Pulmonary Defense Mechanisms - Bowden

Question 1

immunological barriers at the upper airway

Answer 1

Anatomical barriers 
Cough Reflex
Angulation
Mucociliary apparatus
airway epithelium 
IgA
DC, N, lymphocytes

Question 2

immunological barriers at the Alveolar spaces

Answer 2

Alveolar M (usually M2)
Type 1 an dType 2 cells
Clara cells (club cells)
Surfactant
Complement 
N and E

Question 3

branching of the bronchi and the bronchioles causes what

Answer 3

more deposition of the substance

Question 4

Cough Reflex

Answer 4

1. deep inspiration
2. glottis closes to trap air inside
3. rise in intrathoracic P (while trying to expire)
4. P buildup
5. sudden release of trapped air at high P = COUGH

Question 5

3 major functions of the epithelium

Answer 5

1. barrier
2. Defense towards pathogens : release of cytokines, bacteriostatic molecules
3. Translocate IgA (which is in mucus and binds to pathogens)

Question 6

Mucociliary Clearence

Answer 6

particles 2-3um to 10um get deposited in mucus (upper Airway)
Mucus has
1. IgA, lysozyme, lactoferrin, perioxidases
2. cilia on aqueous layer propelling stuff upward to be coughed or swallowed

Question 7

mucus contanis what

Answer 7

1. IgA, lysozyme, lactoferrin, perioxidases

2. cilia on aqueous layer propelling stuff upward to be

Question 8

defected mucociliary clearance is present in what

Answer 8

Asthma
COPD
chronic bronchitis
cystic fibrosis

Question 9

the airway normal has what immune cells present

Answer 9

Tregs (IL10, TGF-B)
DC (IL27, IL10, TGF-B)
M1 (IL10, TGF-B, IL27)

Question 10

first immune cell to appear during any kind of respiratory condition

Answer 10

NEUTROPHILS (acute and fast and first)

Question 11

what comes to the alveoli after the Neutrophil

what can they eventually do

Answer 11

M2 (TGF-B, IL10)
they can become smoke filled alveolar Macrophages (unable to digest what is inside) = scavenger cells
can also recruit M1

Question 12

surfactant A and D function

Answer 12

from type 2 cells and club (Clara) cells
opsonize bacteria
activate macrophages for phagocytosis of BACTERIA

Question 13

Alveolar macrophages activate what type of cells

Answer 13

FOX3P (Treg) cells

Question 14

what is the first thing that happens during acute inflammatory response

Answer 14

IL1 and TNF cause IL8 to be secreted from endothelial cells + alveolar macrophages (some IL6)
this bring neutrophils

Question 15

how does edema happen at the inflammatory site

Answer 15

plasma protiens brought into the contact of damaged area causes fluid buildup

Question 16

what to the proteins at the site of damage activate

Answer 16

1. Clotting factors : blood clot
2. Complement : destroy bacteria
3. Kinin cascade : vasodilation , increase permeability stimulate pain receptors

Question 17

Fibroinolytic protein

Answer 17

degrades the blood clot when the wound is healed

Question 18

Acute inflammatory response steps

Answer 18

1. neutrophils recruited
2. edema and vasodilation
3. epithelium dies and sheds off
4. only BM holds around alveoli
5. NETs cast form neutrophils

Question 19

acute inflammatory response what causes this and outcome

Answer 19

allergen of some sort or pathogen

if the allergen is effectively removed then all goes back to normal = fast recovery

Question 20

Chronic Inflammatory response
what comes
what happens

Answer 20

chronic acute response causes this

1. M1 and Th1, Th17, CTL come
2. hypersecretion of mucus
3. activate proteases
4. tissue remodeling and can lead to fibrosis

Question 21

ex of type 1 hypersensitivity in this lecture

Answer 21

Asthma

Question 22

Early phase for Type 1 HS
what is brought
what happens

Answer 22

Acute Atopic response
IgE 
MAST cell degranulation 
(IL4, IL5, Histamine)
= sneezing , pruritis, rhinorrhea, congestion

Question 23

Late phase for Type 1 HS
what is brought
what happens

Answer 23

after 4-12 hrs
N, E, B, Th2 cells*
MANY MORE MAST cells with Fce receptor

Question 24

what do the eosinophils cause for chronic inflammatory response

Answer 24

local tissue damage and inflammation

fatigue, asthma, myalgias

Question 25

what does the Eosinophils causes for remodeling

Answer 25

1. LEUKOTRIENES C4, D4, E4 : bronchospasm, vascular permeability, mucus made 2. PROSTAGLANDINS D2, E2, F2 : bronchospasm, vasodilation = SM and fibroblasts come and deposit collagen and tissue damage

Question 26

what do Th2 cells secrete for chronic inflammatory response

Answer 26

secretion of IL4, IL5, IL13

Question 27

COPD cytokines involved

Answer 27

1. TGF-B + IL6 causes the IL17, IL22 release 2. IL17 causes 3. IL8 secreted from epithelial cells 4. causes N to come 5. many M an dN try to get rid of the carbon smoked

Question 28

smokers who dont get COPD or are immunosuppressent COPD pts with low Tregs have what kind of cells

Answer 28

anti-inflammatory : TGF-B + IL2 ----> nTreg, Tr1, iTreg

Question 29

``` SIMPLE COMPARISON BETWEEN ASTHMA AND COPD ASTHMA : 1st cells 2nd cells leading to ```

Answer 29

1. Ep cells + mast cells (IL4, IL5, IL13), IgE 2. Eosinophils + CD4+ Th2 cells , N 3. Bronchoconstriction (and other stuff is chronic ) = reversible with inhaler)

Question 30

``` SIMPLE COMPARISON BETWEEN ASTHMA AND COPD COPD : 1st cells 2nd cells leading to ```

Answer 30

1. Avl M + Ep cells 2. Neutrophils, CD8+cells 3. small airway narrowing from mucus and deposition, alveolar destruction

Question 31

Ventilator Associated Lung injury | happens from what

Answer 31

being on a ventilator causes lung damage due to 1. over-inflation 2. mechanical stress 3. Hyper-oxygenation 4. free radicals 5. NEUTROPHILS COME ****

Question 32

Ventilator Associated Lung injury steps

Answer 32

1. endothelium gets activated 2. Neutrophils come 3. Neutrophil NETs 4. platelet activation 5. blood clot formation = thickening of BM and capillaries break

Question 33

Vaping associated with lung injury what is caused what is seen

Answer 33

causes ARDS (Acute Respiratory Distress Syndrome) Bilateral infiltrated on CXR NO infection

Question 34

Vaping associated with lung injury | HOW ARDS is caused

Answer 34

1. inhlation of lipids and oils (VIT E is vaporized in the lungs to an oil 2. causes lipid pneumonia 3. Foam cells develop (M that take up many ipids and cant break them down)

Question 35

other things causing lipid pneumonia

Answer 35

Essenial oils chronically used (petroleum) | Vicks, Olive oil, mineral oil

Question 36

Lipid Pneumonia Tx

Answer 36

steroids Antimicrobials (for secondary complications) supportive care