10 Obstructive - Boards and Beyond

Chronic Bronchitis

  • completely arbitrary clinical definition

  • a lot of mucous and glands
  • normally: mucous layer 0.4 of total bronchiole wall. > 0.5 = severe bronchitis

  • cough from inflammation
  • wheezing from obstruction
  • crackles from mucous

  • left filled with mucous
  • left become hypoxemic
  • 100% O2 will not help

Emphysema

  • think smoke rising up to upper lobe

  • acinus: "berry"
  • smoker: branch portion, centriacinar or centrilobular
  • deficiency: everything

  • bronchus collapse during exhalation

  • big white space, thin septa (tissue dividing space)
  • left lower: black spots, evidence of centrilobular damage

  • hyperventilation: to get remaining functioning alveoli to do more work
  • hyperventilating = more work = weight loss

  • emphysema: blue line shift to left, less elastic recoil
  • FRC shift up, higher volume at end of quiet breath, barrel chest

AAT

  • balance elastase

  • smoking: 60s-70s

COPD

  • usually just include chronic bronchitis and emphysema; asthma has its own treatment

Asthma

  • reversible: go back after acute episode
  • overreact to stimulus and bronchorestrict

  • cold

  • triggered by taking aspirin
  • triad: asthma, rhinosinusitis, nasal polyposis

  • Swollen ASA umpire: aspirin “pseudo-allergy” due to excess leukotriene synthesis (use clopidogrel instead)

  • ASA umpire grabbing Coach Cox: inhibition of COX shifts the AA metabolism to the LOX leukotriene pathway (exaggerated in aspirin-induced asthma)

  • normal I/E: 1 to 2
  • asthma: expiratory phase prolonged, longer for air to get out. 1/4 or 1/5
  • reduced peak flow (image). Highest velocity of air flow
  • status asthmaticus: severe, hypoxia

  • in mucous plugs in sputum: epithelial cells that shed and form whirls
  • eosinophils and eosinophil membrane proteins making crystals

  • drop in systolic blood pressure with inspiration, usually by pericardial effusion and tamponade

Bronchiectasis

  • chronic inflammation causing permanently dilated airways
  • obstruction: small airways thickened

  • infection both cause and consequence
  • rare cause of amyloidosis: anything causes chronic inflammation can lead to secondary amyloidosis

  • tumor: can't clear mucous, backs up
  • smoking: either direct or by infection
  • CF: recurrent infection

Ciliary Dyskinesia

  • either dynein absent or abnormal

  • chronic sinusitis: poor ciliary function
  • infertility: abnormal sperm ciliary

ABPA

  • only immunocompromised (asthma, CF)
  • eosinophilia: important

  • important: symptoms + blood IgE and eosinophils
  • steroids: treat inflammation/allergic reaction

  • plane with letters. Farmer running/migrating, sweating, inhaler in hand: ABPA (allergic bronchopulmonary aspergillosis) is a type I HSR that causes wheezing, fever and migratory pulmonary infiltrates. Also association with CF patients
  • IgE on inhaler: ABPA is associated with asthma and may show increased IgE levels in the serum