Obstructive Lung Disease Overview

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Questions and Answers

What happens to the forced expiratory volume in the first second (FEV1) in obstructive lung disease?

  • It decreases less than forced vital capacity (FVC).
  • It increases significantly.
  • It decreases more than forced vital capacity (FVC). (correct)
  • It remains unchanged.

How does obstructive lung disease affect residual volume and total lung capacity?

  • Residual volume decreases while total lung capacity increases.
  • Both increase from normal values. (correct)
  • Both are unchanged from normal values.
  • Both decrease from normal values.

Which is a key distinguishing feature of obstructive lung disease compared to restrictive lung disease?

  • Decreased airway resistance.
  • Increased forced expiratory flow rate.
  • Decreased residual volume.
  • Increased lung capacity. (correct)

What is the effect of obstruction on airflow during expiration in obstructive lung disease?

<p>Airflow is decreased and slow during expiration. (C)</p> Signup and view all the answers

What is the hallmark of obstructive lung disease regarding the FEV1/FVC ratio?

<p>The ratio is less than normal. (B)</p> Signup and view all the answers

Why is it that total lung capacity is increased in obstructive lung disease?

<p>Due to the lungs' inability to deflate fully. (B)</p> Signup and view all the answers

What typically happens to the force vital capacity (FVC) in obstructive lung disease?

<p>It decreases due to reduced airflow. (C)</p> Signup and view all the answers

What is the primary physiological reason for the increase in residual volume in obstructive lung disease?

<p>Air trapping due to airflow obstruction. (D)</p> Signup and view all the answers

What is the primary genetic inheritance pattern of Kartagener's syndrome?

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

Which protein is primarily involved in the abnormalities seen in Kartagener's syndrome?

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

What is a characteristic organ positioning observed in patients with Kartagener's syndrome?

<p>Situs inversus (A)</p> Signup and view all the answers

In patients with allergic bronchopulmonary aspergillosis (ABPA), which immune marker is often elevated?

<p>IgE levels (A)</p> Signup and view all the answers

Which condition is least likely to be associated with bronchiectasis?

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

What kind of fungal infection is associated with allergic bronchopulmonary aspergillosis?

<p>Aspirgillus fumigatus (C)</p> Signup and view all the answers

What is a common respiratory symptom in children with Kartagener's syndrome?

<p>Chronic cough (C)</p> Signup and view all the answers

What is an abnormal laboratory finding that may suggest ABPA in a patient with asthma?

<p>Blood eosinophilia (C)</p> Signup and view all the answers

Which of the following describes a structural issue in the cilia of patients with primary ciliary dyskinesia?

<p>Defective dynein arms (D)</p> Signup and view all the answers

Which term refers to the condition where internal organs are arranged in a mirror image of their normal positions?

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

What is the predominant location of emphysema damage in smokers?

<p>Upper lobes (C)</p> Signup and view all the answers

What leads to air trapping in emphysema?

<p>Loss of elastic recoil (C)</p> Signup and view all the answers

In patients with antitrypsin deficiency, emphysema damage is primarily where?

<p>Panacinar region (C)</p> Signup and view all the answers

What physiological change occurs in emphysema that contributes to hyperventilation?

<p>Decreased area for gas exchange (C)</p> Signup and view all the answers

Which physical presentation is classic for patients with emphysema?

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

What type of damage occurs in smokers’ lungs regarding emphysema classification?

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

The term 'acinus' in lung anatomy refers to which structure?

<p>Bronchial and alveolar unit (A)</p> Signup and view all the answers

Which condition is classified as a type of obstructive lung disease alongside emphysema?

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

Which disorder is characterized by a reversible response to bronchodilators?

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

What occurs to the functional residual capacity (FRC) in emphysema?

<p>It increases (C)</p> Signup and view all the answers

What is the Reid Index used to measure?

<p>Ratio of mucus secreting glands to total wall thickness (D)</p> Signup and view all the answers

What key finding is indicative of emphysema in lung tissue specimens?

<p>Large air spaces with thin septa (C)</p> Signup and view all the answers

What physiological consequence is NOT typically associated with chronic bronchitis?

<p>Increased lung elasticity (B)</p> Signup and view all the answers

What is the primary cause of airways closing due to mucus in chronic bronchitis?

<p>Mucus plugs preventing airflow (D)</p> Signup and view all the answers

What distinguishes 'pink puffers' from 'blue bloaters'?

