1
Q
What is obstructive lung disease?
A
Diseases of the airways that produce obstruction to expiratory airflow
2
Q
What does obstructive lung disease result in?
A
Incomplete emptying of airways
3
Q
What is obstructive lung disease related to and/or caused by?
A
- Retained secretions
- Inflammation of airway linings
- Bronchial constriction
- Bronchospasm
- Weakening of support structures to airway walls
4
Q
What are major causes of of obstructive lung diseases?
A
- Prolonged inhalation of substances
- Genetic factors
- Early childhood respiratory complications
5
Q
What environmental and occupational factors contribute to obstructive lung disease?
A
- Tobacco smoke
- Environmental toxins and pollution
- Occupational exposures
6
Q
What genetic and early life factors increase the risk for OLD?
A
- Inherited diseases like cystic fibrosis and asthma
- Early respiratory complications during childhood
7
Q
Summarize the step-by-step progression of obstructive lung disease
A
- Inhalation exposure/genetics →
- Inflammation →
- Decreased mucociliary activity →
- Increased secretions →
- Decreased diameter of bronchial lumen →
- Airway obstruction →
- Increased expiratory resistance →
- Hyperinflation from increased effort required to exhale →
- Weakenin of airway connective tissue →
- Barrel chest, horizontal ribs, diaphragmatic flattening shoulder evaluation
8
Q
What physical changes are seen with lung hyperinflation?
A
Elevated shoulder girdle, horizontal ribs, barrel-shaped thorax, and low/flattened diaphragm
9
Q
What does chronic inflammation cause in the lungs?
A
Increased secretion production from all airway linings
10
Q
How does chronic inflammation affect alveoli?
A
Alveoli enlarge and smooth out = less surface area for gas exchange
11
Q
What tissue changes occur with chronic inflammation?
A
Destruction of lung parenchyma (tissue) and loss of alveolar attachments that maintain expansion of small airways
12
Q
What effect does loss of connective tissue have on lung function?
A
Limits lung recoil
13
Q
Why are OLD patients more prone to infections?
A
Due to reatained secretions
14
Q
What is a key physiological problem in all forms of OLD?
A
Increased expiratory resistance and difficulty getting air out
15
Q
What airway changes occur in chronic bronchitis and asthma?
A
Narrowed air tubes, swollen tissues, and excessive mucus production leading to obstruction
16
Q
What are clinical manifestations of OLD?
A
- Lung hyperinflation
- Initially elevated PaCO2 and normal PaO2
- Secretion production
- Cough
- Increased lung volumes
- “Tripoding”
- Anxiety
17
Q
What happens to PaO2 as OLD progresses?
A
PaO2 decreases as severity progresses, and OLD becomes mixed with RLD
18
Q
What is the most common obstructive lung disease?
A
Chronic Obstructive Pulmonary Disease (COPD)
19
Q
What is the hallmark of COPD pathophysiology?
A
Chronic airflow limitation and poor exhalation
20
Q
What is reduced in COPD?
A
Surface area for gas exchange
21
Q
What structural issues cause COPD airflow limitation?
A
Alveolar damage and airway collapse in small to medium airways
22
Q
What two diseases make up COPD?
A
Chronic bronchitis and emphysema
23
Q
What is the clinical manifestation of COPD?
A
- Lung hyperinflation
- Initially elevated PaCO2 and normal PaO2
- Pursed lip breathing
- Secretion production
- Cough
- Increased lung volumes
- “Tripoding”
- Anxiety
24
Q
What is the purpose of pursed-lip breathing in COPD?
A
It maintains airway patency during exhalation and prevents airway collapse.
25
What muscular changes occur in COPD patients?
Peripheral muscle atrophy and a shift from slow-twitch to fast-twitch fibers
26
How do these muscular changes affect exercise?
Increased lactate production and decreased endurance
27
How does COPD cause dyspnea on exertion?
Due to hyperinflation, chest wall remodeling, and ventilatory weakness
28
What is the overall consequence of COPD on functional mobility?
Decreased muscle strength and endurance leading to mobility deconditioning
29
What does chronic COPD cause in relation to CO2?
COPD causes a build-up of CO2 in the blood, leading to more acidic blood (↓ pH), mentation/alertness to rise in CO2, daytime sleepiness, and thickened pulmonary capillary membranes that make gas exchange harder
30
How can elevated CO2 levels decrease in COPD?
By being “blown off” in exhaled air
31
What does over-oxygenationg a COPD patient signals?
