Term
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Definition
| chronic lung disease characterised by periodic episodes of airflow obstruction. |
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Term
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Definition
small airway obstruction -bronchospasm,inflammation+oedema .
paroxysmal attacks ,over distended lungs ,mucus plugs in bronchi +enlarged bronchial mucous glands |
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Term
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Definition
| initial attack can occur at any age , children <10 yrs |
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Term
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Definition
most common type ,triggered by dusts,pollen,animal dander+foods
common +ve family hx .
asthma attacks precede by allergic rhinitis, urticaria or eczema |
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Term
| Candidate gene for predisposition to Atopic asthma |
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Definition
| genes involved antigen presenting ,t cell activation genes,reg of cytokine prod, receptors fro bronchodilators (b adrenergic receptors) |
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Term
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Definition
| no evidence of allergic sensitization, -ve skin test,less common family hx,resp infections due to viruses are common triggers. |
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Term
| Classification systems of asthma |
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Definition
Severity (mild/intermittent ,moderate,severe,persistent) Cause(exercise ,drug,seasonal,occupational)
Response to treatment
Extrinsic /Intrinsic |
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Term
| Clinical features of asthma |
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Definition
| severe dyspnoea,coughing,wheezing triggered by bronchospasm ,status asthmaticus |
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Term
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Definition
| starts in childhood/yound adults, gentle basis,hx of hypersensitivity rxns |
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Term
| extrinsic asthma pathogenesis |
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Definition
| type 1 hypersensitivity rxn, IgE antibodies,increase in eosinophils. |
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Term
| extrinsic asthma common allergens |
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Definition
| pollen ,house dust mite, animal dander,certain foods, aspergillus spores. |
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Term
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Definition
| tends to improve with age , attacks precipitated by anxiety in certain children , skin tests to determine allergic hypersensitivity |
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Term
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Definition
| Starts later in life with worse prognosis, no family Hx,no increase in IgE and Eosinophils, associated chronic bronchitis. |
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Term
| Intrinsic asthma hypersensitivity reaction |
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Definition
| in response to bacterial antigens in the bronchi resulting in an increase in local IgE and eosinophils which then causes bronchospasm |
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Term
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Definition
1.genetic predisposition to type 1 hypersensitivity
2.acute+chronic airway inflammation
3.bronchial hyper responsiveness |
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Term
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Definition
1. Exposure to an inciting factor(allergens,drugs,cold,exercise)
2.Release of inflammatory mediators
3.Bronchoconstriction ,increased vascular permeability+mucous secretions
4.resident inflammatory cells amplify the response |
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Term
| Macroscopic features of asthma |
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Definition
| hyperinflated lungs with air trapping ,reversible overinflation ,thick mucous plugs blocking lumen of bronchi . association with bronchitis . |
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Term
| Death in asthma is due to |
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Definition
| respiratory failure . with frequent severe asthma attacks ,hypoxia can cause pulmonary hypertension which may result in right ventricular failure. |
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Term
| Microscopic features of asthma in the bronchi |
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Definition
oedema+ congestion
eosinophils(lymphocytes+monocytes)
mucous in lumen
smooth muscle hypertrophy
thickening of basement membrane
increase in size of submucosal glands |
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Term
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Definition
| increasingly severe bronchoconstriction that does not respond to drugs. (a serious condition that requires hospitalization, severe hypoxia+hypercapnia) MAY BE FATAL |
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Term
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Definition
b adrenergic agonists
inhaled corticosteroids
anti-cholinergic agents |
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Term
| treatment for status asthmaticus/resistent chronic asthma |
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Definition
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Term
| Obstructive lung diseases |
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Definition
1. chronic bronchitis
2.emphysema
3. bronchiectasis |
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Term
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Definition
| presence of a persistent productive cough for at least 3 months for 2 consecutive years in the absence of any other identifiable disease |
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Term
| Simple Chronic bronchitis |
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Definition
| productive cough but no airflow limitation |
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Term
| chronic asthmatic bronchitis |
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Definition
| patients have hyper reactive airways with bronchospasm |
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Term