<p>Cyanosis vs. hyperventilation (B)</p> Signup and view all the answers

In emphysema, what imbalance primarily leads to tissue destruction of alveoli?

<p>Overproduction of proteases (A)</p> Signup and view all the answers

Which factor primarily contributes to the increased energy expenditure in emphysema patients?

<p>Increased work of breathing (D)</p> Signup and view all the answers

In emphysema, which physiological process occurs when air is exhaled?

<p>Small airways collapse due to pressure (A)</p> Signup and view all the answers

What common symptom is associated with both chronic bronchitis and emphysema?

<p>Cyanosis (C)</p> Signup and view all the answers

What main mechanism leads to hypoxemia in chronic bronchitis?

<p>Mucus blocking alveoli (A)</p> Signup and view all the answers

What initial clinical symptom is often seen in emphysema patients?

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

How does chronic bronchitis affect ventilation in the lungs?

<p>Impairs effective ventilation (D)</p> Signup and view all the answers

Which disorder is primarily associated with smoking as a main risk factor?

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

What occurs in the lungs when there is not enough ventilation due to chronic bronchitis?

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

What is the expected impact of administering 100% oxygen to a patient with chronic bronchitis who has significant shunting?

<p>Minimal contribution to improving hypoxemia (B)</p> Signup and view all the answers

Which is NOT a common sign observed in patients with chronic bronchitis?

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

Which disorder among the following is characterized by gradual tissue destruction and loss of alveolar integrity?

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

What leads to the narrowing of airways in chronic bronchitis?

<p>Hypertrophy of mucus-secreting glands (D)</p> Signup and view all the answers

What distinguishes patients with severe asthma from those with COPD?

<p>Severe asthma may progress to COPD if untreated. (B)</p> Signup and view all the answers

In patients with alpha-1 antitrypsin deficiency, which lung condition is primarily associated?

<p>Panacinar emphysema (A)</p> Signup and view all the answers

Which symptom is characteristically associated with both chronic obstructive pulmonary disease (COPD) and severe asthma?

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

What can lead to lung damage in alpha-1 antitrypsin deficiency?

<p>Deficient levels of antitrypsin (B)</p> Signup and view all the answers

Which of the following conditions is NOT commonly associated with asthma?

<p>Cystic fibrosis (A)</p> Signup and view all the answers

Which language describes the primary difference between asthma and COPD in terms of bronchial response?

<p>Asthma symptoms resolve completely after an episode. (B)</p> Signup and view all the answers

Why should patients with alpha-1 antitrypsin deficiency avoid smoking?

<p>It stimulates neutrophil elastase production. (B)</p> Signup and view all the answers

What is the primary mechanism responsible for aspirin exacerbated respiratory disease?

<p>Dysregulation of arachidonic acid metabolism (C)</p> Signup and view all the answers

In which age group is COPD commonly diagnosed compared to alpha-1 antitrypsin deficiency?

<p>Patients with alpha-1 antitrypsin deficiency are typically diagnosed in their 40's or younger. (A)</p> Signup and view all the answers

What symptom may indicate a trigger for asthma exacerbations?

<p>Upper respiratory infections (A)</p> Signup and view all the answers

Which class of medication is frequently used to treat aspirin exacerbated respiratory disease?

<p>Leukotriene receptor antagonists (C)</p> Signup and view all the answers

Which type of emphysema results from smoking?

<p>Centriacinar emphysema (C)</p> Signup and view all the answers

What occurs when individuals with severe alpha-1 antitrypsin deficiency have antitrypsin build up in the liver?

<p>They can develop liver cirrhosis. (D)</p> Signup and view all the answers

What happens to the I/E ratio in patients with asthma?

<p>It decreases due to prolonged expiratory phase (C)</p> Signup and view all the answers

Which of the following findings is associated with asthma and can be discovered in patients' sputum?

<p>Curschmann's spirals (D)</p> Signup and view all the answers

What condition can develop in severe untreated asthma, potentially leading to death?

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

During a methacholine challenge test, how is a positive result interpreted?

<p>FEV1 drops at a low dose (C)</p> Signup and view all the answers

What physiological effect predominates in bronchiectasis despite having dilated airways?

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

Pulsus paradoxus can occasionally occur in asthma; what does this denote?

<p>Drop in systolic blood pressure during inspiration (A)</p> Signup and view all the answers

What is a common symptom indicative of bronchiectasis?

