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Questions and Answers
What is a primary consequence of airway narrowing in asthma?
What is a primary consequence of airway narrowing in asthma?
Which inflammatory mediator is primarily responsible for smooth muscle constriction in asthma?
Which inflammatory mediator is primarily responsible for smooth muscle constriction in asthma?
How soon can the late response in asthma occur after the early response?
How soon can the late response in asthma occur after the early response?
What triggers the early inflammatory response in asthma?
What triggers the early inflammatory response in asthma?
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What effect does asthma exacerbation have on ventilation distribution?
What effect does asthma exacerbation have on ventilation distribution?
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What is a primary characteristic of patients with chronic obstructive pulmonary disease (COPD)?
What is a primary characteristic of patients with chronic obstructive pulmonary disease (COPD)?
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Which factor is NOT included in the etiology of asthma?
Which factor is NOT included in the etiology of asthma?
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What is the characteristic feature of asthma related to the response of smooth muscles?
What is the characteristic feature of asthma related to the response of smooth muscles?
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What pathology is associated with restrictive lung disease?
What pathology is associated with restrictive lung disease?
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In the context of ventilation-perfusion (V/Q) abnormalities, what occurs in asthma?
In the context of ventilation-perfusion (V/Q) abnormalities, what occurs in asthma?
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At what age is asthma most likely to occur for the first time?
At what age is asthma most likely to occur for the first time?
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Which type of asthma is most common among children?
Which type of asthma is most common among children?
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What is a common feature of cystic fibrosis?
What is a common feature of cystic fibrosis?
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What is the main difference between allergic and nonallergic asthma?
What is the main difference between allergic and nonallergic asthma?
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Which statement best describes the pathology of emphysema?
Which statement best describes the pathology of emphysema?
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What is NOT a provocative factor in the etiology of asthma?
What is NOT a provocative factor in the etiology of asthma?
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Which of the following factors can contribute to nonallergic asthma?
Which of the following factors can contribute to nonallergic asthma?
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What describes the overall approach to discussing restrictive lung disease?
What describes the overall approach to discussing restrictive lung disease?
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Which group of individuals is likely to develop smoke-induced asthma?
Which group of individuals is likely to develop smoke-induced asthma?
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What percentage increase in asthma risk can result from exposure to biologic dusts, gases, and fumes?
What percentage increase in asthma risk can result from exposure to biologic dusts, gases, and fumes?
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Which condition is less likely to trigger allergic asthma?
Which condition is less likely to trigger allergic asthma?
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What begins the progression of restrictive lung disease?
What begins the progression of restrictive lung disease?
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Which function is NOT associated with the interstitium in the lungs?
Which function is NOT associated with the interstitium in the lungs?
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What is the primary symptom associated with restrictive lung disease?
What is the primary symptom associated with restrictive lung disease?
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What aspect of breathing is impacted by restricted lung disease?
What aspect of breathing is impacted by restricted lung disease?
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What characterizes the alveoli in restrictive lung disease?
What characterizes the alveoli in restrictive lung disease?
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What role does the chloride pump play in normal epithelial cells?
What role does the chloride pump play in normal epithelial cells?
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What occurs due to the mutation associated with cystic fibrosis?
What occurs due to the mutation associated with cystic fibrosis?
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How does the mucus produced in cystic fibrosis differ from normal mucus?
How does the mucus produced in cystic fibrosis differ from normal mucus?
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What is a consequence of thickened mucus in the respiratory system of cystic fibrosis patients?
What is a consequence of thickened mucus in the respiratory system of cystic fibrosis patients?
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What facilitates the movement of water in normal epithelial mucus production?
What facilitates the movement of water in normal epithelial mucus production?
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Which statement is true regarding chloride ion movement in cystic fibrosis?
Which statement is true regarding chloride ion movement in cystic fibrosis?
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What is one of the main functions of mucus in the respiratory tract?
