Systemic Pathology 400 (respiratory pathologies 3-4) Flashcards
allergic rhinitis
..
allegic rhinitis mostly where?
mostly nose and eyes
allergic rhinitis occurs in respones to
occur in response to breathing in allergens
allergens (example)
dust, dander, mold, cockroaches, pollen, grass, trees
allergic rhinitis is …
A collection of signs and symptoms
(mostly in the nose and eyes)
what are those collections of SSx?
Itching nose, mouth
Conjunctivitis (EYES)
Sneezing
Sinus and nasal obstruction
Coughing, wheezing
Coryza
SSx are in
eyes,
nose
throat, respiratory tract
sinuses
allergic rhinitis AKA
AKA HAY FEVER or SEASONAL ALLERGIES
how common is allergic rhinitis
VERY COMMON
not as common 50 years ago (?)
allergic rhinitis commonly co-occurs with …
Asthma
Atopic dermatitis
—> Atopy
atopy define
“Atopy is the tendency to produce an exaggerated immunoglobulin E immune response to otherwise harmless substances in the environment.”
“Atopy refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema).”
“derived from the Greek words a and topos, meaning “without” and “place,” respectively.”
allergic rhinitis — PATHOGENESIS
ACUTE VASOMOTOR response mediated by HISTAMINE and related vasoactive substances released locally in the nose from mast cells coated with IgE
what is the acute vasomotor response mediated by?
1) HISTAMINE
2) vasoactive substances
—> released locally in the nose
(from mast cells coated with IgE)
allergic rhinitis — Dx
History
Symptoms
Skin test
skin test – allergic rhinitis
“A skin prick test, also called a puncture or scratch test, checks for immediate allergic reactions to as many as 50 different substances at once. This test is usually done to identify allergies to pollen, mold, pet dander, dust mites and foods. In adults, the test is usually done on the forearm.”
allergic rhinitis – Tx
(Avoid triggers)
Antihistamines
Decongestants
Injections
how does decongestant work?
vasoconstrict
“They work by reducing the swelling of the blood vessels in your nose, which helps to open the airways. Examples include pseudoephedrine (sometimes called by the brand name Sudafed.”
ASTHMA
..
what is asthma?
Increased responsiveness of bronchial tree to certain stimuli
how is asthma multi-factorial?
Complex disorder involving…
biochemical,
autonomic,
immunologic,
infectious,
endocrine,
psychological factors
asthma – how is it chronic vs acute?
Chronic inflammatory condition
with acute exacerbations
asthma can be classified as …
Can be classified as reversible COPD
back to allergies —> “hygiene” theory related to allergies, hypersensitivities, autoimmune diseases, etc.
exposure to pathogens and a variety of substances from early age, reduces likelihood of allergies/hypersensitivities developing.
whereas, children who are sheltered, and don’t spend time outside, and around various substances/animals/people, are more likely to develop hypersensitivities/allergies, etc.
Asthma – Incidence
..
HOW COMMON IS ASTHMA?
The MOST COMMON chronic disease in adults and children
asthma, male to female ratio
Male > female 2:1
asthma, male to female ratio IN SEVERE CASES
Severe cases: Male = female
asthma – incidence vs country development level
and incidence vs socioeconomic class
More common in DEVELOPED countries, specifically those who are of LOW SOCIOECONOMIC STATUS
for asthma in developing countries, which group are more likely to have asthma?
In the developing world it is more common in those who are of high socioeconomic standing.
Why?
access to healthcare (?)
rich people living in cities more often in developing countries (?)
related to occupation (?)
Asthma risk factors
Environment
Small families
Lack of pets
Antibiotics
Age
Gender
Smoking while pregnant
Viral infections
other risk factors for asthma
Obesity
Urban settings
Low SE status
Overcrowding
BMI
Family history
Atopy (tendency for allergies)
allergies as risk factor for asthma?
“The chemicals released by your immune system lead to allergy signs and symptoms, such as nasal congestion, runny nose, itchy eyes or skin reactions. For some people, this same reaction also affects the lungs and airways, leading to asthma symptoms.”
asthma – etiology
Genetics
Viruses
Risk factors (outlined in previous slide)
EXTRINSIC ASTHMA
(atopic or allergic asthma)
results from?
occurs mostly in?
considered a _____ disorder
Results from an allergy to specific triggers
Occurs mostly in children and young adults
considered part of “Hypersensitivity disorders”
is family history a risk factor for asthma
yes
3-6 times more likely
Intrinsic asthma
((nonallergic asthma)
triggers?
onset age?
possibly d/t … ?
