Week 3 Respiratory Disorders ✅

Question 1

What is the difference between chronic bronchitis and emphysema?

Answer 1

Chronic bronchitis = productive cough

Emphysema = structural changes

Question 2

How does FVC change in COPD?

Answer 2

FVC is lower

Question 3

How does FEV1 change in COPD?

Answer 3

FEV1 is lower

Question 4

What is a normal FEV1:FVC and in COPD?

Answer 4

Normal
FEV1:FVC = 4L:5L = 80%

COPD

FEV1:FVC = 2L:5L = 50%

Question 5

How does TLC change in COPD?

Answer 5

Higher due to air trapping

Question 6

How is elastin and collagen broken down in emphysema?

Answer 6

Smoking
Inflammatory reactions in alveoli
Produces IL-8, TNFa, leukotriene B4
Stimulates immune cells
Stimulates proteases (proteases and collagenases)
Breaks down collagen and elastin
Alveoli collapse

Question 7

How does loss of elastin affect respiration?

Answer 7

Breakdown of septa
Larger spaces created
Reduced surface area
Affects O2 and CO2

Question 8

What are the 3 different types of emphysema?

Answer 8

Centriacinar/centrilobular
Panacinar
Paraseptal

Question 9

Where does emphysema usually affect?

Answer 9

Acinus (end of airway)

Question 10

What is centriacinar/centrilobular emphysema?

Answer 10

Only damages central/proximal alveoli
Affects upper lobes

Question 11

What is panacinar emphysema?

Answer 11

Entire acinus affected
Affects lower lobes

Question 12

Which type of emphysema is associated with a1 anti-trypsin deficiency?

Answer 12

Panacinar emphysema

Question 13

What is paraseptal emphysema?

Answer 13

Distal alveoli most affected
Affects periphery of lobes
Can rupture and cause pneumothorax

Question 14

Which is the most common type of emphysema?

Answer 14

Centriacinar/centrilobular

Question 15

What are the symptoms of emphysema?

Answer 15

Dyspnoea
Breathing slowly through pursed lips “pink puffers”
Weight loss due to extra effort breathing
Cough
Barrel chest - air trapping and hyperinflation

Question 16

How does emphysema affect the heart?

Answer 16

If there is poor gas exchange in a healthy person, vasoconstriction can divert blood to efficient area

However

COPD too many vessels involved so right side of heart works harder –> cor pulmonae –> right sided heart failure

Question 17

What is the treatment of emphysema?

Answer 17

Stop smoking
O2
Bronchodilators, inhaled steroids, antibiotics for secondary infections

Question 18

What does the mucosa consist of?

Answer 18

Epithelial cells and lamina proper

Question 19

What does the submucosa consist of?

Answer 19

Smooth muscle

Question 20

What is the atopic triad?

Answer 20

Asthma
Atopic dermatitis
Allergic rhinitis

Question 21

Which immune cells work against allergens?

Answer 21

TH2

Question 22

What is the role of dendrites in asthma?

Answer 22

Dendritic cells present allergen to TH2

TH2 releases IL-5 which recruits eosinophils –> cytokines and leukotrienes released

TH2 also releases IL-4 which activates IgE which releases histamine, prostaglandins etc

Question 23

When eosinophils release chemical mediators, what happens?

Answer 23

Damage endothelium

Question 24

What happens in type 1 asthma?

Answer 24

Smooth muscle spasm
Increased mucus
Airways narrowed
Increased vascular permeability
Increased immune cells

Question 25

What are the long term complications of asthma?

Answer 25

Oedema Scarring Fibrosis Thickening basement membrane

Question 26

What are the TRIGGERS for asthma?

Answer 26

Pollution Allergens Mould Cigarettes

Question 27

What are the symptoms of asthma?

Answer 27

Chest tightness Dyspnoea Wheeze Cough Sputum (curschmann spirals/charcot-leyden crystals)

Question 28

How is asthma classified?

Answer 28

Frequency of symptoms Night time/early morning FEV1 PEFR Frequency of medication use

Question 29

What are the classifications of asthma?

Answer 29

Intermittent Persistent Moderate persistent Severe persistent

Question 30

What are the treatments of asthma?

Answer 30

Avoid trigger Medications: Bronchodilators Corticosteroids Long acting B agonists Leukotriene antagonists IV steroids, magnesium sulfate, O2

Question 31

How is chronic bronchitis defined?

Answer 31

Productive cough >3m

Question 32

What are the risk factors for chronic bronchitis?

Answer 32

Smoking, air pollutants, dust, genetic factors

Question 33

What happens in the airways in chronic bronchitis?

Answer 33

Lungs do not empty properly, air is stuck, so lower volume of air expired (FVC), especially FEV1

Question 34

What is a normal FEV1:FVC radio and what is it like in COPD?

Answer 34

Normal FEV1:FVC is 4L/5L = 80% COPD FEV1:FVC is 2L/4L = 50%

Question 35

What is the TLC of COPD and why?

Answer 35

Higher because of air trapping

Question 36

What is Reid Index and what is it in chronic bronchitis compared to normal?

Answer 36

Thickness of glands/thickness of wall Normal = <40% Chronic bronchitis = >40%

Question 37

What can vasoconstriction in the lungs lead to?

Answer 37

Increased pulmonary vascular resistance Pulmonary hypertension Right heart hypertrophy Right heart failure Cor pulmonale

Question 38

What is the treatment for chronic bronchitis?

Answer 38

Reduce risk factors (stop smoking) Supplemental O2 Bronchodilators, inhaled steroids, antibiotics

Question 39

How is emphysema caused?

Answer 39

Phagocytes release elastase which breaks down elastin in alveolar walls

Question 40

What happens in emphysema?

Answer 40

Reduced elastic recoil Alveoli and small airways collapse which leads to air trapping Scar tissue thickens walls = obstruction

Question 41

What protects the lungs from elastase?

Answer 41

α-1 antitrypsin (produced in liver)

Question 42

What is AAT deficiency?

Answer 42

α-1 antitrypsin deficiency

Question 43

How is chronic bronchitis caused?

Answer 43

Damaged cells release inflammatory mediators which cause capillary dilation, increased capillary wall leakiness, increased goblet cells and attraction of WBC

Question 44

What does capillary dilation in chronic bronchitis lead to?

Answer 44

Red, hot tissue

Question 45

What does increased capillary wall leakiness in chronic bronchitis lead to?

Answer 45

Escape of plasma

Question 46

What does increased number of goblet cells in chronic bronchitis lead to?

Answer 46

Increased mucus production

Question 47

What does attraction of WBC in chronic bronchitis lead to?

Answer 47

Increased inflammation

Question 48

What are the triggers of asthma?

Answer 48

Infection, allergens, irritants, exercise

Question 49

What is the MOA of asthma?

Answer 49

Mediators are released from mast cells and other WBC including histamine and leukotrienes

Question 50

What does the release of mediators in asthma cause?

Answer 50

Swelling of mucosa, excess production of mucus, smooth muscle bronchoconstriction

Question 51

What is a blue bloater?

Answer 51

Cyanosis - chronic bronchitis