Pathology Of Obstructive And Restrictive Lung Disease

Front 1

Blue bloater vs. Pink Puffer

Back 1

chronic bronchitis leads to blue bloater because you get hypoxic and pO2 goes down early. emphysema leads to being a "pink puffer" because he maintains his pO2

Front 2

Asthma

Back 2

three components:
1. recurrent episodes of reversible airway obstruction that resolves spontaneously or with treatment
2. Airway hyperresponsiveness (methacholine challenge)
3. Inflammation of airways

Front 3

Pathology of asthma

Back 3

-edema and hyperemia of bronchial mucosa
-infiltration of bronchial mucosa with TH2 lymphocytes, mast cells, eosinophils
-increased mucus
-constriction of airway smooth muscle
-airway thickening with variable degree of fibrosis with chronic asthma
-shedding of airway epithelium

Front 4

Physiologic changes with asthma

Back 4

1. FEV1 and peak flow are decreased
2. air trapping in acute attack
3. increased responsiveness to methacholine and histamine
4. pO2 is normal or high initially then falls when they get tired.

Front 5

Pathophysiology of smooth muscle

Back 5

1. exagerrated contraction of smooth muscle
2. increased smooth muscle mass
3. increased release of inflammatory mediators

Front 6

Factors that precipitate asthma

Back 6

Allergen
Exercise
Medications (aspirin or beta blockers)
occupation
GERD

Front 7

Physical exam in asthma

Back 7

increased respiratory rate, increased pulsus paradoxus, wheezing in expiration, rhonchi

Front 8

What will you find in arterial blood gases of asthmatic?

Back 8

Acutely- respiratory alkalosis because they hyperventilate and blow off their CO2
Later, the patients will tire and get a metabolic acidosis because of increased lactic acid from muslce. CO2 might go up once they get tired. The patient will then have low pH, low pO2, and high CO2 and will need to be intubated

Front 9

What might you see hematologically in asthmatics?

Back 9

eosinophilia

Front 10

What do you see in the sputum of asthmatics?

Back 10

Charcot-Leyden crystals and creola bodies (clusters of airway epithelial cells)

Front 11

Treatment

Back 11

Relievers: B-adrenergics (relax airway smooth muscles and decrease mucus secretion- side effects are tachycardia and tremor), anticholinergics
Controllers: inhaled corticosteriods (decrease mediator release and decreases shedding but may cause growth retardation, bone loss, cataracts, glaucoma, oral candidiasis)
anti-leukotrienes- Montelukast and Zafirlukast are receptor antagonists and Zileuton is a lipoxygenase inhibitor. leukotrienes are involved in eosinophil recruitment and mucus secretion
-theophylline- inhibits phosphodiesterase and may be antiinflammatory. significant GI, cardiac, and CNS side effects
-Cromylyn and nedocromil

Front 12

What can you use to treat nighttime asthma or chronic maintenace?

Back 12

Salmeterol and formeterol because they are long acting B agonists. They are now used for chronic maintenance. They can cause sudden death

Front 13

Pathophysiology of COPD

Back 13

-inflammation with neutrophils and macrophages
-Destruction of alveoli due to proteases and you get collage deposition (fibrosis) in the alveoli. This fibrosis causes airway obstruction rather than restriction.
-With proteases from neutrophils you get alveolar wall destruction in emphysema and mucus hypersecretion in chronic bronchitis.

Front 14

Centrilobular emphysema vs. Panlobular emphysema

Back 14

Centrilobular is associated with smoking. Damage is in the respiratory bronchiole and it is worse in upper lobes.

Panlobular emphysema- associated with alpha 1 antitrypsin deficiency. Whole alveolar lobule is affected equally. Whole lobule involved.

Front 15

PFT findings with chronic bronchitis

Back 15

reduced FEV1 and mid flow rates but normal FVC and diffusion. ABG shows hypoxemia and hypercarbia in later stages

Front 16

PFT findings with emphesyma

Back 16

-reduced FEV1 and mid flow rates
-FVC decreased, RV increased, TLC increased due to hyperinflation, diffusion decreased, ABG shows normal pO2 till late stages

Front 17

Important factors for survival with COPD

Back 17

1. Smoking cessation
2. Bronchodilators
3. Oxygen therapy