Chapter 21 – Obstructive, Restrictive & Vascular Pulmonary Disorders

What are the main types of obstructive lung disease?

Asthma and COPD (chronic bronchitis and emphysema)

What is the primary risk factor for many lung diseases

Smoking (and second hand smoke)

What other exposures contribute to lung disease

Occupational and environmental exposure to harmful substances

What is asthma

A hyperreactive airway disease of the bronchioles with reversible airway constriction

What happens after repeated asthma attacks

Inflammatory changes and bronchial remodeling

What is the most common cause of asthma

Allergies (type I hypersensitiity)

Name common asthma triggers

Allergens (pollen, dust, smoke, pet dander, mold), respiratory infections, cold air, exercise, irritants, and certain drugs

What is the physiological response in asthma

Airway inflammation, bronchoconstriction, and increased mucus secretion

Which immune cells and mediators are involved in allergic reactions

T cells, IgE, leukotrienes (bronchoconstriction), histamine (inflammation), eosinphils

What are Hallmark asthma symptoms

Prolonged expiration, wheezing, cough, dyspnea, chest tightness, use of accessory muscles

How is asthma diagnosed

Pulmonary function tests (PFTs) to measure airflow and response to bronchodilators

What immune mediators drive asthma symptoms

Histamine, IgE, T cells, and Leukotrienes — they cause airway inflammation, mucus and bronchoconstriction

How is asthma treated

Stepwise approach — maintenance medications (daily) and rescue medications (for acute attacks)

What disorders are combined in COPD

Chronic bronchitis, emphysema, and hyperreactive airways

What are the main causes of COPD

Smoking (major cause), genetic factors (e.g., AAT deficiency), environmental factors

What is Alpha-1 Antitrypsin (AAT) deficiency

A genetic condition that increases risk for pulmonary damage and emphysema

What defines chronic bronchitis

Hypersecretion of mucus and a productive cough for ≥ 3 months per year for 2 consecutive years

What happens in chronic bronchitis

Airway obstruction from mucus and edema → hypoxia and cyanosis

Nickname for chronic bronchitis

“Blue Bloater”

What clinical features are seen in chronic bronchitis

Cough, cyanosis, chronic hypoxia, clubbing of fingers, pulmonary vasoconstriction

What happens in emphysema

Overdistension of alveoli and loss of elastic recoil → air trapping and hyperinflation.

What are physical signs of emphysema

Prolonged exhalation, barrel-shaped chest, flattened diaphragm

What is the nickname for emphysema

“Pink Puffer”

What structural changes occur in emphysema

Destruction of alveolar septa → larger alveoli (blebs/bulla) → air trapping.

Air problem: cant get air IN

Key signs: cyanosis, cough

Nickname: Blue Bloater

Blood Gas changes: chronic hypoxia

Chronic Bronchitis

Air problem: cant get air OUT

Key signs: Barrel chest, prolonged exhalation

Nickname: Pink Puffer

Blood Gas changes: chronic hypercapnia

Emphysema

What are complications of chronic hypoxia

Recurrent respiratory infections, polycythemia (↑ RBCs), clubbing, pulmonary hypertension, cor pulmonale, respiratory failure.

What causes cor pulmonale in severe COPD?

Chronic hypoxia → pulmonary vasoconstriction → increased RV workload → right-sided heart failure.

What are signs of Cor pulmonale

JVD, ascites, hepatomegaly, ankle edema

What causes Cor pulmonale

Chronic pulmonary hypertension from lung disease (especially COPD)

What is the normal breathing stimulus

Increased CO₂ levels.

What happens in severe COPD?

Chronic hypercapnia desensitizes chemoreceptors → O₂ becomes the main stimulus (hypoxic drive).

Why is oxygen therapy given cautiously to COPD patients

Too much O₂ can suppress the hypoxic drive and decrease respiratory effort.

What is a pneumothorax

Air in the pleural cavity causing partial or complete lung collapse

What are the types of pneumothorax

Primary (spontaneous), secondary (due to lung disease), tension, and traumatic

Who is most at risk for primary pneuomothorax

Tall, young men (10-30 years old)

What happens in tension penumothorax

Air enters pleural space but cannot exit → lung and cardiac compression → life-threatening.

What are clinical signs of pneumothorax

Chest pain, dyspnea, tachypnea, asymmetric chest, intercoastal retractions, hyperresonance, absent breath sounds on affected side

What is pleural effusion

Abnormal collection of fluid in the pleural cavity that compresses lung tissue

Effusion= fluid

Pneumothorax= air

PE= clot

What causes pleural effusion

Fluid accumulation in the pleural cavity compresses lung; due to heart failure, severe pulmonary infection, or neoplasm

What are the types of pleural fluid?

Exudate, transudate, purulent, lymph, or sanguineous (bloody)

What are signs and symptoms of pleural effusion

Dyspnea, tachypnea, sharp pleuritic pain, dullness to percussion, diminished or absent breath sounds

What is pulmonary edema

Fluid accumulation in lung tissue that impairs gas exchange at the alveolar-capillary membrane

Finding that is characteristic of PE: pink, frothy sputum from fluid backflow into alveoli

Which signs/symptoms are associated with pulmonary embolism (PE)

Sudden dyspnea, tachycardia, chest pain, hemoptysis

What is the most common cause of pulmonary edema

Left Ventricular failure (LVF)

How does LVF lead to pulmonary edema

Blood backs up into left atrium and pulmonary circulation → ↑ hydrostatic pressure → fluid into alveoli.

What are symptoms of pulmonary edema

Cough, dyspnea, orthopnea, rales, pink frothy sputum, confusion, severe distress

How is pulmonary edema diagnosed and treated

CXR shows fluid; treated with diuretics, O₂, ACE inhibitors/ARBs, ventilation, and management of LVF.

What is pulmonary embolism

A clot lodged in pulmonary arterial circulation causing ventilation-perfusion imbalance

Common sources of PE (pulmonary embolism)

Deep Vein Thrombosis (DVT) from legs or atrial thrombus (from A-fib)

Why is PE dangerous

It can cause sudden death with little warning

What are symptoms of a small embolism

Transient chest pain, cough, dyspnea

What are symptoms of a large embolus

Severe chest pain with cough or deep breath, tachypnea, dyspnea, hemoptysis, hypoxia, anxiety, restlessness, tachycardia

What happens with massive PE (pulmonary embolism)

Crushing chest pain, hypotension, rapid weak pulse, loss of consciousness, cardiac and respiratory arrest