Hypertrophy of mucus- secreting glands in the bronchioles → Reid Index
Reid index [definition and value in COPD]
Mucus secreting gland depth /total thickness of bronchial wall; in COPD, is > 50%
Chronic bronchitis clinical definition
Productive cough For> 3 consecutive months in > 2 years. Disease of small airways
Chronic bronchitis findings
wheezing, crackles, cyanosis (early onset hyypoxemia due to shunting), late onset dyspnea
Enlargement of air spaces and ↓ recoil resulting From destruction of alveolar wall . ↑ in elastase activity→ ↑ lung compliance (loss of elasticity)
dyspnea, ↓ breath sounds, tachycardia, exhalation through pursed lips to ↑ airway resistance and prevent airway collapse - late onset hypoxemia due to eventual loss of capillary beds (occurs with loss of alveolar walls) - early onset dyspnea
all lower diffusing capacity - Acute respiratory distress syndrome (ARDS, Neonatal respiratory distress syndrome (hyaline membrane disease), Pneumoconioses (coalminer's,.silicosis, asbestosis) , Sarcoidosis, Idiopathic pulmonary fibrosis (repeated cycles of lung Injury and wound healing with ↑ collagen), Goodpasture's syndrome, Wegener's granulomatosis, Eosinophilic granuloma (histiocytosis X), Drug toxicity (bleomycin, busulfan, amiodarone)
Coal miners pneumoconiosis
Associated with coal mines. Can result in cor pulmonale, - Caplan's syndrome - Affects upper lobes
Affects upper lobes, eggshell calcifications of hilar lymph nodes - Associated with foundries, sandblasting, and mines. 2. Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. It is thought that silica may disrupt phagolysosomcs and impair macrophages, increasing susceptibility to TB.
Associated with shipbuilding, roofing, and plumbing. Results in "ivory white," calcified pleural plaques. Associated with an ↑ Incidence of bronchogenic carcinoma and mesothelioma 2. Affects lower lobes 3. Abestos bodies are golden-brown fusiform rods resembling dumbbells located inside macrophages
Neonatal respiratory distress syndrome
Surfactant deficiency leading to ↑ surface tension. resulting in alveolar collapse. Surfactant made most abundantly after 35th week of gestation. lecithin-to-sphingomyelin ratio in the amniotic fluid, a measure of lung maturity, is usually < 1.5 in neonatal respiratory distress syndromc. Persistently low O2 tension→ risk of PDA. Therapeutic supplemental O2 can result in retinopathy of prematurity.
NRDS risk factors
prematurity, maternal diabetes (due to elevated insulin which decreases surfactant production), cesarean deliver (↓ release of fetal glucocorticoids)
maternal steroids before birth; artificial surfactant for infant, thyroxine
Acute Respiratory distress syndrome
diffuse alveolar damage → ↑ alveolar capillary permeability→ protein rich leakage into alveoli. Results in formation of intra-alveolar hyaline membrane. Initial damage due to neutrophilic substances toxic to alveolar wall. Activation of coagulation cascade or oxygen-derived free radicals
Carcinoma that occurs in apex of lung and may affect cervical sympathetic plexus, causing Horner's syndrome
Intraalveolar exudate→consolidation, may involve entire lung - Pneumococcus most frequently, Klebsiella
Acute inflammatory infiltrates from bronchioles into adjacent alveoli; patchy distribution involving lobes - S.aureus, H. Flu, Klebsiella, S.pyogenes
Diffuse patchy inflammation localized to interstitial areas at alveolar walls; distribution involving 1+ lobes - generally follows a more indolent course than bronchopneumonia - Viruses(RSV, adeno), mycoplasma, legionella, Chlamydia
Localized collection of pus within parenchyma, usually resulting from bronchial obstruction (e.g., cancer) or aspiration of oropharyngeal contents (especially in patients predisposed to loss of consciousness, e .g., alcoholics or epileptics). Often due to S. aureus or anaerobes
↓ protein content. Due to CHF, nephrotic syndromc, or hepatic cirrhosis
↑ protein content, cloudy. Due to mallgnancy , pneumonia. collagen vascular disease, trauma (occurs in states of ↑ vascular pemeability) must be drained in light of risk of Infection.
relaxes bronchial smooth muscle (β2). But is nonspecific so causes tachycardia (β1)
β2 agonist - relaxes bronchial smooth muscle - used for acute exacerbation
β2 agonist - relaxes bronchial smooth muscle - long acting agent for prophylaxis - adverse effects are tremor and arrhythmia
a methylxanthine - likely causes bronchodilation by inhibiting phosphodiesterase, thereby ↓ cAMP hydrolysis. Usage is limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity); metabolized by P-450. Blocks actions of adenosine.
competitive block of muscarinic receptors, preventing bronchoconstriction. - Also used for COPD.
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute asthmatic attack. Toxicity is rare
corticosteroids that inhibit synthesis of virtually all cytokines. Inactivate NF-kβ, the transcription Factor that induces the production of TNF-α, among other inflammatory agents. 1st-line therapy for chronic asthma
Antileukotrienes - A 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes.
block leukotriene receptors. Especially good For aspirin-induced asthma.
expectorant - Removes excess sputum but large doses necessary; does not suppress cough reflex.
expectorant - mucolytic - can loosen mucous plug in CF patients - also used as antidote for acetominphen overdose
Used to treat pulmonary hypertension. Competitively antagonizes endothelin-1receptors, decreasing pulmonary vascular resistance
Squamous cell carcinoma
Hilar mass arising from bronchus; Cavitation, Clearly linked to Smoking; parathyroid-like activity →PTHrP
Keratin pearls and intercellular bridges
Develops in site of prior pulmonary inflammation or injury (most common lung cancer in nonsmokers and females)
Clara cells→type II pneumocytes; multiple densities on CXR
Not linked to smoking, grows along airways; can present like pneumonia - can result in hypertrophic osteoarthropathy
Clara cells→type II pneumocytes - multiple densities on CXR
Small cell carcinoma
Undifferentiated → very aggressive, often associated with ectopic production of ACTH or ADH , may lead to Lambert-Eaton syndrome (autoantibodies against calcium channels). Responsive to chemotherapy. Inoperable.
Neoplasm of neuroendocrine Kulchitsky cell → small dark blue cells
Large cell carcinoma
Highly anaplastic undifferentiated tumor; poor prognosis; less responsive to chemotherapy. Removed surgically
Pleomorphic giant cells with leukocyte fragments in cytoplasm
Secretes serotonin, can cause carcinoid syndrome (flushing, diarrhea, wheezing, salivation, R sided Heart failure
Malignancy of pleura associated with abestosis - results in hemorrhagic pleural effusions and pleural thickening
Very common, adrenals, brain (epilepsy), bone (path fracture), and liver (jaundice, hepatomegaly)
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