Sketchy Path: Asthma and Bronchiectasis

Question 1

In a nutshell, asthma results from __________________.

Answer 1

overreactive airways that prevent air from escaping the alveoli (like the overreactive kid who’s hitting the bee with the unnecessarily large stick)

Question 2

What is a key feature from the patient’s history that will clue you in to a diagnosis of asthma?

Answer 2

Episodic, reversible periods of difficulty breathing (like the reversed baseball cap on the kid)

Question 3

Asthma is characterized by ______________ hypertrophy.

Answer 3

smooth muscle and mucus gland

Question 4

Briefly describe the cellular process that leads to asthma.

Answer 4

1) Person inhales an antigenic substance
2) The antigen is taken up by APCs and shown to Th2 cells
3) Th2 cells secrete IL-4 and IL-13 which stimulates B cells to make IgE
4) IgE Fc region binds to mast cell
5) Mast cells encounter antigen via IgE in clusters and degranulate leading to release of histamine

(Think of the helper T squirrel and the archer shooting the beehive which is now coated in arrows.)

Question 5

What are the symptoms of the early inflammatory reaction?

Answer 5

• Mucus production (kid drooling)
• Dilated pulmonary vessels (kid’s sleeves dilated)
• Bronchoconstriction (kid gripping bronchi-evoking branch)

Question 6

Why does bronchoconstriction occur in asthma?

Answer 6

Mast cells also release acetylcholine which stimulates bronchoconstriction via M3 receptors.

Question 7

What cells characterize the late inflammatory response?

Answer 7

Eosinophils (like the girl dressed in pink arriving LATER and shooting pink globules at the boy)

Question 8

True or false: the early inflammatory reaction causes damage to the lung.

Answer 8

False. It’s the late phase eosinophils releasing major basic protein that damages the lung.

(Remember that the boy who represents the early phase has the reversible backward hat to show that these changes aren’t permanent.)

Question 9

What structural changes take place in response to chronic asthmatic inflammation?

Answer 9

• Smooth muscle hypertrophy (like the guy doing pull ups next to the remodeling sign)
• Mucous gland hypertrophy (the same guy is dripping sports drink)
• Thickened basement membrane (like the thick concrete slab being remodeled)

Question 10

What might be found in a sputum analysis of a chronic asthmatic?

Answer 10

• Eosinophils (like the girl playing with pink marbles in the mucus)
• Mucus plugs (like the can phone plugged with mucus)
• Kurshman spirals: whorls of epithelium (like the coiled telephone line)
• Charco-Leyden crystals: pink crystals secreted by eosinophils (like the pink jacks in the mucus)

Question 11

What symptoms are characteristic of asthma?

Answer 11

• Acute dyspnea (kid getting short of breath at the top of the ladder)
• Expiratory wheezing –though inspiratory can occur in severe cases (party favor being blown OUT)
• Nocturnal cough (kid waking up in his sleeping bag coughing)
• Pulsus paradoxus (like the kid’s shirt)

Question 12

Those with asthma often have a family history of ______________.

Answer 12

atopic disorders (like the family photo by the sleeping kid)

Question 13

What might x-ray of an asthmatic show?

Answer 13

• Chest expansion
• Vertical heart

Between attacks, though, x-ray will be normal.

(Think of the kite.)

Question 14

What spirometry values are suggestive of asthma?

Answer 14

Decreased FEV/FVC during attacks but normal otherwise (like the falling FEV/FVC ladder)

Question 15

Like COPD, asthma can cause a certain acid-base disturbance?

Answer 15

Initial respiratory alkalosis from compensatory hyperventilation followed by respiratory acidosis in extreme attacks

(Think of the girl blowing the OH bubbles that pop.)

Question 16

What are causes of non-atopic asthma?

Answer 16

• Viruses (lamp)
• Smoking (ashtray)
• Drugs like aspirin (lacrosse player with LOX lacrosse stick)

Question 17

What combination of things causes bronchiectasis?

Answer 17

Obstruction and recurrent infection (like the bacteria lanterns next to the CF mucus ring and the crab drawing –both symbols of obstructive causes)

Question 18

What is the most common cause of bronchiectasis worldwide?

Answer 18

TB, which blocks the airway and allows other infections to develop

(Think of the TB spots on the top of the tree.)

Question 19

Which part of the lung is most affected by bronchiectasis (usually)?

Answer 19

The lower lobes (like the heavy pomegranates that dangle down)

Question 20

What pieces from the clinical history suggest bronchiectasis?

Answer 20

Coughing up “cup fulls” of mucus (like the girl holding cups of rotten pomegranate) and hemoptysis (like how she’s coughing up red)