Chronic Bronchitis

Question 1

Chronic obstructive pulmonary disease

Answer 1

A lung disease characterised by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.

Includes chronic bronchitis and emphysema
Chronic bronchitis- inflammation and swelling of the lining of the airways, leading to narrowing and obstruction generally resulting in daily cough. Inflammation stimulates production of mucus which can cause further blockage of the airways.
Emphysema-a condition in which the air sacs of the lungs are damaged and enlarged causing breathlessness

Question 2

Risk factors for COPD

Answer 2

• males

- elderly

Question 3

Changes that occur in the large airways in chronic bronchitis

Answer 3

Columnar epithelial cells, cilia, goblet cells (secrete mucus to surface of airway), basement membrane, capillaries and venules, smooth muscle, sub mucosal glands communicated with lumen and produce mucous. When foreign particles enter, mucous linings trap them, and cilia aim to move them out of the cell.

Question 4

Small airways

Answer 4

Goblet cells (secrete mucous), ciliated epithelium, smooth muscle, most resistance to airflow - mostly in bronchioles. Smooth muscle in the small airways allows the bronchioles to relax or constrict, which determines the amount of airflow into sections of the lung.

Question 5

Pathogenesis of chronic bronchitis

Answer 5

Increase in the large airways leads to:
An increase in the size and number of submucosal glands
An increased secretion of mucus
Hyperplasia of smooth muscle
Inflammatory reaction 

Constant irritation in the small airways leads to:
Hyperplasia of goblet cells and increased secretion of mucus
Hyperplasia of smooth muscle
An inflammatory reaction

Question 6

Complications in chronic bronchitis

Answer 6

• thicker mucous in alveoli and bronchioles, constricts airways, if bacteria or infection is inhaled it becomes trapped and if difficult to expire.

Question 7

Nosocomial infections

Answer 7

Infection that is clinically acquired.

Question 8

Pulmonary hypertension

Answer 8

• increase of blood pressure in pulmonary arteries and arterioles going into the lung and left ventricles.
• pulmonary arterioles in lungs vasoconstrict when exposed to hypoxic conditions: sustained vasoconstriction can lead to pulmonary hypertension
• obstruction to airflow in chronic bronchitis
• widespread vasoconstriction of arterioles causes high blood pressure in the pulmonary artery. This can lead to Cor pulmonale
• Cor pulmonale: heart trying to pump harder to make up for resistance to blood flow in lungs. So right ventricle enlarges as it pumps harder- right ventricular Hypertrophy which can lead to RV failure.

Question 9

Blue bloater- likely to develop from chronic bronchitis

Answer 9

• usually blue due to low oxygen is haemoglobin
• haematocrit- (% of rbcs), high due to lots of haemoglobin but not saturated
• bloating due to right ventricular failure leads to systemic oedema
• decreased Pa O2, increased Pa CO2, leading to acidosis due to high CO2- however still little respiratory distress

Question 10

Acute exacerbations may arise:

Answer 10

from: 
Bacterial infections 
Viral infections
Air pollution 
Can lead to respiratory failure or right side cardiac failure

Question 11

Blue bloater- likely to develop from chronic bronchitis

Answer 11

• usually blue due to low oxygen is haemoglobin
• haematocrit- (% of rbcs), high due to lots of haemoglobin but not saturated
• bloating due to right ventricular failure leads to systemic oedema
• decreased Pa O2, increased Pa CO2, leading to acidosis due to high CO2- however still little respiratory distress

Question 12

Acute exacerbations may arise:

Answer 12

from: 
Bacterial infections 
Viral infections
Air pollution 
Can lead to respiratory failure or right side cardiac failure

Question 13

Blue bloater- likely to develop from chronic bronchitis

Answer 13

• usually blue due to low oxygen is haemoglobin
• haematocrit- (% of rbcs), high due to lots of haemoglobin but not saturated
• bloating due to right ventricular failure leads to systemic oedema
• decreased Pa O2, increased Pa CO2, leading to acidosis due to high CO2- however still little respiratory distress

Question 14

Acute exacerbations may arise:

Answer 14

from: 
Bacterial infections 
Viral infections
Air pollution 
Can lead to respiratory failure or right side cardiac failure