Emphysema Pathogenesis and Mechanisms

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Questions and Answers

What type of cells are primarily involved in the release of proteases that contribute to emphysema pathogenesis?

  • Macrophages only
  • Neutrophils only
  • Inflammatory cells and epithelial cells (correct)
  • Epithelial cells only

Which of the following is NOT a factor that contributes to the development of emphysema?

  • Increased levels of antiproteases (correct)
  • Oxidative stress from cigarette smoke
  • Genetic predisposition
  • Release of inflammatory mediators

Which of the following inflammatory mediators is implicated in the development of emphysema?

  • Leukotriene B4 (correct)
  • Epinephrine
  • Thyroid hormone
  • Insulin

What is the role of al-antitrypsin in emphysema pathogenesis?

<p>It inhibits the activity of proteases. (C)</p> Signup and view all the answers

Which of the following is a characteristic of emphysema pathogenesis?

<p>Destruction of alveolar walls (A)</p> Signup and view all the answers

What is the primary role of the chemokine IL-8 in the pathogenesis of emphysema?

<p>To recruit additional inflammatory cells to the lungs. (C)</p> Signup and view all the answers

How does the presence of reactive oxygen species (ROS) contribute to emphysema development?

<p>ROS contribute to tissue damage and inflammation. (C)</p> Signup and view all the answers

Which of the following statements about the role of infection in emphysema pathogenesis is true?

<p>Infections can cause acute exacerbations of emphysema. (B)</p> Signup and view all the answers

What distinguishes centriacinar emphysema from other types?

<p>It involves the central or proximal parts of the acini. (C)</p> Signup and view all the answers

Which type of emphysema is most commonly associated with cigarette smoking?

<p>Centriacinar Emphysema (A)</p> Signup and view all the answers

In which region of the lungs does panacinar emphysema most commonly occur?

<p>Lower lung zones (B)</p> Signup and view all the answers

What is a characteristic finding in distal acinar emphysema?

<p>Presence of cystic structures (D)</p> Signup and view all the answers

Irregular emphysema is primarily associated with what feature?

<p>Scarring of lung tissue (C)</p> Signup and view all the answers

Which demographic is most likely to present with distal acinar emphysema?

<p>Young adults (D)</p> Signup and view all the answers

What is the primary cause of lung damage leading to emphysema?

<p>Inhalation of noxious particles (A)</p> Signup and view all the answers

What type of emphysema is characterized by lesions more commonly found in the upper lobes?

<p>Centriacinar Emphysema (B)</p> Signup and view all the answers

What percentage of the US population is homozygous for the Z allele associated with decreased serum levels of alpha-1 antitrypsin?

<p>0.01% (B)</p> Signup and view all the answers

Which of the following factors significantly increases the risk of developing symptomatic panacinar emphysema?

<p>Cigarette smoking (A)</p> Signup and view all the answers

Which statement best describes emphysema?

<p>It involves permanent enlargement of air spaces with wall destruction. (C)</p> Signup and view all the answers

What is the term for the small clusters of three to five acini in the lung structure?

<p>Lobules (D)</p> Signup and view all the answers

Which of the following is NOT a pattern of emphysema?

<p>Axial (D)</p> Signup and view all the answers

What proportion of heavy smokers develops chronic obstructive pulmonary disease (COPD)?

<p>35% to 50% (D)</p> Signup and view all the answers

Which condition is primarily associated with protease-mediated damage of the extracellular matrix?

<p>Emphysema (B)</p> Signup and view all the answers

What is the leading cause of death worldwide that is associated with COPD?

<p>Chronic respiratory diseases (D)</p> Signup and view all the answers

Flashcards

Pathogenesis of Emphysema

The process leading to emphysema, impacted by smoking, genetic factors and oxidative stress.

Oxidative Stress

Tissue damage caused by reactive oxygen species from smoke and inflammatory cells.

Protease-Antiprotease Imbalance

Discrepancy between destructive enzymes (proteases) and protective ones (antiproteases) in emphysema.

Inflammatory Mediators

Substances like IL-8 and TNF that recruit inflammatory cells and amplify the immune response.