<p>Foul-smelling sputum (D)</p> Signup and view all the answers

Which entity is NOT a common cause of bronchiectasis?

<p>Status asthmaticus (C)</p> Signup and view all the answers

What kind of challenge test can help clarify an ambiguous asthma diagnosis?

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

Which of the following findings mainly suggests the presence of eosinophils in asthma patients?

<p>Charcot-Leyden crystals (A)</p> Signup and view all the answers

What major complication is associated with chronic inflammation in bronchiectasis?

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

Which of the following conditions is recognized as a rare cause of bronchiectasis?

<p>Kartagener's syndrome (B)</p> Signup and view all the answers

In asthma patients, what contributes to mucus plugging?

<p>Increased parasympathetic activity (B)</p> Signup and view all the answers

What term describes the temporary dilation of airways due to chronic inflammation, which may occur in bronchiectasis?

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

In obstructive disease, there is air trapped inside the lungs because it can't get ______.

<p>out</p> Signup and view all the answers

The hallmark of obstructive disease is a reduced FEV1 to ______ ratio.

<p>FVC</p> Signup and view all the answers

With obstructive lung disease, both residual volume and total lung ______ increase.

<p>capacity</p> Signup and view all the answers

Obstructive lung disease can be thought of as a balloon with an obstruction at the ______.

<p>outlet</p> Signup and view all the answers

In obstructive lung disease, the total lung capacity can be ______ despite difficulties with airflow.

<p>increased</p> Signup and view all the answers

The opposite of obstructive disease is ______, where lung volumes decrease due to restriction.

<p>restrictive disease</p> Signup and view all the answers

The flow of air going out is ______ in obstructive lung disease due to airflow restriction.

<p>slow</p> Signup and view all the answers

In obstructive lung disease, there is a reduction in the forced expiratory volume in the first second (FEV1) due to ______.

<p>slow flow</p> Signup and view all the answers

Almost always, patients who have one of these disorders also have elements of the other, known as chronic obstructive pulmonary ______.

<p>disease</p> Signup and view all the answers

In smokers, emphysema damage is predominantly in the ______ lobes.

<p>upper</p> Signup and view all the answers

Most patients with asthma do not have COPD, but if asthma is left untreated, it eventually becomes a chronic disorder and then it is called ______.

<p>COPD</p> Signup and view all the answers

Patients with antitrypsin deficiency often have emphysema largely in the ______ lobes.

<p>lower</p> Signup and view all the answers

In patients with alpha-1 anti-trypsin deficiency, there could be decreased or dysfunctional ______.

<p>antitrypsin</p> Signup and view all the answers

Patients with alpha-1 anti-trypsin deficiency often experience panacinar ______.

<p>emphysema</p> Signup and view all the answers

In emphysema, destruction of the ______ leads to obstruction.

<p>alveoli</p> Signup and view all the answers

The most important protease balanced by antitrypsin is ______, found in neutrophils and alveolar macrophages.

<p>elastase</p> Signup and view all the answers

The classic appearance of emphysema is often described as ______ chest.

<p>barrel</p> Signup and view all the answers

Smokers often experience ______ damage in their lungs.

<p>centriacinar</p> Signup and view all the answers

A classic symptom of asthma is ______, which can occur in response to various triggers.

<p>wheezing</p> Signup and view all the answers

Aspirin exacerbated respiratory disease is characterized by asthma symptoms triggered by taking ______.

<p>aspirin</p> Signup and view all the answers

Patients with antitrypsin deficiency typically exhibit ______ damage.

<p>panacinar</p> Signup and view all the answers

In emphysema, ______ occurs leading to less area for gas exchange.

<p>hyperventilation</p> Signup and view all the answers

Asthma is often associated with allergic conditions like allergic ______ or eczema.

<p>rhinitis</p> Signup and view all the answers

The term 'acinus' in relation to the lungs refers to the ______ plus alveoli.

<p>bronchial</p> Signup and view all the answers

Children with asthma often experience exacerbations after an upper respiratory ______.

<p>infection</p> Signup and view all the answers

Patients with antitrypsin deficiency may also suffer from liver ______ due to protein accumulation.

<p>cirrhosis</p> Signup and view all the answers

Patients with chronic bronchitis are often referred to as ______ bloaters.

<p>blue</p> Signup and view all the answers

In patients with severe asthma, symptoms are often ______, meaning they can return to normal after an episode.

