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Pathophys II - Block 1 > COPD: Emphysema and Chronic bronchitis > Flashcards

COPD: Emphysema and Chronic bronchitis Flashcards

1
Q

characterized by an increase in resistance to airflow due to partial or complete obstruction at any bronchial level

A

obstructive airway disease

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2
Q

Can obstructive airway disease be partial or only complete?

A

partial or complete

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3
Q

What does FEV1 mean?

A

forced expiratory volume in 1 second

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4
Q

What happens to FEV1 with obstructive airway disease? What about FVC?

A

decreased FEV1

normal FVC

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5
Q

What does decreased FEV1 mean regarding air exiting the lungs?

A

Less air exits lungs per unit time

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6
Q

Major obstructive airway diseases

A
  • emphysema

- chronic bronchitis

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7
Q

Obstructive pulmonary disease causes chronic ________.

A

Obstructive pulmonary disease causes chronic inflammation.

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8
Q

Obstructive pulmonary diseases are chronic ___-_______ inflammatory disorders.

A

Obstructive pulmonary diseases are chronic cell-mediated inflammatory disorders.

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9
Q

What do these chronic cell-mediated inflammatory disorders activate and release?

A
  • activated T cell, macrophages, and neutrophils

- release cytokines

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10
Q

What are some examples of the cytokines released?

A
  • leukotriene B4

- TNF

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11
Q

What does the chronic inflammation cause variable degrees of?

A
  • Inflammatory mucous secretion

- Tissue remodeling and fibrosis

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12
Q

What is tissue remodeling and fibrosis due to?

A

due to cycles of phagocyte lysosomal protease release and subsequent tissue repair

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13
Q

With chronic inflammation, what do activated macrophages and neutrophils secrete?

A

lysosomal enzymes and oxygen free radicals

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14
Q

What are normally inhibited by circulating protease inhibitors, e.g., α1-antitrypsin?

A

lysosomal proteases

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15
Q

What happens when there are oxygen free radicals present from activated phagocytes or conditions of oxidant stress?

A

oxygen free radicals inactivate α1-antitrypsin

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16
Q

What effect does inactivating α1-antitrypsin inflammation and remodeling of alveolar walls have?

A

Inactivating α1-antitrypsin means that lysosomal proteases are not inhibited and therefore cause prolonged activation of lysozomal enzymes

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17
Q

What does prolonged activation of lysosomal enzymes result in?

A

inflammation and remodeling of alveolar walls

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18
Q

What are emphysema and chronic bronchitis also known as?

A

chronic COPD

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19
Q

What structures does emphysema affect?

A
  • alveoli

- terminal bronchioles

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20
Q

What structures does bronchiolitis affect?

A

-bronchioles

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21
Q

What structures does bronchitis affect?

A

-larger airways

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22
Q

What is the primary cause of chronic COPD?

A

cigarette smoking

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23
Q

What are some other causes of chronic COPD other than smoking?

A
  • environmental pollutants
  • related exposures
  • rare genetic cause
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24
Q

What is the name of the rare genetic cause for chronic COPD?

A

α1-antitrypsin deficiency

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25
Q

What is another chronic obstructive inflammatory disease of the lungs affecting large airways?

A

asthma

26
Q

What is asthma as known as?

A

reversible airway hyperreactivity

27
Q

What are some characteristics of pure chronic bronchitis - large airways?

A

large airways - trachea, bronchi

  • mucus hypersecretion
  • inflammation
28
Q

What are some characteristics of pure chronic bronchitis - small airways?

A

small airways - bronchioles

  • peribronchilar fibrosis
  • airway obstruction
29
Q

What are some characteristics of pure emphysema?

A

acinus (respiratory bronchioles, alveolar ducts, alveoli)

  • loss of elastic recoil
  • loss of surface area
30
Q

Characterized by permanent, abnormal enlargement of the alveoli (may include terminal bronchioles)

A

emphysema

31
Q

How does emphysema affect alveolar walls?

A

Destruction of alveolar walls with or without fibrosis

32
Q

Does emphysema tend affect upper or lower lobes more?

A

upper lobes more than lower lobes

33
Q

What happens to surface area with emphysema?

A

Reduction in surface area that is needed for gas exchange

34
Q

With emphysema, what happens to air in the alveoli and why?

