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BDS1 - Human Body > Restrictive And Obstructive Lung Disease > Flashcards

Restrictive And Obstructive Lung Disease Flashcards

1
Q

Name and explain the 2 categories of lung disease

A

Obstructive: Reduction in flow through airways
Restrictive: Reduction in lung expansion
Both reduce ventilation

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2
Q

what is inspiratory reserve volume?

A

maximum amount of additional air that can be drawn into the lungs by determined effort after normal inspiration

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3
Q

what is tidal volume?

A

normal volume of air displaced between normal inhalation and exhalation, no extra effort applied

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4
Q

what is the expiratory reserve volume?

A

additional amount of air that can be expired from the lungs by determined effort after normal expiration

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5
Q

What is residual volume

A

the amount of air left in the lungs after fully exhaling

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6
Q

what is the functional residual capacity?

A

volume of air left in the lungs after normal expiration

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7
Q

what is the vital capacity?

A

maximum amount of air a person can expel from their lungs after a max inhalation, equal to the sum of inspiratory reserve volume, tidal volume and expiratory reserve volume

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8
Q

what is the inspiratory capacity?

A

amount of air that can be inhaled after the end of a normal expiration

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9
Q

What is compliance

A

-(measure of elasticity) how easy it is for the lungs and thorax to expand during pressure changes
-ruled by changes in volume and pressure

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10
Q

Equation for compliance

A

C = dV/dP

Where dV is the change in volume and dP the change in pleural pressure

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11
Q

what is the inter-pleural pressure?

A

-(intrathoracic pressure) pressure within pleural cavity
-usually less than atm pressure, so negative

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12
Q

when is compliance highest?

A

at moderate lung volumes

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13
Q

when is compliance lowest?

A

at lung volumes at either extremities (v. High or v. Low)

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14
Q

what is lung hysteresis?

A

(Hysteresis - physical changes lag behind changes in the effect causing them)

the compliance being different on inspiration and expiration for identical volumes

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15
Q

what is low compliance caused by?

A

lungs being stiff so more work is required to inspire e.g. in pulmonary fibrosis, lung tissue loses distensibility and becomes more rigid

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16
Q

what is high compliance caused by?

A

loss of elastic recoil so difficult to exhale air - extra work required to get air out of the lungs. Often problems with inhalation too as high compliant lung = collapsed alveoli which makes inflation difficult.
eg. Emphysema, elastic tissue is damaged in response to inhaled irritants, such as cigarette smoke.

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17
Q

what is the relationship between lung function and age?

A

lung function decreases as you get older

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18
Q

what is the relationship between compliance and age?

A

Compliance increases with age

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19
Q

when does peak inspiratory rate and plateau pressure increase?

A

when elastic resistance increases or when pulmonary compliance decreases

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20
Q

what is the difference between fibrotic and emphysematous lungs regarding changes in lung volume w changes in pressure?

A

emphysematous lungs have larger changes in lung volume

RV - amount of air remaining after full exhalation

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21
Q

What are the 2 major components to the elastic recoil of the lungs

A

-anatomical component: elastic nature of cells and ecm, most of ecm is elastin

-elastic recoil due to surface tension generated at air-fluid interface, as air comes out, alveolus reduces in size and the surface tension involved helps w elastic recoil

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22
Q

what could narrowing of the airways be due to?

A

-excess secretions: more mucus, can be temporary
-brochoconstriction: asthmatics will suffer from this, airways narrow in response to irritants
-inflammation due to underlying infection

In all cases there is an increased resistance to the flow of air

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23
Q

what is FEV1?

A

volume of air that a patient can exhale in the first second of forced expiration

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24
Q

what is FVC?

