10 Obstructive
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
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
- 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
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