RESPIRATORY SYSTEM

TUTORIAL :

1. What entities come into your mind while a patient presents with cough?

2. What entities are included in chronic obstructive lung disease?

3. What is the difference between bronchitis and emphysema?

4. Define chronic bronchitis, its pathogenesis. What are histopathological findings. What is Reid Index.

5. What are the various types of Asthma. What histopathological findings will be seen in bronchial
lavage or sputum.

6. A middle aged patient presented with severe cough especially in morning and some bronchial
obstruction with superimposed bacterial infection with dilatation of bronchi.

- What is your likely diagnosis.

- What are the complications.

- What is primary ciliary dyskinesia.

Ans1.
 Chronic bronchitis

 bronchiectasis

 asthma

 bronchiolitis

 common cold

 influenza

 allergies

 pneumonia due to bacteria viruses and fungi tuberculosis

  idiopathic pulmonary Fibrosis

 drug related for example Ace inhibitors

 whooping cough

 pneumoconiosis

 sarcoidosis

 hypersensitivity pneumonitis

 laryngitis

 cystic fibrosis

 lung tumors (chronic cough)

Ans 2. It includes

1.Emphysema

2. Chronic bronchitis

3. Asthma

4. Bronchiectasis.

Ans 3.

FEATURES BRONCHITIS EMPHYSEMA

Appearance Blue bloaters Pink puffers

Age 40-45 50-75

Dyspnea Mild,late Severe,early

Cough Early, copious sputum Late,scanty sputum

Infections Common Occasional

Respiratory insufficiency Repeated Terminal

Elastic recoil Normal Low

 Cor pulmonale Common Rare, terminal

Airway resistance Increased Slightly increased

Ans4

CHRONIC BRONCHITIS

It is defined by the presence of a persistent productive cough for at least three

consecutive months in at least two consecutive years. It is common among cigarette
smokers. In early stages of the disease the cough raises mucoid sputum but airflow is
not obstructed. Some patients with chronic bronchitis show hyperresponsive Airways
with intermittent bronchospasm and wheezing while other bronchitic patients, especially
heavy smokers develop chronic outflow obstruction usually with associated
emphysema.

Pathogenesis

The distinctive feature of chronic bronchitis is hyper secretion of mucus beginning in the
large Airways. The most important cause is cigarette smoking and air pollutant such as
Sulphur dioxide and Nitrogen dioxide. These irritants induce hypertrophy of mucous
glands in the trachea and bronchi as well as an increase in mucin secreting goblet cells
in the epithelium of bronchi and bronchioles. These irritants also cause inflammation
mark by the the infiltration of macrophages neutrophils and lymphocytes. In short the
airflow obstruction in Chronic Bronchitis results from

1) small Airway disease induced by mucus plugging of the the bronchiolar lumen,
inflammation and bronchiolar wall fibrosis

2) coexistent emphysema

These effects on respiratory epithelium are mediated by cytokines such as IL-3 and
innate lymphoid cells.

Histological findings

Enlargement of mucous secreting glands in trachea and larger bronchi.

Variable number of inflammatory cells largely lymphocytes and macrophages but

sometimes neutrophils are seen in the bronchial mucosa.
Chronic bronchiolitis characterized by goblet cells metaplasia, mucus plugging,
inflammation and fibrosis is also seen.

Complete obstruction of lumen as a result of fibrosis in severe cases.

Emphysematous changes also co exist.

REID INDEX

It is the ratio of the thickness of the submucosal gland layer to that of the bronchial wall.
Normal value is 0.4 It is used to assess the magnitude of the increase in size.

Ans5.

TYPES OF ASTHMA

 Atopic asthma

 Non-atopic asthma

 Drug induced asthma

 Occupational asthma

HISTOPATHOLOGICAL FINDINGS

Occlusion of bronchi and bronchioles by thick tenacious mucus plugs containing whorls
of shed epithelium (curschmann spirals)

1. Numerous eosinophils

2. Charcot laden crystals

3. Airway remodeling including

4. Thickening of airway wall

5. Sub-basement membrane fibrosis

6. Increased submucosal vascularity

7. Increase in size of submucosal glands and goblet cell metaplasia of airway

epithelium

8. Hypertrophy and hyperplasia of bronchial muscle

Ans 6

A) Bronchiectasis

B) Complications

Brain abscess,amyloidosis,cor pulmonale

C) Primary ciliary dyskinesia

Also known as immotile cilia syndrome. It is a rare autosomal recessive disorder

frequently associated with bronchiectasis and with male infertility. It is caused by
inherited normalities of cilia that impair the mucociliary clearance of the Airways leading
to persistent infections.