<p>reversible</p> Signup and view all the answers

Loss of ______ is a key factor in the development of barrel chest in emphysema.

<p>elastic recoil</p> Signup and view all the answers

The imbalance between neutrophil elastase and antitrypsin leads to ______ lung damage.

<p>lower</p> Signup and view all the answers

In emphysema, the ______ is increased due to air trapping.

<p>functional residual capacity</p> Signup and view all the answers

Bronchoconstriction in asthma is often due to some type of ______ stimulus.

<p>allergic</p> Signup and view all the answers

A hallmark symptom of emphysema is ______.

<p>dyspnea</p> Signup and view all the answers

The classical distinction between patients with chronic bronchitis and emphysema is referred to as ______ and pink puffers.

<p>blue bloaters</p> Signup and view all the answers

For patients with aspirin-exacerbated disease, treatment with a leukotriene receptor ______ is often effective.

<p>antagonist</p> Signup and view all the answers

Chronic obstructive pulmonary disease (COPD) includes conditions like chronic bronchitis and ______.

<p>emphysema</p> Signup and view all the answers

The four disorders mentioned are chronic bronchitis, emphysema, asthma, and ______.

<p>bronchiectasis</p> Signup and view all the answers

Patients with asthma experience shortness of breath, wheezing, and ______.

<p>cough</p> Signup and view all the answers

The I/E ratio in asthma patients can decrease to as low as ______ or even one to five.

<p>one to four</p> Signup and view all the answers

Asthma is characterized by a ______ response to bronchodilators, unlike other disorders.

<p>reversible</p> Signup and view all the answers

The device used to measure the highest velocity of airflow in asthma patients is called a ______.

<p>peak flow meter</p> Signup and view all the answers

Chronic bronchitis is defined by a chronic cough that produces sputum for at least three months over a period of ______.

<p>two years</p> Signup and view all the answers

Chronic bronchitis is strongly associated with ______.

<p>smoking</p> Signup and view all the answers

Curschmann's spirals are often found inside mucus ______ in asthma patients.

<p>plugs</p> Signup and view all the answers

A methacholine challenge tests for asthma by looking for a significant drop in ______.

<p>FEV1</p> Signup and view all the answers

The Reid Index measures the ratio of the thickness of mucus-secreting glands to the thickness of the entire ______.

<p>wall</p> Signup and view all the answers

In asthma, excessive mucus can lead to airway ______ and shunting.

<p>obstruction</p> Signup and view all the answers

In chronic bronchitis, excessive mucus can lead to ______, which impairs ventilation.

<p>mucus plugging</p> Signup and view all the answers

Pulsus Paradoxus can occur in asthma, causing a drop in systolic blood ______ with inspiration.

<p>pressure</p> Signup and view all the answers

Chronic bronchitis leads to poor ventilation, resulting in a rise of ______ levels in the blood.

<p>carbon dioxide</p> Signup and view all the answers

Hypoxic vasoconstriction in chronic bronchitis can lead to ______ hypertension.

<p>pulmonary</p> Signup and view all the answers

Bronchiectasis is characterized by permanently dilated ______.

<p>airways</p> Signup and view all the answers

Cyanosis in chronic bronchitis occurs as a result of ______.

<p>shunting</p> Signup and view all the answers

Patients with bronchiectasis commonly experience recurrent pulmonary ______.

<p>infections</p> Signup and view all the answers

Emphysema involves the destruction of tissue inside the ______.

<p>alveoli</p> Signup and view all the answers

Smoking is associated with bronchiectasis, but it is unclear if it directly causes ______.

<p>bronchiectasis</p> Signup and view all the answers

The balance between proteases and ______ is crucial for maintaining healthy lung tissue.

<p>anti-proteases</p> Signup and view all the answers

Cystic fibrosis in children can lead to recurrent lung infections and possibly ______.

<p>bronchiectasis</p> Signup and view all the answers

Kartagener's syndrome is a rare cause of ______ that patients need to be aware of.

<p>bronchiectasis</p> Signup and view all the answers

The most common type of emphysema is seen in ______.

<p>smokers</p> Signup and view all the answers

Chronic inflammation in bronchiectasis can lead to secondary ______.

<p>amyloidosis</p> Signup and view all the answers

In chronic bronchitis, administering 100% oxygen has limited effectiveness due to ______ physiology.

<p>shunt</p> Signup and view all the answers

Patients with chronic bronchitis often experience increased susceptibility to respiratory ______.