What is one of the main functions of mucus in the respiratory tract?
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What leads to well-hydrated mucus in normal epithelial function?
What leads to well-hydrated mucus in normal epithelial function?
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What is a significant consequence of bronchial obstruction caused by abnormal mucus in cystic fibrosis?
What is a significant consequence of bronchial obstruction caused by abnormal mucus in cystic fibrosis?
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Which factor is primarily linked to morbidity and mortality in cystic fibrosis patients?
Which factor is primarily linked to morbidity and mortality in cystic fibrosis patients?
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Which condition is characterized by the collapse of lung tissue that can result from external pressure?
Which condition is characterized by the collapse of lung tissue that can result from external pressure?
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What is the primary impact of partial or complete obstruction of the airways in cystic fibrosis?
What is the primary impact of partial or complete obstruction of the airways in cystic fibrosis?
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What is a potential research focus regarding the immune response in cystic fibrosis?
What is a potential research focus regarding the immune response in cystic fibrosis?
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Which of the following conditions may arise from chronic infection in cystic fibrosis?
Which of the following conditions may arise from chronic infection in cystic fibrosis?
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Which statement about the inflammatory response in patients with cystic fibrosis is accurate?
Which statement about the inflammatory response in patients with cystic fibrosis is accurate?
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What role does hyperinflation play in the respiratory pathology of cystic fibrosis?
What role does hyperinflation play in the respiratory pathology of cystic fibrosis?
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Study Notes
Chronic Pulmonary Dysfunction - II
- Presented by Troy Seely BScPT, MScPT, DPT, FCAPMT
- Course focused on health conditions and diseases in rehabilitation
- RS 3060A
Group Assignment
- Due Monday, November 25th
- Hard copy of the group assignment due at the beginning of lecture next week
- Upload the assignment to UWO Brightspace (announcement will be posted later this week)
- Each group member must also complete and post a peer evaluation of their teammates to UWO Brightspace (announcement will be posted later this week)
Outline
-
Introduction/Review:
- COPD review
- Ventilation-perfusion (V/Q) reviewed
-
Discuss Asthma:
- Epidemiology
- Etiology: categories of provocative factors
- Pathology: hyper-reactivity; 2-stage response
-
Discuss Cystic Fibrosis:
- Epidemiology: impact on life span
- Etiology: hereditary
- Pathology: mucus; some elements overlap COPD (chronic obstructive pulmonary disease)
-
Discuss Restrictive Lung Disease:
- Group of diseases
- Etiology: many different causes (broad summary only)
- Pathology: lung stiffness
COPD Review
- Diagram depicts patients with primarily emphysema, average COPD patients, and patients with primarily chronic bronchitis
- Diagram shows degrees of inflammation or alveolar destruction in varying stages
- Differences in air movement during inspiration and expiration with COPD
Abnormal Ventilation-Perfusion Reviewed
- In asthma, no pathology in alveoli; bronchospasm restricts ventilation.
- In chronic bronchitis, mucus plugs could block ventilation.
- If the alveolar wall is removed, you're removing the capillary bed on the opposite side (emphysema)
Asthma
- Defined as: reversible, obstructive lung disease characterized by airway inflammation and associated with airway hyper-responsiveness (reactivity of smooth muscle causing bronchospasm) to various stimuli
- Triggers vary
Asthma: Epidemiology
- Most common chronic disease of childhood, affecting 9.4% of all children
- Can occur at any age, though most likely first occurs before age 5
- More common and severe in boys than girls in childhood
- Young boys have 'dysanapsis' (smaller airway diameters relative to lung volumes compared to girls)
Asthma: Etiology
- Two main types: allergic and non-allergic
- Allergic (extrinsic) asthma is more common
- Allergic asthma involves an immunologic response driven by mast cells in the airways in response to environmental triggers like pollen, mold, dust, and animal dander
- Non-allergic (intrinsic) asthma is less common; causes are often unknown
- May be secondary to chronic or recurrent infections of the bronchi, sinuses, or tonsils.
