Pulmonary Pathophysiology – Key Vocabulary

Vocabulary flashcards covering key terms and definitions from the Pulmonary Pathophysiology lecture, including pneumonia classifications, tuberculosis, COPD, asthma, bronchiectasis, and the respiratory therapist’s role.

Pneumonia

Infection of the lung parenchyma (lower respiratory tract infection).

Community-Acquired Pneumonia (CAP)

Pneumonia contracted outside hospitals or long-term care facilities.

Acute CAP

CAP with rapid onset over hours-days, classically due to Streptococcus pneumoniae.

Chronic CAP

CAP developing gradually over days to months, e.g., tuberculosis.

Health Care-Associated Pneumonia (HCAP)

Pneumonia in patients hospitalized ≥2 days in past 90 days or living in a long-term care facility within 30 days.

Hospital-Acquired Pneumonia (HAP)

Lower respiratory infection developing ≥48 h after hospital admission.

Ventilator-Associated Pneumonia (VAP)

Pneumonia developing 48–72 h after endotracheal intubation.

Inhalation Mechanism of Pneumonia

Infection via aerosolized organisms (e.g., TB, Histoplasma, Legionella).

Aspiration Mechanism of Pneumonia

Entry of oropharyngeal flora into lower airway, common with impaired gag reflex.

Direct Inoculation Mechanism

Introduction of pathogens to lower airway during procedures (e.g., suction catheter).

Contiguous Spread Mechanism

Infection spreading from adjacent structures such as liver abscess through diaphragm.

Hematogenous Spread Mechanism

Seeding of lungs via bloodstream (e.g., right-sided endocarditis).

Reactivation Mechanism

Latent organisms (e.g., TB, Pneumocystis jiroveci) become active with immunodeficiency.

Typical CAP Symptoms

Fever, cough with sputum, pleuritic chest pain, dyspnea.

Atypical CAP in Elderly

May present with dyspnea, confusion, CHF worsening, without fever or cough.

Bacterial CAP Findings

Sudden onset, purulent sputum, crackles/rhonchi, high fever, chills.

Viral CAP Findings

Slower onset, dry or mucoid cough, sore throat, wheezing, diffuse interstitial infiltrates.

Satisfactory Sputum Sample

25 leukocytes and <10 squamous epithelial cells per high-power field.

Acid-Fast Bacilli (AFB)

Stained organisms in sputum indicating tuberculosis.

Chest X-Ray in Pneumonia

Diagnosis by new infiltrate, but early disease or dehydration may produce normal film.

Bacterial CAP Radiology

Localized infiltrates with consolidation or atelectasis.

Viral CAP Radiology

Diffuse or patchy interstitial infiltrates; possible hyperinflation with RSV.

Leukocytosis

Elevated white blood cell count, typical in bacterial CAP.

Latent Tuberculosis

Asymptomatic infection controlled by immune system; can reactivate later.

Primary Tuberculosis

Active TB upon initial exposure, common in children and HIV patients.

PPD Skin Test

Purified protein derivative test showing delayed hypersensitivity to TB antigen.

TB Radiology

Upper-lobe infiltrates ± cavities; primary TB shows hilar adenopathy.

TB Classic Symptoms

Fatigue, fever, night sweats, weight loss, chronic cough ± hemoptysis.

First-Line Anti-TB Drugs

Isoniazid, Rifampin, Pyrazinamide, Ethambutol (6-9 month regimen).

Obstructive Lung Disease

Group of disorders with decreased expiratory airflow (e.g., COPD, asthma).

Restrictive Lung Disease

Conditions causing reduced lung volumes, especially vital capacity.

Chronic Obstructive Pulmonary Disease (COPD)

Progressive, incompletely reversible airflow obstruction due to emphysema and/or chronic bronchitis.

Emphysema

Permanent enlargement of airspaces distal to terminal bronchioles with alveolar wall destruction.

Chronic Bronchitis

Productive cough ≥3 months per year for ≥2 consecutive years.

Centrilobular Emphysema

Smoking-related destruction centered in respiratory bronchioles of upper lobes.