<p>infections</p> Signup and view all the answers

The thickened bronchial walls in bronchiectasis primarily affect the ______ and medium airways.

<p>small</p> Signup and view all the answers

Eosinophils and Charcot-Leyden crystals can be found in the sputum of asthma patients, alongside the ______ spirals.

<p>Curschmann's</p> Signup and view all the answers

Kartagener's syndrome is part of a group of conditions called primary ______ dyskinesia.

<p>ciliary</p> Signup and view all the answers

In patients with Kartagener's syndrome, the crucial motor protein affected is called ______.

<p>dynein</p> Signup and view all the answers

Patients with Kartagener's syndrome often develop ______ from poor ciliary function in the sinuses.

<p>chronic sinusitis</p> Signup and view all the answers

A classic presentation of Kartagener's syndrome includes situs ______ where the organs are reversed in position.

<p>inversus</p> Signup and view all the answers

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic reaction to the fungus ______.

<p>aspergillus</p> Signup and view all the answers

In patients with ABPA, a common laboratory finding is increased levels of ______ in the blood.

<p>eosinophilia</p> Signup and view all the answers

Cilia comprise a series of circular structures known as ______.

<p>spokes</p> Signup and view all the answers

Chronic bronchitis, emphysema, asthma, and ______ are the four causes of obstructive lung disease.

<p>bronchiectasis</p> Signup and view all the answers

A key characteristic of ciliary dyskinesia is that the cilia are unable to ______ or may be absent altogether.

<p>beat</p> Signup and view all the answers

In patients with ABPA, high levels of ______ are often observed during immunological assessments.

<p>IgE</p> Signup and view all the answers

Flashcards

Obstructive Lung Disease

Lung condition where air gets trapped and can't leave easily due to blocked airways.

Reduced FEV1/FVC Ratio

In obstructive lung disease, the percentage of forced expiratory volume (FEV1) to forced vital capacity (FVC) is significantly lower than normal.

Air Trapping

Air becomes trapped in the lungs during exhalation in obstructive lung disease because airways are blocked.

Increased Residual Volume

The amount of air remaining in the lungs at the end of exhalation increases in obstructive disease from trapped air.

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Increased Total Lung Capacity

The total volume of air lungs can hold in obstructive disease is higher due to air trapping and difficulty exhaling.

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Reduced FEV1

The amount of air forcefully exhaled in the first second is lower in obstructive lung disease due to restricted airflow.

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Reduced FVC

The total amount of air forcefully exhaled from the lungs in obstructive lung disease, is lower due to airway blockage.

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Obstructive vs. Restrictive

Obstructive diseases affect exhalation, leading to increased total lung capacity, while restrictive diseases affect inhalation, causing decreased total lung capacity.

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Chronic Bronchitis Definition

Chronic cough producing sputum for at least 3 months in 2 years, with no other cause.

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Chronic Bronchitis Cause

Strongly associated with smoking.

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Reid Index

Ratio of mucus gland thickness to total airway wall thickness in chronic bronchitis.

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Mucus Plugging

Airways blocked by excessive mucus, hindering lung ventilation.

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Obstructive PFTs

Respiratory tests showing airflow problems.

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Bronchodilators

Medications that open airways to improve breathing.

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Asthma Reversibility

Asthma improves with bronchodilators.

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COPD

Combination of chronic bronchitis and emphysema.

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Emphysema

Lung tissue destruction, usually due to protease-anti-protease imbalance.

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Proteases/Anti-proteases

Enzymes in lung tissue with opposite functions: proteases break down tissue while anti-proteases protect it.

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Smoking and Emphysema

Smoking causes an increase in proteases, leading lung tissue destruction.

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Shunting

Low oxygen blood flow past non-functioning alveoli, leading to low blood levels of oxygen.

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Hypoxia

Low blood oxygen levels.

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Pulmonary Hypertension

High blood pressure in the blood vessels of the lungs.

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Cor Pulmonale

Right-sided heart failure due to lung disease.

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Emphysema Damage Location (Smokers)

Damage in emphysema, primarily in the upper lobes of the lungs, due to smoke rising.

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Emphysema (Antitrypsin Deficiency)

Rare type of emphysema caused by a genetic condition, affecting lower lung lobes.

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Emphysema Alveoli Destruction

Emphysema involves the breakdown of air sacs (alveoli) in the lungs.

