Cardio

11/23/99

• Simple Chronic—3 months of mucus production and coughing for 2 consecutive years
• Smoking can lead to acute bronchitis and over time leads to simple chronic
• Leads to changes in the bronchiole walls
• These changes are believed to be reversible
• Chronic obstructive (Respiratory Bronchiolitis)
• Occurs in late 40's to 50's
• Early emphysema
• Once it has reached the respiratory zone it is classified as emphysema
• Findings
• Spirometry findings
• Blood gases may show some changes

Anatomy

• Bronchus
• Columnar ciliated epithelial
• Mucus glands
• Goblet cells
• Serous glands
• Bronchiole
• Cubiodal epithelial cells ciliated
• No mucus glands or goblet cells
• Alveolus
• Clara cells—produces a watery lining of the alveolar wall for O2 diffusion
• Type II cells produce surfactant
• Type I cells are the squamous lining
• Mucus
• 2 layers
• Sol—thin and watery, bottom layer, ¯viscous
• Gel—thick and tenacious, ¯ viscous
• Goblet and mucus produce the thick layer of mucus
• Mucus is the thickest
• Goblet is less thick than mucus
• Serous glands produce the sol portion
• Do not want the sol layer to become thick and tenacious
• Mucociliary escalator
• Cilia beat towards the mouth
• Rhythmic beating—as long as the bottom layer is thin and watery
• About 200/cell
• Mucokinesis (movement of the diminishes if the bottom layer becomes thick
• What makes mucus thick and tenacious
• Increased number and size of mucous glands
• Increase the number of mucus glands from serous glands that grow up
• A cause of this is chronic exposure to cigarette smoke
• A nervous reflex can lead to the hypertrophy of mucus is sympatheticotonia
• Korr says that NE will enhance the function of mucus glands
• Reid Index in chronic bronchitis—no more than ½ the thickness of the wall should be the mucous gland
• Normal is .3-.5
• Abnormal is >.5
• This stage is reversible—may take up to 5 years after quitting smoking and change of life style
• Chronic inflammation of the wall can also create the same problem
• Cilia will disappear
• Mucus will become thick and tenacious
• Change of mucous glands
• Nervous reflexes play a roll
• Large airways
• Thicker mucus
• Cilia diminishes
• Mucous glands increase in size and number
• Serous glands disappear
• Smaller airways
• Alveoli
• Smokers or constant irritation the Clara cells become goblet cells
• A more viscous fluid will line the alveoli
• A dry cough is not bronchitis
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