Panlobular Emphysema

Uniform destruction of entire acinus, associated with α1-antitrypsin deficiency.

Bullous Emphysema

Formation of air-filled spaces >1 cm (bullae) in lung parenchyma.

α1-Antitrypsin (AAT) Deficiency

Genetic lack of protease inhibitor leading to early-onset panlobular emphysema.

Major COPD Risk Factor

Cigarette smoking.

Other COPD Risk Factors

Passive smoke, air pollution, occupational dust, airway hyperresponsiveness, low socioeconomic status.

Airflow Limitation Mechanisms in COPD

Small airway inflammation, loss of elasticity, active bronchospasm.

Barrel Chest

Thoracic hyperinflation in COPD where anteroposterior equals transverse diameter (≈1:1).

COPD Radiology

Flattened diaphragms, hyperlucent lungs, increased retrosternal air space.

Bronchodilator Reversibility Test

Post-bronchodilator FEV1 increase ≥12% suggests reversible component.

GOLD Stage I COPD

FEV1 ≥80% predicted; mild disease.

GOLD Stage IV COPD

FEV1 <30% predicted or <50% with chronic respiratory failure; very severe.

COPD Acute Exacerbation Therapy

Short-acting bronchodilator, antibiotics for purulent sputum, systemic steroids, oxygen, possible NIV.

Pulmonary Rehabilitation

Program combining exercise, breathing training, education, psychosocial support to improve QOL in COPD.

Long-Term Oxygen Therapy (LTOT)

≥15 h/day oxygen shown to improve survival in chronic hypoxemic COPD.

Asthma

Inflammatory airway disease with hyperreactivity and reversible obstruction.

Asthma Triggers

Allergens, infections, exercise, cold air, stress, smoke, occupational stimuli.

IgE-Mediated Response

Antigens cross-link IgE on mast cells → mediator release → bronchoconstriction.

Asthma Clinical Triad

Episodic wheezing, shortness of breath/cough, chest tightness.

Asthma Reversibility Criterion

FEV1 increase ≥12% and ≥200 ml after bronchodilator.

Methacholine Challenge

Bronchoprovocation test used when baseline PFTs are normal.

Stepwise Asthma Therapy

Escalating treatment from intermittent (step 1) to severe persistent (step 4) based on symptoms & lung function.

Inhaled Corticosteroids

First-line long-term anti-inflammatory therapy for persistent asthma.

Short-Acting β2-Agonists (SABA)

Most rapid bronchodilators for symptom relief and exercise-induced bronchospasm.

Leukotriene Inhibitors

Oral agents that modestly control mild-moderate asthma by blocking leukotriene pathways.

Cromolyn

Mast-cell stabilizer used prophylactically; ineffective during acute asthma attack.

Tiotropium in Asthma

Long-acting anticholinergic that aids control when added to inhaled steroid therapy.

Anti-IgE Therapy (Omalizumab)

Monoclonal antibody that blocks IgE; for allergic asthma not controlled with steroids.

Asthma Emergency Management

Frequent nebulized SABA, systemic steroids, oxygen, possible ventilation with permissive hypercapnia.

Bronchiectasis

Irreversible bronchi dilation due to chronic infection/inflammation.

Cylindrical (Tubular) Bronchiectasis

Uniform airway dilation along its length.

Varicose (Fusiform) Bronchiectasis

Alternating constrictions and dilations of airway.

Cystic (Saccular) Bronchiectasis

Progressive distal sac-like dilations forming clusters of cysts.

Bronchiectasis Hallmark

Chronic production of copious purulent sputum in three-layer separation.

Fine-Cut CT Scan

Gold standard imaging for diagnosing bronchiectasis.

Bronchiectasis Management

Antibiotics, bronchopulmonary hygiene, oxygen, lung expansion therapy, inhaled bronchodilators.

Respiratory Therapist (RT) Diagnostic Role

Performing PFTs and collecting sputum samples.

RT Management Role

Delivering medications, airway clearance, oxygen, invasive/non-invasive ventilation.

Smoking Cessation Counseling

Key RT follow-up service to slow COPD progression.