Smoking and the Lung

Question 1

What are two things that govern how quickly you are able to get air out in the first second

Answer 1

How dilated the air tubes are and the elastic recoil of the lungs

Question 2

What is FEV1

Answer 2

How quickly you are able to get air out in the first second

Question 3

What happens during inspiration

Answer 3

Take a breath in: move diaphragm down and chest wall out with external intercostals, increase volume in chest cavity, decrease the pressure resulting in negative intrapleural pressure and air goes from high pressure to low pressure (helical springs stretched)

Question 4

What happens during expiration

Answer 4

(normally passive): reliant on elastic recoil of lungs

Question 5

Why do you get diminished patency in chronic bronchitis

Answer 5

Air tubes are full of mucus leading to diminished patency (diameter) meaning you can’t get as much air out.

Question 6

Why do you lose elastic recoil in emphysema

Answer 6

Elastin degraded so lungs lose elastic recoil (over stretched spring), easy to inflate lungs but then lose elastic recoil

Question 7

What is COPD

Answer 7

Umbrella term for chronic bronchitis, emphysema and asthma

Question 8

What are obstructive diseases

Answer 8

COPD, chronic bronchitis, emphysema and asthma

Question 9

What does your ability to breathe or blow out air depend on

Answer 9

1. The patency of your airtubes

2. The elasticity of your lungs/ chest wall (or helical springs)

Question 10

Why do you have an increased risk of pneumonia and acute bronchitis if you smoke

Answer 10

Smoking inhibits alveolar macrophage function and mucociliary clearance

Question 11

What does smoking cause increased risk of

Answer 11

Pneumonia and acute bronchitis lung cancer (and loads of other cancers), difficult asthma, inflammatory (interstitial) lung disease (DIP, RIBLD)

Question 12

How can interstitial lung disease be treated

Answer 12

By stopping smoking

Question 13

What does smoking during pregnancy do

Answer 13

Increases the risk of uterine retardation

Question 14

What does smoking before an operation make

Answer 14

Wound healing more difficult

Question 15

What does cigarette smoke cause

Answer 15

Tissue injury and activates the inflammatory cascade (responsible for pathological damage)

Question 16

Describe the effect of cigarette smoke in chronic bronchitis

Answer 16

Damages cilia, directly damages airway epithelium, inhibits leukocyte removal of bacterial and other pathogens

Question 17

Why do smokers develop an overnight cough

Answer 17

They don’t smoke overnight meaning that their cilia go into overdrive

Question 18

What is COPD

Answer 18

Chronic obstructive pulmonary disease. Chronic means long standing, obstructive means blocking. In COPD the airways are narrowed

Question 19

Describe the aetiology of COPD

Answer 19

Cigarette smoke is dose dependant. Only 30% of smokers develop COPD-dose relationship. Genetic factors-number of genes associated (α1 antitrypsin deficiency etc.), this can be a cause of emphysema if you have never smoked a single cigarette. Occupational (coal dust, silica, cadmium etc.)- controversial, probably increase risk of COPD in smokers. Biomass fuel emission- poorly ventilated kitchens in countries such as Bangladesh and Pakistan. Other factors- nutrition (low diet in vitamin C&E and antioxidants), low birth weight, maternal smoking.

Question 20

What do people with chronic bronchitis have

Answer 20

A cough and sputum on most days

Question 21

What is emphysema

Answer 21

Abnormal and permanent dilation of the airspace distal to the terminal bronchioles with destruction of their walls

Question 22

COPD can be describes as multicomponent and includes

Answer 22

Inflammation, mucociliary dysfunction, tissue damage

Question 23

Describe inflammatory in COPD

Answer 23

Inflammation (respiratory pathogens) such as Haemophilus influenzae and Pseudomonas aeruginosa, secrete lipooligosaccharide, an inflammatory stimulus leading to an increase in neutrophils, macrophages, eosinophils and T-lymphocytes in various parts of the lung).

Question 24

Describe mucociliary dysfunction in COPD

Answer 24

Hypersecretion and inhibited ciliary activity

Question 25

Describe tissue damage in COPD

Answer 25

Bacterial colonisation damages epithelial cells

Question 26

What are the signs and symptoms characteristic of COPD

Answer 26

Decline in lung function and exaserbations

Question 27

Describe the pathology of chronic bronchitis

Answer 27

Hypertrophy of submucosal glands, increased number of goblet cells, muco-ciliary dysfunction. All lead to mucous hypersecretion and retention

Question 28

Describe the consequences of chronic bronchitis

Answer 28

Inability to clear mucous. Leads to mucous retention and airway blocking. Retained mucous is also more likely to become infected, this also leads to greater airway inflammation and bronchial wall thickening and ‘narrowed airtubes’

Question 29

What happens in emphysema

Answer 29

Neutrophils result in release of metalloproteinases which degrade elastin resulting in lungs losing their elastic recoil

Question 30

What does degradation of elastin in emphysema lead to

Answer 30

Hyperinflation or ballooning of alveloi, destruction of alveolar walls, destruction of alveolar capillary walls loss of lung elasticity

Question 31

What are the symptoms of COPD

Answer 31

Progressive breathlessness and exercise intolerance. Cough with sputum. Wheeze. “Winter bronchitis” or “exacerbations”. Fatigue. Weight loss/ loss of appetite. Oedema

Question 32

Describe the clinical features you would find on examination of someone with COPD

Answer 32

Hyperinflated chest- air trapping. Breathing quickly/ using accessory muscles. Cachexic- loss of muscle mass. Reduced breath sounds/ wheezing

Question 33

What does FEV1 depend on

Answer 33

Patency of airtubes and elastic recoil of the lungs

Question 34

What is FEV1 reduced in

Answer 34

COPD

Question 35

What is FEV1 used in

Answer 35

Diagnosing COPD and grade the severity.

Question 36

What is FVC

Answer 36

Forced vital capacity- the volume of air blown out at the end of a forced expiratory manoeuver

Question 37

What is FVC reduced in

Answer 37

Restrictive disorders

Question 38

Describe FEV1/FVC ratio

Answer 38

. FEV1/FVC ratio- normal is >0.7, obstructive 0.7, but both FEV1 and FVC need to be low in terms of percentage predicted

Question 39

How do lungs with emphysema appear on x-ray

Answer 39

Hyperventilated meaning that you are able to see more anterior ribs