By Duncan M. Geddes MD, MRCP (auth.)
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Extra info for Airways Obstruction
As the space enlarges, the surface tension of its wall decreases, predisposing to further enlargement. Valve Mechanism An airway may be distorted or narrowed by disease and so allow air to enter the bulla more easily than it leaves. The distortion may be caused by fibrosis or another bulla. Endobronchial sarcoidosis rarely acts as a valve. Traction In lung fibrosis, parts of the lung may shrink relative to others. This traction leads to bullae formation in the more normal lung. Coexisting distortion of airways may contribute.
Prevention of Progression Progression can be prevented by breathing clean air and stopping smoking. Environmental pollution has been considerably reduced by the Clean Air Acts of 1956 and 1968 and working conditions are also improving, but these advances have not been matched by changes in smoking habits. If a patient with chronic obstructive bronchitis stops smoking, the rate of deterioration of his lung function will be halved. Prevention of infective exacerbations probably has little effect on disease progression, but may reduce the amount of time off work.
The mediators released from mast cells act on the smooth muscle by altering the intracellular level of cyclic AMP and probably GMP. The mediators also change the cyclic nucleotide levels in mast cells, an increase in cyclic AMP depressing mediator release. The overall effect is to cause bronchoconstriction as well as feeding back on the mast cells to inhibit further mediator release. The same changes are brought about by an increase in parasympathetic nervous tone. The changes also affect pulmonary blood vessels with contraction of smooth muscle and increase in capillary permeability.
Airways Obstruction by Duncan M. Geddes MD, MRCP (auth.)