Inas Izzuddini
011411133065
Class of Medical Program 2014
1. How can ephysema cause pulmonary hypertension?
(Pvri.info)
Emphysema is defined as “an anatomic
alteration of the lung characterized by
an abnormal airspace enlargement
distal to the terminal bronchioles
accompanied by destructive changes of
2. How can central chemoreceptor in medulla oblongata control the
concentration of CO2 in cerebrospinal fluid? With illustration.
the alveolar walls” and is a variable
component of the syndrome COPD
which is now understood to have also
extrapulmonary systemic
manifestations.
Most patients with COPD/emphysema
have small elevations of the pulmonary
artery pressure at rest, a small
subgroup of the COPD patients
(around 1%) presents with pulmonary
artery pressures at rest that are in the
range usually observed in patients with
idiopathic forms of PH. The
pathobiology of the PH in these
patients remains unexplored and lung
histological studies have not been
reported. Because echocardiographic
evaluation of patients with
hyperinflated lungs is problematic,
hemodynamic assessment of these
patients is necessary. It should become
the standard procedure to evaluate
exercise hemodynamics in these
patients, in particular if the clinician
wants to rule out PH as a cause of
dyspnea. (Voelkel, Mizuno and
Gomez-Arroyo, 2011)
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3. Why does wheezing in asthma happen specially in expiration?
Wheezing may result from localized or diffuse airway narrowing or obstruction from
the level of the larynx to the small bronchi. The airway narrowing may be caused by
bronchoconstriction, mucosal edema, external compression, or partial obstruction by a
tumor, foreign body, or tenacious secretions. Wheezes are believed to be generated by
oscillations or vibrations of nearly closed airway walls. Air passing through a
narrowed portion of an airway at high velocity produces decreased gas pressure and
flow in the constricted region (according to Bernoulli's principle). The internal airway
pressure ultimately begins to increase and barely reopens the airway lumen. The
alternation of the airway(s) between nearly closed and nearly open produces a
"fluttering" of the airway walls and a musical, "continuous" sound. The flow rate and
mechanical properties of the adjacent tissues that are set into oscillation determine the
intensity, pitch, composition (monophonic or polyphonic notes), duration (long or
short), and timing (inspiratory or expiratory, early or late) of this dynamic symptom
and sign. Wheezes are heard more commonly during expiration because the airways
normally narrow during this phase of respiration. Wheezing during expiration alone is
generally indicative of milder obstruction than if present during both inspiration and
expiration, which suggests more severe airway narrowing. However, most asthmatic
patients are unable accurately to correlate their wheezing (or other respiratory
symptoms) to the severity of airway obstruction as measured objectively by
pulmonary function tests. (Henry Gong, 1990)

References
Henry Gong, JR. 'Wheezing And Asthma'. Butterworths (1990): n. pag. Web. 16 Oct.
2015.
Image.slidesharecdn.com,. N.p., 2015. Web. 16 Oct. 2015.
Pvri.info,. 'Comparison Between Pulmonary Hypertension In The Setting Of
COPD/Emphysema (Left) And Pulmonary Hypertension Due To Left
Ventricular Dysfunction (Right) | Pulmonary Vascular Research Institute
(PVRI)'. N.p., 2015. Web. 16 Oct. 2015.
Voelkel, NorbertF, Shiro Mizuno, and Jose Gomez-Arroyo. 'COPD/Emphysema: The
Vascular Story'. Pulm Circ 1.3 (2011): 320. Web. 16 Oct. 2015.