- Also caused by hypersensitivity to bacteria or viruses causing infection
- Other recognized categories: exercise-induced, aspirin sensitive, occupational, smoke induced, latex induced, exposure to biologic dusts, gases, and fumes
Asthma: Pathology
- Inflammation of bronchial mucosa causes narrowing of the airways, bronchospasm, and increased bronchial secretions in response to a trigger.
- Narrowed airways increase resistance to airflow, cause air trapping during exhalation, resulting in hyperinflation
- Similar to COPD (chronic bronchitis) presentation.
- Narrowed airways cause abnormal distribution of ventilation to the alveoli, affecting ventilation/perfusion ratio
- Asthma exacerbations can self-resolve.
Asthma Pathology - Early Response
- Antibodies bind to foreign substances (allergens) causing airway mucosa inflammation
- Mediators like histamine cause smooth muscle constriction, mucosal edema, and mucus secretion
Asthma Pathology - Late Response
- Inflammatory cell recruitment after 4-8 hours (up to 24 hrs) from initial response in more severe asthma cases (50% of patients).
- Increased inflammatory mediators cause more bronchospasm, edema, and mucus secretion
- Epithelial damage and impaired mucociliary function from toxic inflammatory effects.
- Chronic increase in inflammation leads to long-term changes like goblet cell hyperplasia, airway wall remodeling, and smooth muscle hypertrophy
Asthma - Clinical Presentation
- Clinical symptoms during exacerbation: dyspnea (shortness of breath) on exertion or at rest, cough, chest pain, wheezing
- Posture: chest held in expanded position, showing hyperinflation
- Accessory muscles of ventilation may be required for breathing
- Auscultation: wheezing is characteristic, but crackles can also be present in severe airway obstruction
- Pulmonary function tests (PFTs): show decreased FEV1 (less than 70-80% of predicted value), and increased residual volume and FRC (functional residual capacity), due to air trapping
- Reversibility of abnormalities is characteristic of asthma
- During remission, patients have near-normal PFT results.
Asthma and Lung Volumes
- Diagrams illustrating normal & asthma lung volumes (IRV, TV, ERV, RV, FRC) and demonstrating differences between them. Asthma shows consistent with hyperinflation: FRC and RV increased
Asthma Classification
- Step 4 (severe persistent): continual symptoms; frequent exacerbations; limited physical activity
- Step 3 (moderate persistent): daily symptoms; effects activity
- Step 2 (mild persistent): exacerbations less than daily, but greater than 2 times per week. May impact activity
- Step 1 (mild intermittent): exacerbations two times a week (or less); asymptomatic otherwise.
Asthma - Clinical Course
- Most children with asthma no longer have symptoms in adulthood.
- Asthma onset later in life usually shows progressive pulmonary function changes even during periods of remission
- Possible airway remodelling in response to chronic inflammation
Cystic Fibrosis
- Inherited, chronic disease affecting excretory glands
- Secretions are thicker and more viscous than normal, affecting multiple body systems
- Includes pulmonary, pancreatic, hepatic, and reproductive systems
Cystic Fibrosis: Epidemiology
- Approximately 4,200 Canadians live with CF
- Roughly 1 child born with CF in every 3,600 live births in Canada
Cystic Fibrosis and Lifespan
- Data show the median predicted survival age differing from the 1990s cohort to the current cohort
- Significant improvement in life expectancies since the 1990's
Cystic Fibrosis: Etiology
- Autosomal recessive genetically transmitted disorder
- For a child to have CF, both parents must be carriers or have CF
Cystic Fibrosis: Etiology
- CF gene on the long arm of chromosome 7
- Gene functions in transporting electrolytes (chloride, sodium, and water) in and out of epithelial cells in many organs
- Defective transport leads to thickened, difficult-to-move mucus
Cystic Fibrosis: Pathology
- Chronic pulmonary component related to abnormally viscous mucus
- Altered secretions cause airway obstruction and hyperinflation
- Partial or complete airway obstruction reduces ventilation to alveoli where ventilation and perfusion are not matched
- Leads to infection susceptibility
Cystic Fibrosis: Pathology
- Obstruction of bronchi predisposes to infections (pneumonia, fibrosis, and cystic dilations)
- Recent research explores high salt concentration as an inhibitor to immune response
- Pulmonary system dysfunction is a significant cause of morbidity and mortality in CF patients
Atelectasis
- Lung tissue collapse.