Signals the brainstem that there is no need increase respiratory rate or dapth to improved exhalation
32
Why might COPD patients have lower SpO₂ goals?
To ensure their respiratory drive remains active enough to exhale enoough CO2 and maintain gas balanced
33
What defines chronic bronchitis?
A productive cough lasting more than 3 months in at least 2 consecutive years
34
When is coughing worse in chronic bronchitis?
Typically worse in the mornings
35
What happens to mucus production and airway structure in chronic bronchitis?
There’s excess mucus production, damage to ciliated epithelium, and mucus first forms in large airways before spreading to distal airways
36
What structural changes occur in emphysema?
Destruction of alveolar walls and enlargement of airspaces distal to terminal bronchioles
37
How do alveoli trap air in emphysema?
The enlarged, misshapen alveoli prevent normal exhalation and trap air inside
38
How does smoking contribute to emphysema?
Smoking leads to inflammatory cell recruitment, injury to extracellular matrix, airway wall perforation/obliteration
39
What are the two main types of emphysema?
1. Centrilobular
2. Panlobular
40
Describe Centrilobular emphysema
* Most common → linked to smoking
* Dilation of terminal and respiratory bronchioles
* Alveolar ducts and sacs remain normal
* Seen in upper and posterior lungs
41
Describe Panlobular emphysema
* Dilation of all airspace, including alveolar ducts and sacs
* Seen in lung bases
42
What is distal acinar (subpleural) emphysema?
* Dilation of airspaces just underneath the visceral pleura
* Can cause tension pneumothorax (PNX) if ruptured
43
What is a bleb?
Small abnormal airspace (<1 cm)
44
What is a bulla?
Large abnormal airspace (>1 cm)
45
How do blebs and bullae relate to each other?
* Bleb can come together anf form a bulla
* Both blebs and bullae can rupture and allow air to escape into the pleural space
46
What are some causes of subpleural emphysema besides cigarette smoking?
Any inhaled substance can lead to subpleural emphysema, not just cigarette smoke
47
What does the term “Blue Bloater” refer to?
A patient with chronic bronchitis - typically overweight, cyanotic, with productive cough for 3 months or more in at least 2 years, peripheral edema, rhonchi, and wheezing
48
What does the term “Pink Puffer” refer to?
A patient with emphysema - usually thin, older, severe dyspnea, with quiet chest, hyperinflated lungs, and flattened diaphragm
49
What causes bronchiectasis?
Genetics, severe infections, or immune reactions
50
What structural change occurs in bronchiectasis?
Dilation of the bronchi
51
Is bronchiectasis reversible or irreversible?
It is irreversible with chronic inflammation and infection.
52
What are the airway changes seen in bronchiectasis?
Distortion, thickening, widening, and herniation of airways that cannot clear secretions normally
53
What major issue occurs with mucus in bronchiectasis?
Massive secretion buildup that cannot be easily cleared
54
What are the clinical manifestation of bronchiectasis?
* Heavy sputum production
* Recurrent and/or chronic lung infections
* Hemoptysis
* Fatigue
* Dyspnea
* Periods of exacerbation characterized by worsening inflammation, secretion production, and dyspnea at rest
55
What is Bronchiolitis Obliterans and what causes it?
A long term complication of lung transplant and suggestive of chronic rejection
Fibrosis and necrosis of small airways, of both epithelial lining and smooth muscle
56
How does fibrosis and inflammation progress in Bronchiolitis Obliterans?
Extends into the interstitial space
57
When does Bronchiolitis Obliterans usually occur post-transplant?
Occurs at least 8-12 months post lung transplant and usually preceded by viral infection
58
What other conditions can accompany BO?
Bronchiectasis and recurrent infections
59
What is the most common cause of death post lung transplant?
Combination of infection and Bronchiolitis Obliterans
60
What is cystic fibrosis (CF)?
Multi-organ system disorder affecting any/all organs with epithelial linings, seen commonly in pediatric population
61
How does CF affect the lungs?
Causes excessive secretion/mucus production, obstruction, inflammation
62
How does CF affect the stomach?
Excessive secretion/mucus production, poor absorption
63
How does CF affect the pancreas?
Exocrine dysfunction, poor fat absorption, impaired growth
64
How does CF affect the sweat glands?
Increased NaCl in sweat
65
How does CF affect sinuses?
Recurrent infections
66
What organs/structures are affected in CF?