A

total volume of air that the patient can forcible exhale in one breath

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25
what is FEV1/FVC?
ratio of FEV1 to slow vital capacity Values of FEV1 and FVC are expressed as a percentage of the predicted normal for a person of the same sex, age and height
26
what is used to measure lung volume values?
Spirometer
27
what is a flow volume loop?
a plot of inspiratory and expiratory flow (L/sec) against volume (L) during forced expiration
28
what are the main features of a flow volume loop?
-peak expiratory flow -FEV1
29
describe the appearance of a normal spirometry
rapid rise to max expiratory flow followed by a steady, uniform decline until all the air is exhaled
30
how will the spirometry be different for someone with an obstructive disease?
the FEV1 will be lower
31
how is an obstructive disease defined?
FVC is less than 80% of predicted FVC
32
what is predicted FVC based on?
age, gender, height, weight
33
how is the flow volume loop different for a person suffering from an obstructive disease?
-initial flow and peak flow c an be similar -sharp fall in flow rate so concave curve -longer to exhale so FEV1 will change but FVC may stay the same
34
give examples of some obstructive diseases
Chronic obstructive pulmonary disease (COPD) - structural changes Chronic Bronchitis Persistent productive cough and excessive mucus secretion (three consecutive months in last two years) Emphysema – loss of elastin Asthma - inflammatory disease
35
what is COPD?
-chronic obstructive pulmonary disease -can have two phenotypes: pink puffers and blue bloaters
36
what are pink puffers and blue bloaters used for?
-pink puffers for emPhysema -blue bloaters for chronic Bronchitis
37
E.C.L.I.P.S.E study identified the real heterogeneity of disease, what does eclipse stand for
ECLIPSE = Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints
38
what are the signs and symptoms of chronic bronchitis?
-daily productive cough for three months or more in at least 2 consecutive years -overweight and cyanotic -elevated Hb -peripheral oedema (oedema in tissues perfused by peripheral vascular system) -rhonchi and wheezing -hypertrophy of submucosal glands so hypersecretion of mucus -oedematous - bloater, probs due to right ventricular failure bc less blood is being pumped which causes fluid and water retention -cough
39
what are the signs and symptoms of emphysema?
-permanent enlargements and destruction of airspaces distal to the terminal bronchiole -older and thin -severe dyspnea -quiet chest -x-ray will show hyperventilation with flattened diaphragms -hypoxemia so pink -barrel chest (loss of skeletal muscle and subcutaneous fat) -alveoli can rupture -respiratory muscle fatigue from increased use -no cough
40
why do pink puffers hyperventilate?
because they have less surface area available for gas exchange and reduced vascular bed. Breath through Pursed lips.
41
what is the pathological definition of emphysema?
permanent dilation of air spaces distal to the terminal bronchiole with destruction of alveolar walls
42
what are the two types of emphysema?
centriacinar/centrilobular and panacinar/panlobular
43
what is Centriacinar or centrilobular emphysema?
-central part of acinus affected with distal alveoli unaffected -upper lobes, especially apical segments are involved -closely involved w cigarette smoking
44
what is panacinar or panlobular emphysema?
-entire acinus is affected, from respiratory bronchiole to distal alveoli -lower lobes affected -closely associated with α1 antitrypsin deficiency
45
what is alpha-1 antitrypsin deficiency?
-rare, inherited genetic disorder which can cause lung and liver problems -onset of lung problems is between 20 and 50 years old -lack of enzyme inhibitor (alpha-1 antitrypsin) makes them more vulnerable to effects of inhaling smoke and other chemicals
46
what does alpha-1 antitrypsin do?
blocks enzymes that degrade elastin in the alveoli and leads to lower compliance
47
Further symptoms of pink puffer
No cyanosis (hypoxemia) – pink. Barrel chest – loss of skeletal muscle and subcutaneous fat due to inadequate food intake and inflammatory cytokines (TNF ) that cause wasting. Alveoli can rupture – pneumothorax and/or decreased airway resistance. Respiratory muscle fatigue from increased use as well as the flattening of the diaphragm which impairs its function. No cough
