The Pulmonary System: Emphysema and Chronic Bronchitis

Question 1

What is spirometry testing?

Answer 1

Pulmonary function test; measures volume and speed of air movement during inspiration and expiration to asses ling function

Question 2

Forced Vital Capacity

Answer 2

volume of air that can forcibly be blown out after full inspiration

Question 3

Forced expiratory volume in 1 second (FEV1)

Answer 3

volume of air that can forcible be blown out in one second after full inspiration

Question 4

FEV1/ FVC ration

Answer 4

in healthy adults this should be approximately 70-85%

Question 5

Peak expiratory flow(PEF)

Answer 5

maximal air flow achieved during maximally forced expiration initiated at full inspiration

Question 6

Forced expiratory flow (FEF)

Answer 6

flow of air coming out of lungs at various times

Question 7

Obstructive airway disease is characterized by ?

Answer 7

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

• less air exits lungs per unit time (decrease FEV1)
• total volume is less affected (normal to somewhat reduced FVC)

Question 8

What are the major chronic obstructive airway diseases? (copd).
Are they reversible?

Answer 8

• emphysema and chronic bronchitis

- not reversible

Question 9

Chromic cell-mediated inflammatory disorders

Answer 9

• activated T cells, macrophages and neutrophils

- release of cytokines (leukotriene B4, TNF)

Question 10

There are variable degrees of inflammatory _____ secretion. _______ and ____ due to cycles of phagocyte lysosomal protease release and subsequent tissue repair.

Answer 10

mucous; tissue remodeling and fibrosis

Question 11

activated macrophages and neutrophils secrete _____ and _____

Answer 11

lysosomal enzymes and oxygen free radicals

Question 12

Lysosomal proteases are normally inhibited by circulating _______ ex: ____

Answer 12

protease inhibitors ex: alpha-1 antitrypsin (produced in liver)

Question 13

oxygen free radicals from activated phagocytes or conditions of oxidant stress inactivate _____

Answer 13

alpha 1- antitrypsin

Question 14

prolonged activation of lysosomal enzymes results in ____ and _____ of alveolar walls

Answer 14

inflammation and remodeling

Question 15

COPD affects _________

Answer 15

alveoli and terminal bronchioles (emphysema), bronchioles(bronchiolitis) or larger airways (bronchitis)

Question 16

what is the primary cause of COPD?

Answer 16

cigarette smoking

• environmental pollutants are related exposures may also contribute
• rare genetic cause (alpha 1- antitrypsin deficiency)

Question 17

____ is a reversible chronic obstructive inflammatory disease of the lungs

Answer 17

asthma

Question 18

asthma primarily affects the _____. and is know as _____

Answer 18

large airways (bronchi)
- is known as reversible airway hyperactivity

Question 19

______ is characterized with alveolar wall destruction- overinflation

Answer 19

emphysema

Question 20

_______ is associated with productive cough and airway inflammation. Overlap of emphysema can be seen in some cases.

Answer 20

chronic bronchitis

Question 21

______ is associated with reversible obstruction; bronchial hyper responsiveness triggered by allergens, infection, ect.

Answer 21

Asthma

Question 22

Emphysema is characterized by ___________

Answer 22

permanent, abnormal enlargement of the respiratory bronchioles and alveoli and destruction of alveolar wall (with or without fibrosis)

Question 23

Emphysema tends to affect ___ lobes more than ___ lobes

Answer 23

affects upper lobes more than lower lobes

Question 24

In emphysema, air becomes trapped due to ___ and _______ resulting in air accumulation and overall ________

Answer 24

obstruction and loss of alveolar recoil; hyperinflation (results in increased AP chest diameter- “barrel chest”)

Question 25

Emphysema is classified by its anatomic location - affects _______ to ____

Answer 25

respiratory bronchioles to the alveoli

Question 26

what are the three classified locations of emphysema

Answer 26

- centriacinar (centrilobar) - panacinar (panlobular) - distal acing (paraseptal)

Question 27

Bullae are large ______ usually form near the ___ and rupture results in ____

Answer 27

sub pleural blebs; apex; pneumothorax

Question 28

patients who are homozygous for alpha-1 antitrypsin deficiency mutation are unable to activate ____, resulting in tissue destruction; this mutation markedly _____ the risk for COPD development and early onset emphysema (18-30 years)

Answer 28

proteases; increase

Question 29

X ray findings that are typical for emphysema

Answer 29

- air trapping causing hyperinflation - hyperlucent lung field (black, 'over--penetrated' - increase retrosternal air - flattening of diaphragms - loss of peripheral vascular markings - vertical heart

Question 30

is Interstitial Emphysema related to COPD?

Answer 30

NO

Question 31

Interstital Emphysema occurs when _______. Can occur in trauma, cough with obstruction

Answer 31

air is forced into soft tissue

Question 32

Chronic bronchitis is inflammation of bronchi and trachea with ______ resulting is _______-

Answer 32

hyper secretion of mucous; mucous gland hypertrophy, thickening of bronchiolar walls, and loss of respiratory cilia.

Question 33

Mucous hyper secretion results in ________ (does not affect respiratory bronchioles)

Answer 33

non-obstructive airway obstruction

Question 34

does chronic bronchitis have the same cause as emphysema? there is also an increased risk of ______

Answer 34

yes; pneumonia

Question 35

Chronic bronchitis is a ____ diagnosis. Persistant _____ for at least 3 months in at least 2 consecutive years (without cause)

Answer 35

persistant cough with sputum production

Question 36

chronic bronchitis may lead to ______ due to pulmonary hypertension

Answer 36

right heart failure

Question 37

Chronic bronchitis may be concurrent with ____. and is sometimes associated with intermittent bronchospasm and wheezing called ______-

Answer 37

emphysema; chronic asthmatic bronchitis

Question 38

Can chronic bronchitis be diagnosed with x ray finding?

Answer 38

NO - CXR can be helpful to exclude other conditions which can clinically mimic the disease

Question 39

Evaluation of Emphysema and Chronic Bronchitis includes:

Answer 39

- history and physical examination - spirometry - CRX, CT - Oximetry - CBC - consider assessing serum alpha 1- antitrypsin activity