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Smokers Emphysema Macrophages

In smokers, smoke activates macrophages, which lead to neutrophil recruitment and protease release.

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Emphysema Elastic Recoil Loss

Loss of elastic recoil in the lungs due to alveoli destruction.

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Obstructive Lung Disease (Emphysema)

Emphysema causes small airway collapse during exhalation, trapping air in the lungs.

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Emphysema Clinical Findings

Emphysema symptoms include shortness of breath (dyspnea) and cough; less sputum than in chronic bronchitis.

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Emphysema Hyperventilation

Hyperventilation in emphysema is a response to gas exchange issues due to damaged alveoli.

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Emphysema Weight Loss

Emphysema patients may lose weight due to increased calorie burning from hyperventilation.

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Emphysema Barrel Chest

Barrel chest is a characteristic symptom of emphysema due to air trapping.

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Acinus in Lungs

The acinus is the functional unit within the lungs encompassing bronchioles and alveoli.

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Emphysema (Centrilobular)

Smoker's emphysema, concentrating damage in respiratory bronchioles.

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Emphysema (Panacinar)

Emphysema in patients with antitrypsin deficiency, encompassing damage to entire acini.

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COPD Definition

Chronic Obstructive Pulmonary Disease; a general term encompassing chronic bronchitis and emphysema.

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Blue Bloater vs Pink Puffer

Distinction between chronic bronchitis (blue bloater) and emphysema (pink puffer) patients.

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Chronic Obstructive Pulmonary Disease (COPD)

A group of lung diseases, including chronic bronchitis, emphysema, and severe, unremitting asthma. Characterized by persistent breathing problems.

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Asthma

A respiratory condition marked by recurring episodes of bronchospasm (narrowing of airways), wheezing, and difficulty breathing, usually triggered by allergies.

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Alpha-1 Antitrypsin Deficiency

An inherited disorder where the body doesn't produce enough or functional alpha-1 antitrypsin. This can leads to emphysema.

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Panacinar Emphysema

A form of emphysema where damage to alveoli occurs throughout the lung.

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Centriacinar Emphysema

A form of emphysema primarily affecting the central parts of the lung's alveoli. Related to smoking.

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Neutrophil Elastase

An enzyme that destroys elastin, a protein in lung tissue, in the absence of antitrypsin.

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Liver Cirrhosis

Severe scarring of the liver tissue, frequently caused by abnormal accumulation of alpha-1 antitrypsin in some cases.

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Reversible Bronchoconstriction

The narrowing of airways (bronchi) that can return to normal after an episode, as observed in asthma.

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Aspirin-Exacerbated Respiratory Disease

A rare form of asthma triggered by aspirin and other NSAIDs; chronic inflammation and lung reactivity involved.

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Leukotrienes

Molecules that contribute to inflammation and bronchoconstriction, particularly in aspirin-sensitive asthma.

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Montelukast (and Zafirlukast)

Leukotriene receptor antagonists used to treat aspirin-sensitive asthma.

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Allergic Stimulus

Substance triggering an allergic reaction, leading to asthma or allergies responses.

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Trigger for Asthma

Anything that causes an asthma attack, including upper respiratory infections, allergens, stress, and exercise.

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Asthma I/E Ratio

The ratio of inspiration time to expiration time is decreased in asthma. Normally it's around 1:2 to 1:3, but in asthma, it can become 1:4 or even 1:5 due to prolonged expiration.

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Reduced Peak Flow in Asthma

Peak flow is the maximum speed of air exhaled, measured using a peak flow meter. In asthma, peak flow is reduced because airways are narrowed, making it harder to push air out quickly.

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Mucus Plugging in Asthma

Thick mucus can build up and block airways in asthma, leading to further obstruction and even shunting (blood bypassing the lungs).

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Status Asthmaticus

Severe, persistent worsening of asthma that leads to hypoxia (low blood oxygen) and can be life-threatening. It requires immediate medical attention.

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Methacholine Challenge

A test used to diagnose asthma by administering the drug methacholine, which causes bronchoconstriction (narrowing of airways). If FEV1 (forced expiratory volume in 1 second) falls significantly, it's a positive test suggesting asthma.

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Curschmann's Spirals

These are distinctive, spiral-shaped structures often found in mucus plugs from asthma patients, formed by shed epithelial cells.

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Charcot-Leyden Crystals

These crystals, usually found in mucus or at autopsy, are made of eosinophil membrane proteins, often seen in asthma patients.

