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

• 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