No known triggers
Adult onset
Possibly viral exposure
—> Post-viral asthma
(POST-VIRAL BRONCHOCONSTRICTION)
Occupation Asthma
NARROWING OF AIRWAYS
caused by workplace exposure
exercise-induced Asthma
Bronchoconstriction can occur in those without other forms of asthma
—> Up to 20% of the healthy population
(More common in cold temperatures)
asthma – pathogenesis
An inflammatory response in the airway causes:
Cellular infiltration
Epithelial disruption
Mucosal edema
Mucous plugging
The inflammatory mediators produce:
Smooth muscle spasm
Vascular congestion
Increased vascular permeability
Edema formation
PRODUCTION OF THICK, TENACIOUS MUCOUS
Impaired mucociliary function
Mediators also cause:
Thickening of airway walls
Increased contractile response of bronchial smooth muscle
This leads to airway hyper-responsiveness and, along with swollen airways and mucous plugs, causes trapping of distal air leading to:
HYPOXEMIA/hypoxia
Obstructed airflow
Increased work of breathing
in long run, what can asthma cause
barrel chest – but not as common
asthma – SSx, clinical manife
Cough
SOB
Wheezing
Degree – mild, moderate, severe
Frequency
asthma attacks are usually …
Most attacks are short-lived with asymptomatic periods between attacks.
long term asthma and repeated acute episodes can lead to…
Repeated episodes may leads to …
barrel chest,
elevated shoulders,
hypertonicity of accessory muscles of respiration, etc.
acute severe asthma — aka
formerly known as STATUS ASTHMATICUS:
“a severe condition in which asthma attacks follow one another without pause.”
acute severe asthma is …
Acute severe asthma (formerly status asthmaticus) –
an acute attack that cannot be altered with standard bronchodilators
acute severe asthma requires ____
can be ____
requires emergency medical care
can be fatal
asthma — Dx
History
Clinical manifestation
Pulmonary function tests (FEV-1) — FORCED EXPIRATORY VOLUME
fev-1 diagnostic tool
forced expiratory volume test
“FEV1 helps measure the progression of lung conditions such as chronic obstructive pulmonary disease (COPD) or asthma. FEV stands for forced expiratory volume, which is the air you exhale in 1 second. A low FEV1 suggests a breathing obstruction.”
asthma – Tx
Identify and avoid specific triggers
Medications
—> Corticosteroids
—> Bronchodilators
asthma – Px for children
Asthma resolves in many children, but for as many as one in four, wheezing persists into adulthood or relapse occurs in later years
asthma – mortality rate ?
About 4000 deaths/yr in the US are attributable to asthma, most of which are preventable with treatment. Thus, the prognosis is good with adequate access and adherence to treatment
long term asthma —-> structural effects on lungs
What can prevent these structural changes?
Over time, the airways in some patients with asthma undergo permanent structural changes (remodeling) that prevent return to normal lung functioning.
Early aggressive use of anti-inflammatory drugs may help prevent this remodeling
PNEUMOCONIOSES
Restrictive lung diseases
caused by inhalation of MINERAL DUSTS and various INORGANIC particulate
—> leads to permanent deposition of substantial amounts of particles in the lungs
which substances are commonly involved in PNEUMOCONIOSIS?
Particularly inorganic DUST such as IRON ore or COAL
—> inhaled and deposited in lung tissue
pneumoconiosis etymology
pneumo – of or related to lungs
konis – dust
osis – condition/disease
pneumoconiosis – commonly as a result of
Most classified as occupational and a consequence of long term exposure in the workplace
“coal worker’s pneumoconiosis”
(aka anthracosis)
etymology:
anthrax/anthrak – coal
osis – condition/disease
3 types of pneumoconiosis
1) coal worker’s pneumoconiosis (anthracosis)
2) silicosis
3) asbestosis
whether or not there is damage to lungs during pneumoconioses, depends on a THREE FACTORS
A) Duration of exposure
B) Concentration of particles
C) Size, shape and solubility of particles
D) Biochemical composition of the inhaled dust
how does size of particles determine whether a risk factor for pneumoconioses?
