Pulmonary Pathophysiology – Pneumonia, COPD, Asthma & Bronchiectasis

Vocabulary flashcards cover major terms, diseases, mechanisms, presentations, diagnostics, and treatments discussed in the Pulmonary Pathophysiology lecture.

Pneumonia

Infection of the lung parenchyma; a lower-respiratory-tract infection.

Community-Acquired Pneumonia (CAP)

Pneumonia contracted outside hospitals; appears acutely in hours–days or chronically over weeks–months.

Health-Care–Associated Pneumonia (HCAP)

Pneumonia in a patient hospitalized ≥2 days in the past 90 days or who lived 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 arising ≥48–72 h after endotracheal intubation.

Pathogenetic Mechanisms of Pneumonia

Inhalation, aspiration, direct inoculation, spread from adjacent sites, hematogenous spread, latent reactivation.

Aspiration Risk Factors

Impaired gag reflex due to narcotics, alcohol intoxication, prior stroke, etc.

Bacterial CAP – Key Presentation

Sudden onset, productive cough with purulent or occasionally bloody sputum, high fever and chills.

Viral CAP – Key Presentation

Acute but slower onset, dry cough, sore throat, malaise, mucoid non-purulent sputum.

Crackles

Fine, discontinuous sounds on auscultation indicating fluid in alveoli, common in bacterial CAP.

Satisfactory Sputum Sample

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

Acid-Fast Bacilli (AFB) in Sputum

Microscopic finding suggestive of tuberculosis infection.

Pulmonary Infiltrate

New area of opacity on chest radiograph consistent with pneumonia.

Latent Tuberculosis

Asymptomatic infection with M. tuberculosis controlled by intact immunity; skin test positive.

Primary Tuberculosis

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

Reactivation (Secondary) TB

Latent TB becoming active when immunity wanes months to years later.

Tuberculosis Transmission

Inhalation of airborne droplets containing Mycobacterium tuberculosis.

First-Line Anti-TB Drugs

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

Emphysema

Permanent enlargement of airspaces distal to terminal bronchioles with destruction of walls, no fibrosis.

Chronic Bronchitis

Productive cough ≥3 months/yr for ≥2 consecutive years.

COPD Definition (ATS)

Inflammatory disorder with partially reversible, usually progressive airflow obstruction.

Centrilobular Emphysema

Smoking-related destruction centered in respiratory bronchioles, upper lobes predominant.

Panlobular Emphysema

Diffuse alveolar wall destruction; associated with α1-antitrypsin deficiency and aging.

Bullous Emphysema

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

α1-Antitrypsin Deficiency

Hereditary lack of protease inhibitor leading to early panlobular emphysema.

Barrel Chest

Increased anteroposterior diameter of thorax due to lung hyperinflation in COPD.

Cor Pulmonale

Right-sided heart failure secondary to chronic lung disease such as COPD.

Smoking – COPD Pathogenesis

Causes ciliary inhibition, bronchospasm, macrophage dysfunction, alveolar wall damage.

Small-Airway Inflammation (<2 mm)

Major mechanism of airflow limitation in COPD.

Loss of Elastic Recoil

Destruction of elastin causing alveolar wall collapse and air trapping in COPD.

Active Bronchospasm

Reversible smooth-muscle constriction contributing to airflow limitation in COPD.

PRN Bronchodilator

Short-acting β2-agonist or anticholinergic used as needed by all COPD patients.

Systemic Corticosteroid Trial

Short course to test reversibility; responders continue inhaled steroids.

Long-Term Oxygen Therapy (LTOT)

15 h/day supplemental O2 shown to improve COPD survival.

Pulmonary Rehabilitation

Exercise, breathing retraining, education and support to reduce dyspnea and hospitalizations.

Asthma

Chronic inflammatory airway disease with hyperreactivity and reversible airflow obstruction.

Asthma Triggers

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

IgE-Mediated Mast-Cell Degranulation

Key immunologic event releasing mediators that cause bronchoconstriction in asthma.

Methacholine Challenge

Bronchoprovocation test to diagnose airway hyperresponsiveness in asthma.

Inhaled Corticosteroids (ICS)

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

Short-Acting β2-Agonists (SABA)

Rapid bronchodilators used for rescue in asthma or exercise-induced symptoms.