| obstructive chronic bronchitis |
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Definition
| common with heavy smokers usually associated with emphysema |
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Term
| Pathogenesis of chronic bronchitis |
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Definition
| damage to bronchial epithelium -squamous metaplasia |
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Term
| Macroscopic features of chronic bronchitis |
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Definition
| inflamed mucous membranes +excess mucous secretion |
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Term
| Microscopic features of chronic bronchitis |
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Definition
1. chronic inflammation of airwaus with predominance of lymphocytes
2.increase in size of mucous glands
3.hyperplasia +hypertrophy of the mucous cells
4.increased reid index (mucous gland layer thickness vs thickness of bronchial wall) |
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Term
| Clinical features of chronic bronchitis |
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Definition
| occurs together with emphysema , chronic productive cough ,exertional dyspnoea +cyanosis"blue bloater", increased risk of bacterial infection |
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Term
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Definition
| chronic lung disease characterized by enlargement of airspaces distal to the terminal brochioles with destruction of their walls but without fibrosis |
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Term
| Centriacinar/centrilobular emphysema |
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Definition
| heavy smokers , coexistent chronic bronchitis |
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Term
| Centriacinar/centrilobular emphysema pathology |
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Definition
| involves central part of acini formed by resp bronchioles and spares distal alveoli , commonly distributed in upper lobes |
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Term
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Definition
uniform enlargement from the level of the resp bronchiole to the terminal blind alveoli
lower zone distribution , associated with alpha 1 antitrypsin deficiency |
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Term
| Distal acinar/paraseptal emphysema |
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Definition
proximal part of acinis normal with distal part predominantly involved,found usually along the lung septa/pleura
associated with fibrosis/scarring/actelectasis
spontaneous pneumothorax in young males |
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Term
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Definition
| associated with scarring due to a healed inflammatory process |
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Term
| Microscopic features of emphysema |
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Definition
1.abnormally large alveoli separated by thin septae
2.enlargement of pores of kohn ,alveoli appear floating
3.feature of concurrent chronic bronchitis maybe seen |
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Term
| Pathogenesis of emphysema |
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Definition
major cause is cigarette smoking(reduces alapha 1 antitrypsin activity -unopposed destruction of elastic in distal airways)
Proteolysis -antiproteolysis theory (imblaance btw elastic synthesis and catabolism )
Large number of neutrophils+serine elastase +other proteases |
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Term
| Complications of emphysema |
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Definition
| resp failure ,chronic hypoxia/increase in Co2-cor pulmonale , rupture of bullae in lungs to cause pneumothorax , chronic hypoxia- polycythemia,acute bronchitis +bronchopneumonia predisposition |
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Term
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Definition
| permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue resulting from chronic necrotising infections. |
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Term
| Diseases associated with bronchiectasis |
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Definition
| cystic fibrosis ,intralobular sequestrations of lung ,immunodeficiency states bronchial obstruction(tumours,foreign ,bodies, mucous impaction) |
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Term
| Patthogenesis of bronchiectasis |
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Definition
| bronchial obstruction(pooling of secretions clearing mechanism impairment) +infection which lead to inflammation which leads to bronchial damage,fibrosis +dilation . |
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Term
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Definition
| accumulation of thick viscous mucous which leads to airway obstruction. |
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Term
| Primary ciliary dyskinesia |
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Definition
| abnormal movement of the cilia on resp epithelium which results in decreased mucous clearance >>pooling>>infections |
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Term
| Macroscopic features of bronchiectasis |
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Definition
| usually lower lobes,airway dilation,cylindrical airways,bronchi followed to the pleural surface |
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Term
| Microscopic features of bronchiectasis |
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Definition
active cases:acute+chronic inflammation__airway ulceration +necrosis
chronic cases: bronchial wall fibrosis +squamous metaplasia |
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Term
| Bronchiectasis local complications |
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Definition
| lung abcess formation,recurrent resp tract infections, hemoptysis, resp failure, pulmonary hypertension>>right ventricular failure |
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Term
| Systemic complications of bronchiectasis |
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Definition
septicaema ,pyemia(systemic abscess formation, brain abscess)
Amyloidosis(accumulation of proteins insoluable fibers ) |
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