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Non-Cardiac Pulsus Paradoxus

A drop in systolic blood pressure during inspiration, not caused by heart problems. Asthma and COPD are rare, non-cardiac causes of this.

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Bronchiectasis

Permanent widening (dilation) of airways, usually caused by chronic inflammation and recurrent infections. It leads to airway obstruction despite the widened airways.

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Bronchiectasis - Causes

Common causes include recurrent pulmonary infections, smoking, cystic fibrosis. Rarer causes include Kartagener's Syndrome and allergic bronchopulmonary aspergillosis.

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Bronchiectasis Symptoms

Patients experience recurrent infections, cough, excessive foul-smelling sputum, sometimes hemoptysis (coughing up blood), hypoxia leading to cor pulmonale, and rarely amyloidosis.

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Bronchiectasis - Tumor Obstruction

Tumors in airways can block mucus flow, increasing infections and leading to bronchiectasis.

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Bronchiectasis - Smoking

Smoking is associated with bronchiectasis, possibly by causing recurrent infections and other lung damage.

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Bronchiectasis - Cystic Fibrosis

Patients with cystic fibrosis are prone to recurrent infections leading to bronchiectasis.

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Bronchiectasis - Rare Causes

Kartagener's syndrome and allergic bronchopulmonary aspergillosis are two rare causes of bronchiectasis.

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Primary Ciliary Dyskinesia

A group of inherited disorders where cilia, hair-like structures that move fluids, are unable to beat properly or are absent, affecting various organs.

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Dynein

A motor protein essential for cilia movement. Mutations in the dynein gene can cause Primary Ciliary Dyskinesia.

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Kartagener's Syndrome

A collection of symptoms related to Primary Ciliary Dyskinesia, including chronic sinus infections, lung problems (bronchiectasis), male infertility, and situs inversus.

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Situs Inversus

A condition where major organs in the chest and abdomen are reversed from their normal location.

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Allergic Bronchopulmonary Aspergillosis (ABPA)

An allergic reaction to the fungus Aspergillus fumigatus, common in people with asthma or cystic fibrosis.

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Eosinophilia

An increased number of eosinophils, a type of white blood cell, in the blood.

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High IgE Levels

Increased levels of Immunoglobulin E (IgE), an antibody involved in allergic responses.

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Brownish Mucus Plugs

Thick, dark mucus that blocks airways in patients with ABPA.

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Hemoptysis

Coughing up blood, often a symptom of ABPA.

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FEV1/FVC Ratio

The ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC). In obstructive lung disease, this ratio is significantly lower than normal because FEV1 is reduced more than FVC due to airflow obstruction.

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Residual Volume

The amount of air that remains in the lungs after a maximal exhalation. In obstructive lung disease, this amount is higher than normal due to air trapping.

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Total Lung Capacity

The total volume of air the lungs can hold. In obstructive lung disease, total lung capacity is increased due to air trapping.

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Causes of Obstructive Lung Disease

Common causes of obstructive lung disease include chronic obstructive pulmonary disease (COPD) which encompasses chronic bronchitis and emphysema, and asthma. Other rarer causes include bronchiectasis.

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What's the key to differentiating obstructive lung disorders?

The response to bronchodilators helps distinguish between asthma (reversible) and other obstructive lung diseases (irreversible, like chronic bronchitis, emphysema, and bronchiectasis).

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Chronic Bronchitis

A chronic cough producing sputum for at least 3 months over 2 years, with no other cause, strongly associated with smoking.

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Barrel Chest

Characteristic symptom of emphysema due to air trapping, causing the chest to expand.

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Emphysema Damage Location (Antitrypsin Deficiency)

Emphysema caused by antitrypsin deficiency, a rare genetic condition, predominantly occurs in the lower lobes of the lungs.

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Asthma Triggers

Factors causing asthma attacks, including upper respiratory infections, allergens, stress, and exercise.

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Causes of Bronchiectasis

Common causes include recurrent pulmonary infections, smoking, cystic fibrosis. Rarer causes include Kartagener's syndrome and allergic bronchopulmonary aspergillosis.

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Decreased I/E Ratio

In asthma, the time it takes to exhale is longer than normal, leading to a decreased ratio of inspiration time to expiration time.

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Reduced Peak Flow

The highest velocity of air a patient can exhale is lower in asthma due to airway obstruction.