- Can range from asymptomatic to respiratory failure.
- Two types:
- Compression atelectasis: due to external pressure
- Absorption atelectasis: air removal from obstructed or hypoventilated alveolus
Bronchiectasis
- Chronic lung condition where bronchus walls thicken due to frequent infection and inflammation.
- Destroys elastic tissue and muscle in bronchi.
- Leads to abnormal dilatation, bronchospasm, copious mucus production, and subsequent ventilation-perfusion abnormalities
- Occurs in all CF patients over 0.5 years of age
Cystic Fibrosis: Clinical Presentation
- Initial presentation of CF stems from involvement of different organ systems: -Diabetes due to pancreatic dysfunction -Failure to thrive due to gastrointestinal dysfunction -Frequent pulmonary infections and chronic cough
- Specific to lung function: -Thick secretions (difficult to clear) -Barrel-shaped chest wall (hyperinflation) -Decreased breath sounds with wheezing and crackles upon auscultation -Pursed-lip breathing, cyanosis, digital clubbing
Restrictive Lung Disease
- Group of diseases of varying etiologies leading to difficulty expanding the lungs and reduced lung volume
- Characteristics include: difficulty expanding lungs, reduced lung volume, and reduced lung capacities.
RLD: Epidemiology
- Adults aged 35-44 have 2.7 cases per 100,000 people
- Patients over 75 have >175 cases per 100,000 people
Restrictive Lung Disease: Etiology
- Caused by harmful effects of: -Radiation therapy, inorganic dusts (metal/minerals), noxious gases, asbestos exposure, and tuberculosis
- Idiopathic pulmonary fibrosis is most common
Restrictive Lung Disease: Pathophysiology
- Usually begins with inflammation, leading to thickening of alveolar walls (interstitium) and fibrosis of distal air spaces
- Distal air spaces become fibrotic and more resistant to expansion (increased stiffness)
- This differs from increased compliance in COPD
What is the Interstitium?
- The complex structural space between the airspace epithelium and the vascular endothelium in the lungs.
Role of the Interstitium
- Separates and binds vascular and pleural cell layers
- Includes connective tissue, immune cells, and communicates with the lymphatic system
- Provides integrity yet allows for deformation
RLD Symptoms
- Major symptom is shortness of breath (dyspnea)
- Cough is nonproductive
- Weakness and fatigue
- Limited chest expansion
- Rapid, shallow breathing
Elastic & Air Flow Resistive Components of Breathing
- Shows total work minimized by slow deep breathing in a normal lung, increased elastic resistance and air flow resistance in restrictive disease
- Diagram illustrates how total work in breathing is minimized by rapid shallow breathing
Lung Capacity : RLD vs Normal
- Illustrates TLC, VC, and FRC reduced in restrictive lung diseases compared to normal findings
Summary of Chronic Pulmonary Disease
- Presents a tabular summary of different pulmonary conditions with their corresponding etiologies, pathology, and primary symptoms.
Studying That Suits You
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Description
Test your knowledge on asthma and chronic obstructive pulmonary disease (COPD) with this quiz. It covers key concepts such as inflammatory responses, airway narrowing, and patient characteristics. Challenge yourself with questions about triggers, pathology, and ventilation abnormalities.
