Flashcards in Obstructive Lung Disease Deck (13):
Identify the major types of lung diseases manifest by
airflow obstruction and their anatomic correlation (i.e. bronchi vs. bronchioles)
•Asthma - Bronchioles
•COPD (Emphysema, Chronic Bronchitis)- Alveolar sacs
•Bronchitis - Bronchi
•Bronchiolitis - Respiratory Bronchioles
•Upper Airway Obstruction - Trachea
Describe how the function of the diaphragm is impaired in
obstructive lung diseases and how this further contributes to decreased airflow
At the same level of muscle tension, a flat diaphragm generates less inspiratory pressure due to the increased radius of curvature.
Alternatively, in order to generate the same intrapleural pressure, the diaphram must generate more tension than at lower radii of curvature
Identify how broncho-provocation testing may be helpful in evaluating suspected asthma (including methacholine and exercise testing)
Bronchoprovocation can detect occult asthma (or exclude the diagnosis).
Chronic inflammatory disorder of the airways. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of
wheezing, breathlessness, chest tightness, and coughing
particularly at night or in the early morning. Inflammation by mast cells, esosinophils, T-cells, macrophages and neutrophils. There is ncrease in airway smooth muscle cells, Blood vessel proliferation and Mucus hype-
secretion in the context of increased number of goblet cells and increase size of submucosal glands.
REVERSIBLE with albeuterol
Asthma severity determination
Intermittent; Symptoms ≤ 2x per week, asymptomatic between episodes. Nighttime episodes less than 2x/mo
Mild: more than 2x/wk but less than once a day
Moderate: Daily symptoms, Nighttime episodes more than once a week
Severe: Continual symptoms, Nightly episodes
Treatment of Asthma
Reduce airway tone:
*beta-agonists (salmeterol, formoterol)
*anti-cholinergic (pratoprium, tiotropium)
*leukotriene inhibitor (montelukast; zileuton)
*corticosteroids: oral, inhaled, or intravenous
*mast cell stabilizers (cromolyn; nedocromil)
*Anti-Ig E therapy
Defined by irreversible airflow limitation FEV/FVC
Defined clinically as a productive cough present for three months per year over a two-year period without another identified medical cause such as bronchiectasis
Mucosal glands are hypertrophied and increased in number, and Goblet cell frequency is increased and smooth muscle cell size and number may be increase
Abnormal, permanent enlargement of the air spaces
distal to terminal bronchioles accompanied by destruction of their walls without obvious fibrosis.
NOT reversible and it is primarily a disease of the air spaces. Airflow obstruction occurs due to airway collapse
during expiration not due to edema or to an increased in smooth muscle tone.
Chronic Bronchitis vs Emphysema
Chronic bronchitis is a disease of the airways. This differentiates it from emphysema which is a parenchymal disease caused by loss of tissue elastic recoil.
In chronic bronchitis the integrity of the alveolar-capillary
surface is maintained
Diagnosis made clinically based on chronic daily cough with sputum production in the context of radiographic evidence of bronchial wall thickening and luminal dilation on chest CT. ilation commonly is associated with chronic bacterial infection and frequently with production of large quantities of foul-smelling sputum
Treatment should start with treating the underlying condition
Nonspecific inflammatory injury that affects the small
airways (less than 2mm in diameter). The auscultatory
hallmark of bronchiolitis is the inspiratory squeak, which is probably due to shear stress developed upon late opening
of inflamed bronchioles.
Infectious bronchiolitis can be a serious problem in children resulting in long-term pulmonary disease particularly airflow obstruction. Commonly RSV