By Duncan M. Geddes MD, MRCP (auth.)
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This is partly because of the differences in gas exchange. Cardiac Output Cardiac output tends to fall as the pulmonary capillary bed is attenuated. However, since the P0 2 is well maintained, hypoxic vasoconstriction does not occur and pulmonary hypertension and cor pulmonale are unusual. Compliance Loss of alveolar walls makes the lungs more compliant. As a result they expand more under the influence of a negative intrathoracic pressure. Total lung capacity is therefore increased and the chest is overinflated.
Cotton carding in a faCtory. ) Plate 11. Thickened airway wall in asthma. (Courtesy of Dr B. ) Plate 12. Rib deformity (pigeon chest) in chronic asthma. Plate 13. Hyphae of Aspergillus fumigatus in sputum plug from patient with allergic bronchopulmonary aspergillosis. ) Plate 14. Aspergillus sputum plug. ) Plate 15. Endobronchial sarcoidosis: note subcarinal node enlargement and the white plaques. (Courtesy of Dr P. ) Plate 16. Bronchiolitis showing narrowing and inflammation ofa small airway. Bronchiectasis and Cystic Fibrosis 45 patient should keep a supply of antibiotics at home and start a course as soon as the infection begins.
It is likely that the at antitrypsin deficiency allows increased protein breakdown within the lungs and is not simply a genetic marker of disease. About one to three per cent of patients with emphysema have at antitrypsin deficiency. The diagnosis is made by demonstrating a low serum at antitrypsin level and confirmed by phenotyping. Management The patient's relatives should be seen and serum specimens taken for phenotyping. Any individual with a ZZ phenotype is likely to develop emphysema. Smoking should therefore be forbidden.