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Study Notes

Obstructive Lung Disease

  • Obstructive lung diseases involve air trapping in the lungs due to impaired airflow.
  • Key feature: reduced FEV1/FVC ratio (FEV1 falls more than FVC).
  • Reduced forced expiratory volume (FEV1) and forced vital capacity (FVC).
  • Increased residual volume and total lung capacity.

Causes of Obstructive Lung Disease

  • Chronic Bronchitis:

    • Chronic productive cough (3+ months/2+ years).
    • Smoking strongly associated.
    • Hypertrophy of mucus-secreting glands (Reid index > 0.4).
    • Mucus plugging: blocks ventilation.
    • Impaired mucociliary clearance increases infection risk.
    • Physiologic consequences: increased CO2, decreased O2, hypoxic vasoconstriction, pulmonary hypertension, cor pulmonale.
    • Symptoms: cough, wheezing, crackles, dyspnea, cyanosis.
    • Shunting: blood bypasses functioning alveoli, resulting in hypoxemia.
    • 100% O2 may not fully correct hypoxemia.
  • Emphysema:

    • Destruction of alveoli.
    • Balance of proteases (destroyers) and antiproteases in the lung is disrupted.
    • Common type: Smoker's emphysema. Smoking activates elastase that overwhelms antitrypsin. Damage predominantly in upper lobes.
    • Rare type: Alpha-1 antitrypsin deficiency. Lack of antiproteases leads to lower lobe damage.
    • Physiologic consequences: Loss of elastic recoil, collapse of small airways, air trapping, reduced gas exchange.
    • Symptoms: dyspnea, cough (less sputum than bronchitis), hyperventilation (weight loss), cor pulmonale.
    • Barrel chest: a hallmark symptom caused by air trapping.
      • Acinus: the functional unit of the bronchus (part of the bronchial tree) and alveoli.
      • Centriacinar: Damage to the bronchioles.
      • Panacinar: Damage to the entire acinus.
  • Asthma:

    • Reversible bronchoconstriction.
    • Allergic stimulus, hyperresponsive airways.
    • Common in children, often with other allergies.
    • Triggers: infections, allergens (animal dander, dust mites), stress, exercise, cold.
    • Aspirin-exacerbated respiratory disease (rare subtype): asthma, sinusitis, polyps/ nasal obstruction; triggered by aspirin or NSAIDs, leukotriene overproduction.
  • Bronchiectasis:

    • Permanent dilation of airways due to chronic recurrent inflammation.

    • Recurrent infections are common causes and consequences.

    • Symptoms: cough, excessive sputum (foul-smelling), hemoptysis, cor pulmonale.

    • Multiple etiologies: obstructions, smoking, cystic fibrosis, Kartagener's syndrome, and allergic bronchopulmonary aspergillosis (ABPA).

    • ABPA: (Allergic bronchopulmonary aspergillosis).

      • Allergic to fungus aspergillus fumigatus.
      • Occurs in patients with asthma or cystic fibrosis.
      • Symptoms: exacerbation of asthma/CF symptoms, eosinophilia (increased eosinophil count).
      • Diagnosable with high IgE and testing for fungus.

Alpha-1 Antitrypsin Deficiency

  • Inherited disease with dysfunctional antitrypsin.
  • Alveolar macrophages and neutrophils have elastase, which destroys elastin.
  • Imparied antitrypsin = lower lung damage (different from smoker's emphysema).
  • Liver cirrhosis in some subtypes: abnormal accumulation of antitrypsin leads to liver damage.
    • Key distinguishing factor: younger patients with COPD compared to smokers.

Additional Concepts

  • COPD (Chronic Obstructive Pulmonary Disease): The modern term for chronic bronchitis and/or emphysema.
  • PFTs (Pulmonary Function Tests): A diagnostic tool to measure lung functions.
  • Bronchodilator: Improves lung functions in some obstructive conditions like asthma.
  • I/E ratio: The ratio of inspiration to expiration time, which is prolonged in asthma.
  • Peak Flow meter: measures the highest airflow velocity.
  • Methacholine challenge: A test to identify hyperreactive airways (asthma).
  • Curschmann's spirals and Charcot–Leyden crystals: Specific findings in asthma sputum.
  • Pulsus paradoxus: A decrease in systolic blood pressure during inspiration; a rare sign of asthma, COPD.
  • Situs inversus: (Kartagener's syndrome) organs are reversed in position.

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