Obstructive Lung Diseases

Question 1

What is the most important risk factor of COPD?

Answer 1

Smoking; Cessation at any time improves health

Question 2

Discuss alpha-antitrypsin deficiency

Answer 2

Degradation of interstitial elastin by elastase d/t dec α1-antitrypsin; Causes panlobar emphysema

Question 3

Pathogenesis of COPD

Answer 3

Chronic airflow limitation results from an abnormal inflammatory response

Question 4

Clinical presentation of COPD?

Answer 4

Hx: chronic dyspnea, chronic cough, sputum production

PE: expiratory wheeze (airflow obstruction), over-distention of lungs, low diaphragm, dec heart/breath sounds, pursed-lip breathing, use of accessory respiratory muscles,

Question 5

Labs of COPD pt

Answer 5

CXR: Low diagphragm (severe)
PFTs: Normal FVC, dec FEV1/FVC

Question 6

Treatment approaches of COPD pt

Answer 6

Pharmcologlical: Beta2 agonists, inhaled steroids, anticholinegics, PDE4i

Non-pharmacological: OXYGEN

Question 7

SEs of beta2 agonists

Answer 7

Tremor, tachycardia, hypokalemia

ALBUTEROL

Question 8

Anticholingerics

Answer 8

Decrease mucus and block bronchospasm

Ipatropium:Dry mouth, difficulty urinating, constipation

Question 9

Why is oxygen tx so important?

Answer 9

Its the only therapy proven to prolong life after stabilization.

Question 10

Which pts are candidates for oxygen therapy?

Answer 10

1. Resting PaO2 <55mmHg
2. Exercise SaO2 <88%
3. PaO2 <59 and edema or Hct< 55

Question 11

What is emphysema?

Answer 11

Abnormal & permanent enlargement of airspaces distal to terminal bronchioles
Centrilobular, Panlobular, Irregular

Question 12

CXR of Emphysema pt

Answer 12

1. flattened diaphragm
2. Increased rib spaces
3. Hyperinflation

Question 13

Histology of Morphology of emphysema pt

Answer 13

Morph: Anthracosis, bullae
Histo: Enlarged airspaces, BM thickening, NO FIBROSIS, inflammed bronchi

Question 14

Clinical presentation of Emphysema

Answer 14

Pink Puffer
Hunched over, pursed lips, barrel chested, thin/weight loss, retractions
Dyspnea w/ prolonged expiration, normal ABGs

Question 15

Pathogenesis of Chronic Bronchitis

Answer 15

Hypertrophy/hyperplasia of mucus glands in large airways d/t smoke/pollution
FIBROSIS in smaller airways

Question 16

Hx of Chronic Bronchitis

Answer 16

Persistent productive cough for 3 months in at least 2 consecutive years

Question 17

Presentation of Chronic Bronchitis pt

Answer 17

Blue Bloater

chronic productive cough, cyanosis, hypercapnia, hypoxemia

Question 18

What makes asthma unique?

Answer 18

It is reversible

Question 19

Distinguish Atopic and Non-atopic asthma

Answer 19

Atopic: Evidence of allergy sensitization

Non-Atopic: No association with allergy; typically triggered by viral URI

Question 20

Histology of Asthma

Answer 20

Curschmann spirals (remnant of shed epithelial cells), Eosinophils

Question 21

Clinical presentation of asthma

Answer 21

1. Dyspnea with exercise

2. Subsides spontaneously w/ treatment

Question 22

Tx of asthma

Answer 22

Step up & down until lowest level is maintained

Question 23

What is bronchiectasis?

Answer 23

Permanent bronchi/bronchiole dilation d/t wall destruction SECONDARY to recurrent infection & obstruction

Question 24

Morphology of Bronchiectasis?

Answer 24

Gross: Dilation of bronchi, vertical airways in lower lobes, bronchi filled with foul smelling exudates

Histo: Ulcerated epithelium thats necrotic and sloughing

Question 25

Clinical presentation of Bronchiectasis

Answer 25

Persistent, severe cough w/ foul smelling sputum