally associated with asthma

A

Hayfever and eczema

58
Q

What type of hypersensitivity reaction is the bronchoconstriction in atopic asthma associated with

A

Type I hypersensitivity (IgE mediated)

59
Q

What are the results of the hypersensitivity reaction in asthma

A
  • Bronchial obstruction and distal over inflation (due to one way valve) or collapse (due to complete obstruction)
  • Mucus plugging of the bronchi
  • Bronchial inflammation
  • Mucus gland hypertrophy
  • Bronchial wall smooth muscle hypertrophy
60
Q

How is asthma treated

A

The effects of asthma are the targets for treatment. The bronchoconstriction is targeted with a bronchodilator, the oedema is treated with steroids and the mucus hyper-secretion is treated with physiotherapy.

61
Q

What is non-atopic asthma

A

This is associated with recurrent infections and is not immunologically mediated.

62
Q

What is aspirin induced asthma thought to be associated with and mediated by

A

Aspirin induced asthma is associated with recurrent rhinitis and nasal polyps. It is thought to be mediated by prostaglandins and leukotrienes.

63
Q

What is occuptatinal asthma

A

Occupational asthma is hypersensitivity to an inhaled antigen. It may be a non-specific response in those with hyper-reactive airways or may be a specific allergen response.

64
Q

What is ABPA caused by

A

A specific response to the spores of aspergillus fumigatus.

65
Q

What type of hypersensitivity reaction is ABPA

A

Mixed type I and III

66
Q

What is type I hypersensitivity

A

Allergy - it is an IgE response

67
Q

What is type II hypersensitivity

A

Cytotoxic - it is antibody dependent (IgM or IgG)

68
Q

What is type III hypersensitivity

A

Immune complex mediated

69
Q

What is type IV hypersensitivity

A

Delayed - it is T cell mediated.

70
Q

What are two common feature of ABPA

A
  • Mucus plugs

- Bronchiectasis

71
Q

What is bronchiectasis

A

Permanent dilatation of the bronchi and bronchioles. It is due to a combination of obstruction and inflammation.

72
Q

What are the two types of bronchiectasis

A

Localised and diffuse - localised can be treated surgically while diffuse cannot.

73
Q

Which childhood infections is bronchiectasis usually associated with

A

Whooping cough and measles.

74
Q

What are three features of bronchiectasis

A
  • Bronchial dilatation
  • Acute and chronic inflammation
  • Fibrosis.
75
Q

What are the clinical presentations of bronchiectasis

A
  • Chronic cough
  • Production of sputum
  • reduced mucus with therapy
  • Finger clubbing
76
Q

What are the complications of bronchiectasis

A
  • Spread of infection such as pneumonia if spread to the lungs or meningitis if spread to the brain.
  • Amyloidosis
  • Respiratory failure.

The Respiratory System (20 decks)

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