E.g.
Large dust particles retained in the nasal mucus and do not reach the lower respiratory tract
How does biochemical composition of the inhaled dust determine risk for developing pneumoconioses?
E.g. Inert particles, like coal particles, are less reactive
E.g. silica particles are more reactive and produce more prominent tissue injury
E.g. asbestos particles are insoluble and remain lodged in lungs permanently
pneumoconiosis – incidence and etiology
Occurs most commonly in miners, sandblasters, stonecutters, asbestos works, insulators
Increasing incidence with age because cumulative effects of exposure
Overall incidence decreasing (BETTER OCCUPATIONAL SAFETY STANDARDS)
1) Coal worker’s pneumoconiosis
Amorphous carbon particles retained in nasal mucosa
Ingestion of inhaled coal dust by alveolar macrophages; expectorated
—> Black lung
2) SILICOSIS
Cells membranes of macrophages destroyed; macrophages die and release silica which is ingested by macrophages
Dead macrophages release
biochemically active substances
that stimulate formation of
COLLAGENOUS NODULES
Confluent nodules destroy lung
parenchyma and cause
massive pulmonary fibrosis
____ is a common complication of SILICOSIS
TB common complication
if silicosis is caused by volcanoes it is called ____
Pneumonoultramicroscopicsilicovolcanoconiosis
silicosis define
“Silicosis is a type of pulmonary fibrosis, a lung disease caused by breathing in tiny bits of silica, a common mineral found in sand, quartz and many other types of rock.”
“Silicosis mainly affects workers exposed to silica dust in jobs such as construction and mining. Over time, exposure to silica particles causes scarring in the lungs, which can harm your ability to breathe.”
3) Asbestosis
Asbestos particles engulfed by macrophages
Macrophages activated to release inflammatory mediators
asbestos associated with increased risk of ____
whereas silicosis is associated with increased risk of _____
Associated with increased risk of LUNG CANCER
silicosis is associated with increased risk of TUBERCULOSIS
pneumoconiosis — Clinical manifestations
Progressive dyspnea
Chest pain
Chronic cough
Expectoration of mucus
pneumoconiosis — Dx
workplace exposure,
CXR,
clinical manifestation,
pulmonary function tests (FEV1?)
pneumoconiosis – safety measures
Prevention and safety measures
pneumoconiosis – is there Tx when it happens?
No standard treatment
pneumoconiosis – what about Px ?
Poor prognosis generally
HYPERSENSITIVITY PNEUMONITIS
Hypersensitivity reaction in the alveoli as a response to inhaled ORGANIC particulate
BOTH of these are considered to be OCCUPATIONAL PATHOLOGIES
Hypersensitivity Pneumonitis
Pneumoconiosis
BOTH of these are considered to be RESTRICTIVE LUNG DISEASES
Hypersensitivity pneumonitis
Pneumoconiosis
Hypersensitivity pneumonitis causes
“Hypersensitivity pneumonitis can happen when you repeatedly breathe in bacteria , mold, or chemicals in your environment that cause inflammation in your lungs. These harmful substances may be found in: Air conditioners, humidifiers, and ventilation systems. Bird droppings, feathers, and animal furs.”
one difference between pneumoconiosis and hypersensitivity pneumonitis
PNEUMOCONIOSIS usually involves inhalation of INORGANIC particles
HYPERSENSITIVITY PNEUMONITIS usually involves inhalation of ORGANIC particles
hypersensitivity pneumonitis – relation to allergies and allergens
“Hypersensitivity pneumonitis causes a different immune reaction in your body than pollen or pet allergies. Unlike common allergies that cause hay fever and asthma, repeated exposure to allergens that cause HP can lead to inflammation that can permanently damage your lungs.”
hypersensitivity pneumonitis — SSx
Fever
Cough
Dyspnea
Headache
Pleuritis
Clubbing (hypoxia?)
Honeycomb lungs
Bronchiolitis
Crackles (aka RALES)
hypersensitivity pneumonitis – Dx
History
Blood tests
X-ray
Biopsy
PFT (e.g. FEV1)
