copd lecture
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RAHEEF ALATASSIFree syria
objectives chronic bronchitis :
definition causes path physiology morphology mechanism of obstruction management complication S/S Investigation
Emphysema: definition Causes path physiology morphology types management complication S/S Investigation
Pulmonary hypertension: Definition
CHRONIC BRONCHITIS
Definition
It is defined as a persistent productive cough for at least 3 consecutive months in at least 2 consecutive years
forms features
Simple chronic bronchitis the productive cough raises mucoid sputum, but airflow is not obstructed
Chronic asthmatic bronchitis hyper-responsive airways with intermittent bronchospasm and wheezing
Chronic obstructive bronchitis develops chronic outflow obstructionAssociated with emphysema
Causes
Pathogenesis of Chronic Bronchitis
Pathogenesis of Chronic Bronchitis
Cigarette smoking or other air pollutants lead to:
1-Hypertrophy and hyper secretion of bronchial mucous glands
2-Metaplastic formation of goblet cells
3-Infiltration by CD+8 lymphocytes ,macrophages and neutrophils
mucous gland hyperplasia,
morphology The trachea
in the mid-upper field is hyperemic
the bifurcation & bronchi contain mucopurulent exudate secretion.
enlargement of the mucus-secreting glands
management Stop smoking > inhaled
bronchodilator (anticholinergic agonist or b2 agonist) > combination > glucocorticosteroid > oxygen.
Complications: Pulmonary hypertension and cardiac failure Recurrent infections Respiratory failure
S/S : cough , sputum ,frequent infections ,
intermittent dyspnea, wheeze. Some patients develop significant COPD with
outflow obstruction: hypercapnia, hypoxemia, cyanosis
Investigation Spirometry
CXR > hyperinflation FBC > polycythemia ABG > hypoxemia or hypercapnia
Severity of COPD (GOLD scale)
FEV1 % predicted
Mild ≥80
Moderate 50–79
Severe 30–49
Very severe <30 or chronic respiratory failure symptoms
The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and
Spirometry
EMPHYSEMA
definition
• It is permanent enlargement of air spaces distal to terminal bronchioles, accompanied by destruction of their walls.
• not associate with fibrosis
Causes:SmokingDeficinecy of a1 antitrypsin
path physiology
Pathogenesis of Emphysema
Emphysema arises as a consequence of two imbalances:Protease-antiprotease imbalanceOxidant-antioxidant imbalance * INCRESE elastase
The destructive effect of protease in subjects with low antiprotease activity leads to emphysema
Free radical → deplete the lung antioxidant mechanisms → tissue damage
Protease releasefree radical
Tobacco smoke
free radical
morphology
The external surfaces of the upper lobes of both the right and left lungs have large bullae.
Distal type. bullaeCyst more than 1 cm.
the permanent enlargement of the airspace, accompanied by destruction of the septa
typestype features
Centriacinar It involve the central or proximal parts of the aciniThe lesions are more common and severe in the upper lobesThis type is seen as a result of cigarette smoking
Panacinar It occurs more commonly in the lower lung zonesThe type of emphysema occurs in α1-antitrypsin deficiency
Distal Acinar The distal part of the acinus is involved It is seen adjacent to the pleura, along the lobular
margins,scarring. Cystlike structures can be formed (bullae)
Irregular The acinus is irregularly involvedIt is associated with scarringClinically asymptomaticThe most common form of emphysema
Management & Investigation
The same treatment & Investigation as the chronic bronchitis
Chronic hypoxia
Pulmonary vasoconstriction
Muscularizati
on
Intimal hyperplasia
Fibrosis
Obliteration
Pulmonary hypertension
Cor pulmonale
Death
Edema
Pulmonary Hypertension in COPD
complication
I. Pulmonary hypertension;hypoxia-induced pulmonary vascular spasm loss of capillary surface area due to alveolar wall
destructionII. Right side heart failureIII. Respiratory failure
S/S Patients present with dyspnea, and
abnormal pulmonary function tests
Patients with underlying chronic bronchitis
They have less dyspnea and retain more CO2
They are always hypoxic and cyanotic (blue bloaters)
Patients with no bronchitis They have more severe dyspnea and hyperventilation
They have normal gas exchange and adequate oxygenation of hemoglobin (pink puffers)
Pulmonary hypertension:
The pulmonary circulation is normally one of low resistance, with pulmonary blood pressures being only about one-eighth of systemic pressure. Pulmonary hypertension (when mean pulmonary pressures reach one-fourth or more of systemic levels) is most often secondary to a decrease in the cross-sectional area of the pulmonary vascular bed, or to increased pulmonary vascular blood flow
morphology
A, Gross photograph of atheroma formation, a finding usually limited to large vessels.
B, Marked medial hypertrophy.
C, Plexogenic lesion characteristic of advanced pulmonary hypertension seen in small arteries.
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