48
Symptoms of blue bloater
Develop and tolerate hypercapnia earlier (abnormally elevated carbon dioxide (CO2) levels in the blood) Cyanosed – blue, inadequate oxygenation of the blood, most prominent in lips and nail beds Chronic bronchitis - persistent cough with sputum for at least 3 months in at least 2 consecutive years, no other causes 4-10 times more common in heavy smokers (20 pack years) Hypertrophy of submucosal glands = hypersecretion of mucus, increased goblet cells, increased infection Oedematous – bloater, probably due to right ventricular failure or cor pulmonale Usually dyspnoea triggered by infection Cough – irritation of cough receptors by mucous Wheezy due to obstruction (not as in asthma) Ronchi – gurgling sound due to mucus hypersecretion in airways
49
why may blue bloaters be cyanosed?
blue tinge to skin because of inadequate oxygenation of blood, prominent
50
what are the differences between COPD and asthma?
-almost all COPD patients are smokers, fewer asthmatic smokers -rare for COPD patients to show symptoms under 35, asthmatics do -common for COPD patients to have chronic productive cough, uncommon for asthmatics -COPD patients have persistent and progressive breathlessness but variable for asthmatics -night time waking w breathlessness is uncommon for COPD patients but is common for asthma patients -significant diurnal variability common for asthmatics but not for COPD patients -asthma is reversible, COPD is not
51
name atopic and non-atopic triggers of asthma
-atopic (extrinsic): allergies, contact w inhaled allergens -non-atopic (intrinsic): respiratory infections, cold air, stress, exercise, inhaled irritants, drugs
52
what is the response to triggers in asthma?
-movement of inflammatory cells into the airways, release of inflammatory mediators such as histamine and subsequent bronchoconstriction which reduces the area for air to move in and out
53
describe short acting treatment for asthma
beta-2-adrenoreceptor agonists e.g. salbutamol causes dilation of airways
54
describe longer acting treatment for asthma
-inhaled steroids -glucocorticoids are a class of steroid hormones that act to reduce the inflammatory response -long acting beta-adrenoreceptor agonists can also be used
55
why are there reduced chest expansion in restrictive lung disease?
-chest wall abnormalities -muscle contraction deficiencies
56
why is there loss of compliance (fibrosis) in restrictive lung disease?
-part of normal ageing process -increase in collagen occurs -exposure to environmental factors
57
what are the differences in spirometry for a patient with a restrictive diseases?
-reduced vital capacity -FEV1 can remain unchanged or increase
58
what are the differences on a flow volume loop for a patient with a restrictive disease?
-reduction in air removed -reduction in peak flow
59
how does spirometry indicate the presence of an abnormality?
-FEV1 <80% predicted normal -FVC <80% of predicted normal -FEV1/FVC ratio <0.7
60
what will an obstructive disorder show on spirometry?
-FEV1 reduced -FVC usually reduced but to lesser extent than FEV1 -FEV1/FVC ratio reduced
61
what will a restrictive disorder show on spirometry?
-FEV1 reduced -FVC reduced -FEV1/FVC ratio normal
62
what is asbestos?
group of minerals made up of microscopic fibres which can damage your lungs if breathed in
63
how do asbestos affect your lungs?
-when breathed in, they can settle at the bottom of lungs and stay there for a lung time w/o causing problems and then 30/40 years later you will develop either fibrosis or mesothelioma or asbestosis
64
what is idiopathic pulmonary fibrosis (IPF)?
-fibrosis of lung interstitium -involves progressive and irreversible decline in lung function
65
what are the symptoms of IPF?
-gradual onset of shortness of breath and dry cough -symptoms are caused by chronic hypoxemia
66
what complications can IPF cause?
-pulmonary hypertension -heart failure -pneumonia -pulmonary embolism
67
what is the underlying mechanism of IPF?
-scarring of lungs so build up of fibrotic tissue, leading to lower compliance
68
what does IPF involve?
-alveolar remodelling -fibrous tissue build up -scarred interstitium which disrupts exchange of oxygen and carbon dioxide bw alveolus and blood vessels

BDS1 - Human Body (22 decks)

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