A

Air becomes trapped due to obstruction and loss of alveolar recoil

35
Q

With emphysema, what is the result of air being trapped in the alveoli?

A

results in air accumulation and overall hyperinflation

36
Q

What does air accumulation and hyperinflation present as on physical exam?

A

increased AP chest diameter (“barrel chest”)

37
Q

How is emphysema classified and what are those categories?

A

Classified by its anatomic location:

  • Centriacinar (centrilobar)
  • Panacinar (panlobular)
  • Distal acinar (paraseptal)
38
Q

What are bullae and where do they usually form?

A

Bullae are large subpleural blebs, usually form near the apex

39
Q

What does a rupture of a bullae result in?

A

pneumothorax

40
Q

Patients who are _________ for α1-antitrypsin deficiency mutation are unable to
_______ proteases, resulting in tissue _________.

A

Patients who are homozygous for α1-antitrypsin deficiency mutation are unable to inactivate proteases, resulting in tissue destruction.

41
Q

What do patients with α1-antitrypsin deficiency markedly increased in developing?

A

COPD

42
Q

Patient with α1-antitrypsin deficiency can have early onset _________ between ages _________, especially in the presence of ________.

A

Patient with α1-antitrypsin deficiency can have early onset emphysema between ages 18-31, especially in the presence of smoking.

43
Q

What are some xray findings of emphysema? (7)

A
  • Air trapping causing hyperinflation (count > 10 ribs)
  • Hyperlucent lung fields (black, look “over-penetrated”)
  • Increased retrosternal air
  • Blebs
  • Flattening of diaphragms
  • Loss of peripheral vascular markings
  • Vertical heart (QRS axis closer to 90°)
44
Q

Is interstitial emphysema related to COPD or not?

A

NOT related to COPD

45
Q

occurs when air is forced into soft tissue

A

interstitial emphysema

46
Q

What are some examples of when interstitial emphysema occurs?

A
  • trauma

- cough with obstruction

47
Q

Inflammation of bronchi and trachea with hypersecretion of mucus

A

chronic bronchitis

48
Q

What does mucus hypersecretion cause?

A

airway obstruction

49
Q

What does inflammation of bronchi and trachea with hypersecretion of mucus result in? (3)

A
  • mucous gland hypertrophy
  • thickening of bronchiolar walls
  • loss of respiratory cilia
50
Q

What do people with chronic bronchitis have an increased risk of?

A

pneumonia

51
Q

The clinical diagnosis for chronic bronchitis is: Persistent ____ with ______ production for at least __ months in at least __ consecutive years (without other cause).

A

The clinical diagnosis for chronic bronchitis is: Persistent cough with sputum production for at least 3 months in at least 2 consecutive years (without other cause).

52
Q

What may chronic bronchitis lead to?

A

right heart failure (cor pulmonale)

53
Q

What is chronic bronchitis a risk factor for?

A

lung cancer due to increase in dysplastic changes in bronchiole epithelial cells

54
Q

What is chronic bronchitis sometimes associated with?

A

with intermittent bronchospasm and high pitched wheezing

55
Q

What is another name for an intermittent bronchospasm and high pitched wheezing?

A

chronic asthmatic bronchitis

56
Q

What are some xray findings for chronic bronchitis?

A

Nonspecific signs:

  • Increased lung markings
  • Kerley lines (type A, B, C; thin linear opacities caused by fluid infiltration into the lung interstitium)
  • Bronchial wall cuffing
57
Q

Can chronic bronchitis be diagnose radiologically?

A

YES

58
Q

What can CXR be helpful in doing for chronic bronchitis?

A

CXR helpful to exclude other conditions which can clinically mimic the disease (e.g., bronchiectasis)

59
Q

What are the components of evaluation of emphysema and chronic bronchitis?

A
  • history and PE
  • spirometry
  • CXR, CT
  • oximetry, arterial blood gas, acid-base assessment
  • CBC
  • serum α1-antitrypsin activity
60
Q

What does spirometry usually show for COPD?

A
  • reduced FEV1

- +/- normal FVC

61
Q

What does CBC usually show for COPD?

A

usually normal, may show polycythemia secondary to hypoxia

62
Q

What population would you particularly consider assessing serum α1-antitrypsin activity?

A

nonsmokers < 40 years old, earlier for smokers

Pathophys II - Block 1 (8 decks)

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