Pathology of Obstructive Lung Diseases

Question 1

Name 3 types of obstructive airway diseases

Answer 1

Chronic Bronchitis
Emphysema
Asthma

Question 2

What is Chronic Bronchitis and emphysema better known as

Answer 2

Chronic Obstructive Pulmonary Disease (COPD)

Question 3

What is FEV1

Answer 3

The Forced Expiratory Volume of air that can exit the lung in the first second after taking a deep breath in

Question 4

What is FVC

Answer 4

Forced vital capacity

The final total amount of air expired

Question 5

How much of FEV1 makes up FVC

Answer 5

About 70-80%

Question 6

What is the normal FEV1 in litres

Answer 6

3.5 - 4 L

Question 7

What is the normal FVC in litres

Answer 7

5 L

Question 8

What is the normal FEV1:FVC ratio

Answer 8

0.7-0.8

Question 9

What is predicted FVC based on

Answer 9

Age, sex and height

Question 10

How can the obstructed lung disease be demonstrated

Answer 10

Using PEFR (Peak Expiratory Flow Rate)

Question 11

What is a normal PEFR in litres

Answer 11

400-600 litres/min

Question 12

What is considered the normal range for PEFR

Answer 12

80-100% of best values

Question 13

What is considered a moderate fall for PEFR

Answer 13

50-80% of best values

Question 14

What is considered a marked fall for PEFR

Answer 14

Under 50% of best values

Question 15

What is the main limitation caused by obstructive lung disease

Answer 15

Aiflow limitations

Question 16

What happens to the PEFR, FEV1 and FVC values in obstructive lung diseases

Answer 16

PEFR and FEV1 is reduced
FVC may be reduced
FEV1 is less than 70% of FVC

Question 17

What type of hypersensitivity does bronchial asthma have

Answer 17

Type 1 hypersensitivity of the airway

Question 18

What occurs in bronchial asthma

Answer 18

Simultaneous contraction of smooth muscle and inflammation

Question 19

What is the identifying factor of bronchial asthma

Answer 19

Its reversibility

Question 20

Why is bronchial asthma considered a reversible airway obstruction

Answer 20

As it can be reversed spontaneously or with medical intervention

Question 21

What can mimic bronchial asthma in adults

Answer 21

Chronic bronchitis

Question 22

What are the causes of chronic bronchitis and emphysema

Answer 22

Smoking
Atmospheric Pollution
Occupation: dust

Question 23

What is an extremely rare cause of emphysema

Answer 23

Alpha-1-antiprotease (antitrypsin) deficiency

Question 24

Why is chronic bronchitis more common in the elderly

Answer 24

As these conditions are caused by the buildup of pollution and smoking which will cause these individuals to become more susceptible

Question 25

Why is chronic bronchitis and emphysema more common in men

Answer 25

Due to higher patterns of smoking in men and their occupation

Question 26

In what type of countries are chronic bronchitis and emphysema increasing

Answer 26

Developing countries

Question 27

What is the clinical definition of chronic bronchitis

Answer 27

Cough productive of sputum most days in at least 3 consecutive months for 2 or more consecutive years (excludes TB, bronchiectasis etc)

Question 28

When is chronic bronchitis considered chronic

Answer 28

When it becomes mucopurulent (acute infective exacerbation) or FEV1 falls below 0.7

Question 29

What morphological changes occur in the large airways in chronic bronchitis

Answer 29

Mucous gland hyperplasia Goblet cell hyperplasia Minor component of inflammation and fibrosis

Question 30

What morphological changes occur in the small airways in chronic bronchitis

Answer 30

Goblet cells appear | Inflammation and fibrosis in long standing disease

Question 31

What is the pathological definition of emphysema

Answer 31

An increase beyond the normal in the size of airspaces distal to the terminal bronchiole arising either from dilatation or from destruction of their walls and without obvious fibrosis

Question 32

What is emphysema

Answer 32

The loss of lung tissue due to the destruction of alveolar walls

Question 33

Name the 4 different types of emphysema

Answer 33

Centriacinar Panacinar Periacinar Scar (‘irregular’ and ‘Bullous emphysema’)

Question 34

What is centriacinar emphysema associated with

Answer 34

Smoking

Question 35

What does centriacinar emphysema begin with

Answer 35

Bronchiolar dilatation then causes alveolar tissue to be lost

Question 36

What does panacinar emphysema cause and where is it mainly found

Answer 36

A massive loss of lung tissue and predominates in the lower zones of lungs

Question 37

What is a bulla

Answer 37

Emphysematous space greater than 1cm

Question 38

What is a bleb

Answer 38

The space just underneath the pleura

Question 39

What does periacinar emphysema tend to affect

Answer 39

The acinar that are near the pleura by forming a bleb which can burst causing a pneumothorax

Question 40

How do people with emphysema find it easier to breath

Answer 40

Find it easier to breath while retaining a small amount of air in their lungs

Question 41

What is constantly present in low levels in alpha 1 antitrypsin deficiency

Answer 41

Anti-elastase

Question 42

What is increased and decreased in smoking

Answer 42

``` Increased: Neutrophils Macrophages Elastases Decreased: Anti-elastases Repair mechanism elastin synthesis ```

Question 43

How do the large airways contribute to airway obstruction in COPD

Answer 43

There is a small contribution by the glands and mucous

Question 44

How do the small airways contribute to airway obstruction in COPD

Answer 44

``` Through: Smooth muscle tone Inflammation Fibrosis Partial collapse of airway walls on expiration ```

Question 45

Which part of the small airways in COPD is able to respond to pharmacological intervention

Answer 45

Smooth muscle tone | Inflammation

Question 46

What causes airflow limitation in emphysema

Answer 46

Loss of alveolar attachment

Question 47

What does alveolar hypoventilation cause

Answer 47

Type 2 respiratory failure