The Pulmonary System: Emphysema and Chronic Bronchitis Flashcards
What is spirometry testing?
Pulmonary function test; measures volume and speed of air movement during inspiration and expiration to asses ling function
Forced Vital Capacity
volume of air that can forcibly be blown out after full inspiration
Forced expiratory volume in 1 second (FEV1)
volume of air that can forcible be blown out in one second after full inspiration
FEV1/ FVC ration
in healthy adults this should be approximately 70-85%
Peak expiratory flow(PEF)
maximal air flow achieved during maximally forced expiration initiated at full inspiration
Forced expiratory flow (FEF)
flow of air coming out of lungs at various times
Obstructive airway disease is characterized by ?
an increase in airflow resistance due to partial or complete obstruction at any bronchial level
- less air exits lungs per unit time (decrease FEV1)
- total volume is less affected (normal to somewhat reduced FVC)
What are the major chronic obstructive airway diseases? (copd).
Are they reversible?
- emphysema and chronic bronchitis
- not reversible
Chromic cell-mediated inflammatory disorders
- activated T cells, macrophages and neutrophils
- release of cytokines (leukotriene B4, TNF)
There are variable degrees of inflammatory _____ secretion. _______ and ____ due to cycles of phagocyte lysosomal protease release and subsequent tissue repair.
mucous; tissue remodeling and fibrosis
activated macrophages and neutrophils secrete _____ and _____
lysosomal enzymes and oxygen free radicals
Lysosomal proteases are normally inhibited by circulating _______ ex: ____
protease inhibitors ex: alpha-1 antitrypsin (produced in liver)
oxygen free radicals from activated phagocytes or conditions of oxidant stress inactivate _____
alpha 1- antitrypsin
prolonged activation of lysosomal enzymes results in ____ and _____ of alveolar walls
inflammation and remodeling
COPD affects _________
alveoli and terminal bronchioles (emphysema), bronchioles(bronchiolitis) or larger airways (bronchitis)
what is the primary cause of COPD?
cigarette smoking
- environmental pollutants are related exposures may also contribute
- rare genetic cause (alpha 1- antitrypsin deficiency)
____ is a reversible chronic obstructive inflammatory disease of the lungs
asthma
asthma primarily affects the _____. and is know as _____
large airways (bronchi) - is known as reversible airway hyperactivity
______ is characterized with alveolar wall destruction- overinflation
emphysema
_______ is associated with productive cough and airway inflammation. Overlap of emphysema can be seen in some cases.
chronic bronchitis
______ is associated with reversible obstruction; bronchial hyper responsiveness triggered by allergens, infection, ect.
Asthma
Emphysema is characterized by ___________
permanent, abnormal enlargement of the respiratory bronchioles and alveoli and destruction of alveolar wall (with or without fibrosis)
Emphysema tends to affect ___ lobes more than ___ lobes
affects upper lobes more than lower lobes
In emphysema, air becomes trapped due to ___ and _______ resulting in air accumulation and overall ________
obstruction and loss of alveolar recoil; hyperinflation (results in increased AP chest diameter- “barrel chest”)
Emphysema is classified by its anatomic location - affects _______ to ____
respiratory bronchioles to the alveoli
what are the three classified locations of emphysema
- centriacinar (centrilobar)
- panacinar (panlobular)
- distal acing (paraseptal)
Bullae are large ______ usually form near the ___ and rupture results in ____
sub pleural blebs; apex; pneumothorax
patients who are homozygous for alpha-1 antitrypsin deficiency mutation are unable to activate ____, resulting in tissue destruction; this mutation markedly _____ the risk for COPD development and early onset emphysema (18-30 years)
proteases; increase
X ray findings that are typical for emphysema
- air trapping causing hyperinflation
- hyperlucent lung field (black, ‘over–penetrated’
- increase retrosternal air
- flattening of diaphragms
- loss of peripheral vascular markings
- vertical heart
is Interstitial Emphysema related to COPD?
NO
Interstital Emphysema occurs when _______. Can occur in trauma, cough with obstruction
air is forced into soft tissue
Chronic bronchitis is inflammation of bronchi and trachea with ______ resulting is _______-
hyper secretion of mucous; mucous gland hypertrophy, thickening of bronchiolar walls, and loss of respiratory cilia.
Mucous hyper secretion results in ________ (does not affect respiratory bronchioles)
non-obstructive airway obstruction
does chronic bronchitis have the same cause as emphysema? there is also an increased risk of ______
yes; pneumonia
Chronic bronchitis is a ____ diagnosis. Persistant _____ for at least 3 months in at least 2 consecutive years (without cause)
persistant cough with sputum production
chronic bronchitis may lead to ______ due to pulmonary hypertension
right heart failure
Chronic bronchitis may be concurrent with ____. and is sometimes associated with intermittent bronchospasm and wheezing called ______-
emphysema; chronic asthmatic bronchitis
Can chronic bronchitis be diagnosed with x ray finding?
NO - CXR can be helpful to exclude other conditions which can clinically mimic the disease
Evaluation of Emphysema and Chronic Bronchitis includes:
- history and physical examination
- spirometry
- CRX, CT
- Oximetry
- CBC
- consider assessing serum alpha 1- antitrypsin activity