Lungs, stomach, pancreas, sweat glands, and sinuses
67
What genetic defect causes CF?
Abnormality in a protein that regulates sodium movement in/out of cells
68
What does CF result in?
Excess, thickened secretion production and impaired mucociliary function in lung airway
69
What happens when mucus deposits build up in the bronchi and bronchioles in cystic fibrosis?
Mucus buildup makes it difficult to clear secretions, which causes chronic inflammation, airway obstruction, and higher infection rates
70
What symptom results from impaired mucociliary clearance and excess mucus?
Chronic productive cough
71
Describe the chain of pathophysiologic events in CF.
CFTR gene defect → defective ion transport → airway surface liquid depletion → defective mucociliary clearance → mucus obstruction → infection → inflammation
72
What is asthma?
Chronic inflammation of the airways, causeing episodes of wheezing, dyspnea, chest thightness, coughing
73
What causes airway obstruction in asthma?
Bronchospasm and airway inflammation create difficulty exhaling and narrowed airways
74
What are key signs during an acute asthma episode?
Sudden worsening of wheezing, chest tightness, and audible wheezing on exhalation
75
What type of disease is asthma considered?
Reactive airway disease
76
What initiates the cascade response in asthma?
Some form of trigger starts the cascade of response that leads to expiratory wheezing, chest tightness, and cough
77
What happens during very severe asthma attacks?
They lead to impaired gas exchange (both O2 and CO2) from impaired exhalation and inhalation due to airway constriction
78
What can asthma become when gas exchange is impaired?
It can become mixed OLD and RLD
79
What is the hallmark sign of asthma?
The reversibility of airway obstruction from bronchospasm with inhaled bronchodilators
80
What causes obstructive sleep apnea?
Structural or anatomical obstruction that leads to a partial or total collapse of the pharynx, causing impaired air exchange
81
What collapses into the airway during deep sleep in obstructive sleep apnea?
Muscles or soft tissue (like the tongue) collapse into the airway during deep sleep.
82
Why is exhalation harder than inhalation in obstructive sleep apnea?
Because exhaling against airway obstruction is harder than actively inhaling
83
How is obstructive sleep apnea classified?
Classified as OLD, but has components of RLD if getting air in past the obstruction also occurs
84
What are the results or consequences of obstructive sleep apnea?
Poor sleep quality, chronic hypercapnia (↑CO2), HTN/HF, PAH, and autonomic dysfunction
85
What is a key treatment focus for OSA?
Maintaining patent airways during sleep through various solutions
86
What is the main problem in restrictive lung disease?
Difficulty getting air IN due to decreased lung volumes and tissue compliance
Poor gas exchange
87
What is the main problem in obstructive lung disease?
Difficulty getting air OUT due to airway resistance
Retained secretions
88
What symptom is common to both restrictive and obstructive diseases?
SOB
89
What happens to lung compliance in restrictive vs obstructive disease?
Restrictive: Decreased compliance
Obstructive: Increased compliance
90
Describe inhalation and exhalation in restrictive lung disease.
Reduced inhalation, normal exhalation
91
Describe inhalation and exhalation in obstructive lung disease
Normal inhalation (at first), reduced exhalation
92
Where is the primary site of damage in RLD vs OLD?
RLD: Alveolar-capillary membrane
OLD: Alveoli and airway spaces
93
What type of breathing difficulty is seen in restrictive vs obstructive diseases?
RLD: Difficulty breathing IN
OLD: Difficulty breathing OUT
94
How are O2 and CO2 levels affected in RLD?
Decreased O2, normal CO2
95
How does lung capacity differ between restrictive and obstructive diseases?
RLD: Decreased capacity
OLD: Increased capacity
96
How are O2 and CO2 levels affected in OLD?
Normal O2 (at first), elevated CO2
97
How is the ability to breathe out air at the right speed affected in RLD vs OLD?
RLD: Normal
OLD: Impaired
98
What happens to vital capacity (VC) and total lung capacity (TLC) in restrictive disease?
Both are decreased.
99
What happens to vital capacity (VC) and total lung capacity (TLC) in obstructive disease?
Both are increased
100
What are the biggest limitations to functional endurance in restrictive disease?
↓ Inspiratory reserve volume (IRV) and ↓ Expiratory reserve volume (ERV)
101
What are the biggest limitations to functional endurance in obstructive disease?
↑ Expiratory reserve volume (ERV) and ↑ Residual volume (RV)