Leukotriene Inhibitors

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

Anticholinergics in Asthma

Add-on bronchodilators (e.g., tiotropium) when β2-agonists and steroids insufficient.

Omalizumab

Anti-IgE monoclonal antibody for moderate–severe allergic asthma uncontrolled on ICS.

Permissive Hypercapnia

Ventilation strategy in severe asthma using low VT and allowing high CO2 to avoid barotrauma.

Bronchiectasis

Irreversible dilation of bronchi due to chronic inflammation and airway wall destruction.

Cylindrical (Tubular) Bronchiectasis

Uniformly dilated airways along their length.

Varicose (Fusiform) Bronchiectasis

Irregular airway constrictions and dilations giving a beaded appearance.

Cystic (Saccular) Bronchiectasis

Progressive distal sac-like dilations forming clusters of cysts.

Three-Layer Sputum

Bronchiectasis sputum: frothy top, mucopurulent middle, thick purulent bottom.

Halitosis

Foul breath common in bronchiectasis due to chronic infection.

Fine-Cut CT Scan

Imaging gold standard for diagnosing bronchiectasis.

Bronchopulmonary Hygiene

Postural drainage, cough maneuvers, humidification to clear secretions in bronchiectasis.

Inhalation Therapy – Mannitol

Dry-powder hyperosmolar agent that aids mucus clearance in bronchiectasis.

Incentive Spirometry

Lung-expansion technique to keep distal airways open in bronchiectasis management.

Obstructive Lung Disease

Group causing reduced airflow rates: COPD, asthma, bronchiectasis, bronchiolitis, CF.

Restrictive Lung Disease

Conditions that decrease lung volumes such as vital capacity.

Crackles vs. Rhonchi

Crackles: popping sounds; Rhonchi: low-pitched snoring; both heard in bacterial pneumonia.

Diffuse Interstitial Infiltrates

Radiographic pattern typical of viral CAP.

Localized Consolidation

Alveolar filling seen on x-ray in bacterial CAP.

Decreased PaO2

Arterial oxygen tension drop common in pneumonia or COPD exacerbation.

White Blood Cell Count

Elevated in bacterial infections; normal in viral CAP.

Night Sweats

Classic constitutional symptom of active tuberculosis.

Bronchial Breath Sounds

Harsh sounds over consolidated lung in TB or pneumonia.

Sputum Clearance Techniques

PEP therapy and autogenic drainage taught by RTs.

Nosocomial Infection

Hospital-acquired; HAP and VAP are most common in U.S. healthcare.

Right-Sided Endocarditis

Possible hematogenous source of septic pulmonary emboli causing pneumonia.

Parasite Larval Migration

Threadworm or hookworm larvae traveling via blood to lungs causing pneumonia.

Alpha1-Antichymotrypsin Deficiency

Rare hereditary cause linked to COPD development.

Airway Reversibility Criterion

Post-bronchodilator FEV1 increase ≥12% and 200 mL indicates significant response.

Pink Puffer

Emphysema patient with dyspnea, cachexia, minimal cyanosis, pursed-lip breathing.

Blue Bloater

Chronic bronchitis phenotype with cyanosis, edema, and productive cough.

Asterixis

Flapping tremor of hands seen in severe CO2 retention in COPD.

Stage I COPD

Mild: FEV1/FVC <70% and FEV1 ≥80% predicted; treat with risk reduction plus PRN SABA.

Stage IV COPD

Very severe: FEV1 <30% or <50% with chronic respiratory failure; consider LTOT, surgery.

Pulmonary Function Test (PFT)

Diagnostic test measuring lung volumes and flows; RTs often perform.

Postural Drainage

Positioning technique to drain specific lung segments of secretions.

Hyperinflation

Excess lung air volume leading to flattened diaphragm on x-ray in COPD.

RSV (Respiratory Syncytial Virus)

Common viral cause of diffuse infiltrates and hyperinflation in pediatric viral CAP.

Bronchiolitis

Inflammation of small bronchioles; obstructive disease often viral in children.

Mucopurulent Sputum

Mixture of mucus and pus, typical in bacterial infections.

Rehabilitation Goals

Maximize daily functional capacity, reduce dyspnea, improve quality of life.

Influenza & Pneumococcal Vaccines

Preventive measures recommended for all COPD patients.