Inflam & Lung Disease

Question 1

What immune mediated cells sit in the lamina propria?

Answer 1

Mast cells + macrophages

Lamina propria = loosely connected area of tissue under basement membrane

Question 2

What happens to the immunity in the inflamed airway?

Answer 2

Lamina propria becomes swollen + expands as other inflam cells recruited + more mucus produced

Question 3

What is COPD?

Answer 3

• Emphysema + bronchitis
• Progressive + irreversible airflow limitation
• Primary cause = abnormal inflam. in response to noxious gases + particles

Question 4

Define asthma

Answer 4

Reversible airflow limitation

Associated with allergy

Question 5

What effect do carbon particles have on airway epithelium?

Answer 5

Activate macrophages + irritates epithelium = produces cytokines

Question 6

Summarise the COPD inflam mechanisms

Answer 6

Macrophage activation > neutrophil + monocyte recruit > proteases > alveolar destruction, damage to cilia, mucus hyper-secretion > air trapping, increased infection, increased obstruction + reduced air flow

Epithelial cell activation > fibroblast prolif + CD8 & CTC recruit > collagen deposition scar, alveolar destruction (emphysema) > increased obstruction, reduced airflow + gas exchange

Question 7

What anti-inflam therapies are used for COPD?

Answer 7

Corticosteroids

• inhibits multiple inflam pathways
• increased risk pneumonia
• steroid resistance = problem

PDE4 inhibitors
- inhibits cAMP production in macrophages, neutrophils + eosinophils

Question 8

Summarise the asthma inflam mechanisms

Answer 8

Dendritic cells recognise allergens > CD4 + TH2 cell activation

> B cells secrete allergen specific IgE > mast cell activation by allergens > inflam lipids + cytokines + histamine > inflam cell recruitment + vasodilation increased permeability + SM contraction > inflam airway narrowing, bronchoconstriction

> Eosinophil recruit, airway activation > Cytotoxic proteins > Damage to epithelium > increased infection, increased sensitivity pollutants, tissue remodelling, membrane thickening, increased goblet and mucus

Question 9

What anti-inflam therapies are used for asthma?

Answer 9

Na cromoglicate/Nedocromil Na
- inhibits mast cell histamine release

Corticosteroids

Leukotriene receptor antagonists
- relax smooth muscle

Anti-IgE antibodies

• prevents IgE interaction with mast cells
• pt with severe persistent allergic disease

Question 10

What is cystic fibrosis?

Answer 10

• SNPs in Cl- anion channels CFTR = impaired
• Thick mucus in lungs + GI
• Impaired mucociliary action + neutrophil function = chronic infection + inflam

Question 11

How do neutrophils kill bacteria?

Answer 11

1. Oxidative mechanisms - produce ROS - target bacteria lipids + proteins within phagosome
2. Non-oxidative mechanism - proteases (e.g. elastase + MMPs) - target bacterial proteins within phagosome

Question 12

What are the consequences of excess protease activity?

Answer 12

• Degrade structural proteins
• Impaired ciliary function
• Increased protease expresion
• Impaired innate defense
• Pro-inflam

Question 13

What is the difference in the amount of macrophages and neutrophils in acute and chronic inflam response?

Answer 13

High levels of macrophages in acute

Longer duration of neutrophils in chronic

Question 14

What causes the yellow/green colour of sputum?

Answer 14

Myeloperoxidase = heme containing protein in neutrophils
Indicates inflam
Greener sputum = more neutrophils

Question 15

What are the anti-inflam therapies for CF?

Answer 15

Corticosteroids - alleviate wheezing

Ibuprofen