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Alveolar Wall Destruction

The breakdown of lung structure leading to loss of function in emphysema patients.

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a1-antitrypsin Deficiency

A genetic condition that increases susceptibility to emphysema due to lack of protective protein.

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Role of Inflammation in Emphysema

Inflammation drives cell recruitment and changes that contribute to lung damage.

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Airway Infection Impact

Infections may worsen emphysema but are not the cause of lung damage.

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Centriacinar Emphysema

A type of emphysema involving central acini, sparing distal alveoli, common in smokers.

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Panacinar Emphysema

Uniform enlargement of acini, affecting lung zones more in the lower part, linked to alpha-1 antitrypsin deficiency.

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Distal Acinar Emphysema

Affects the acinus distal to the respiratory bronchiole, often found near pleura, and can lead to bullae.

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Irregular Emphysema

Emphysema where acinus involvement is uneven, usually associated with scarring and clinically insignificant.

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Chronic Bronchitis

A long-term inflammation of the bronchi, often associated with smoking and can occur with centriacinar emphysema.

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Alpha-1 Antitrypsin Deficiency

A genetic deficiency that can lead to panacinar emphysema due to lack of protection against lung tissue damage.

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Bullae

Enlarged air spaces in the lungs often caused by emphysema; can form from distal acinar changes.

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Spontaneous Pneumothorax

A sudden collapse of the lung often noted in young adults due to conditions like distal acinar emphysema.

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Pi locus

A genetic location associated with serum levels of alpha-1 antitrypsin.

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COPD

Chronic Obstructive Pulmonary Disease, characterized by persistent respiratory symptoms and airflow limitation.

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Risk factors for COPD

Include smoking, poor lung development, environmental exposure, and genetic factors.

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Emphysema classification types

Four patterns: centriacinar, panacinar, distal acinar, irregular.

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Airway obstruction in emphysema

Caused by protease-mediated damage to the extracellular matrix leading to loss of elastic tissue.

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Study Notes

Emphysema Pathogenesis

  • Emphysema results from parenchymal destruction, influenced by factors like inflammation, protease-antiprotease imbalance, and oxidative stress.
  • Inflammatory mediators (e.g., leukotriene B4, IL-8, TNF) recruit inflammatory cells (neutrophils, macrophages, T-cells) and trigger tissue damage.
  • Proteases released from inflammatory cells break down connective tissues. A deficiency in antiproteases (like α1-antitrypsin) exacerbates this process.
  • Oxidative stress from cigarette smoke and other particles further stimulates reactive oxygen species release, contributing to tissue damage.
  • Airway infections can trigger acute exacerbations, though they don't directly cause the initial destruction.

Protease-Antiprotease Imbalance

  • α1-antitrypsin, a protease inhibitor, is crucial for protecting lung tissue.
  • Inherited α1-antitrypsin deficiency markedly increases the risk of emphysema, often presenting in younger individuals, particularly if those individuals smoke.
  • This deficiency is encoded on chromosome 14, and the Z allele is associated with decreased α1-antitrypsin levels.
  • The homozygous Z allele is linked to emphysema development, particularly if smoking ensues.

Types of Emphysema

  • Centriacinar (centrilobular): Affects the central regions of acini (clusters of alveoli) in the respiratory bronchioles; typically occurs in smokers.
  • Panacinar (panlobular): Homogenous enlargement of the acini from respiratory bronchioles to the alveoli. Frequently linked with α1-antitrypsin deficiency.

Additional Emphysema Factors

  • Smoking: A major risk factor; compounds the effects of other factors like α1-antitrypsin deficiency.
  • Other Factors (e.g., genetic polymorphisms, airway hyperresponsiveness) also contribute to COPD-related emphysema.

Alveolar Structure and Damage

  • The acinus is a fundamental lung unit that has respiratory bronchioles, alveolar ducts, and alveoli.
  • Emphysema involves the destruction of alveoli and the enlarging of airspaces, impairing lung elasticity and causing airflow obstruction.
  • Distal acinar type features airspaces near the pleura. Irregular emphysema displays scattered enlarged airspaces.

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