Basics on Chronic obstructive Pulmonary disease

The basic understanding on COPD

1. COPD GROUP 8

2. NAMES OF GROUP MEMBERS AND ID NUMBERS Fatima Zainab Kamara 22044 Isata K attie Koroma 22058 Mohamed Saidu Mansaray 22064 Patricia King Conteh 22016 Mariama M. Bendu 22011 Precious Faith Kanu 22048 Isatu N. Turay 22081

3. OUTLINE Introduction (Definition) Etiology & Risk factors Pathophysiology Common presentations of COPD Emphysema Chronic Bronchitis Bronchiectasis Investigations management Questions Summary

4. Introduction Chronic obstructive pulmonary disease (COPD) is a chronic lung condition characterized by air flow obstruction and breathing difficulties It typically present with a combination of symptoms, which can vary in severity among individuals

5. Etiology & Risk factors Smoking Genetic factors Occupational exposures Air pollution Respiratory infections Asthma Aging

6. Pathophysiology The pathophysiology of COPD involves a complex interplay of various factors, which includes: Genetic predisposition ands Environmental pollutants

7. Pathophysiology

8. Common features – signs & symptoms Progressive breathlessness Chronic cough Increased sputum production Wheezing Chest tightness Fatigue Recurrent respiratory infections

9. Emphysema Emphysema is characterized by permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls without significant fibrosis. N.B. the acinus is the structure distal to terminal bronchioles, and a cluster of three to five acini is called a lobule

10. Emphysema There are four major types of emphysema: (1) centriacinar, (2) panacinar, (3) distal acinar, and (4) irregular. Only the first two types cause significant airway obstruction, with centriacinar emphysema being about 20 times more common than panacinar disease.

11. Emphysema

12. Centriacinar ( C entrilobular) Emphysema The distinctive feature of centriacinar emphysema is that the central or proximal parts of the acini , formed by respiratory bronchioles, are affected, while distal alveoli are spared. Thus, both emphysematous and normal air spaces exist within the same acinus and lobule The lesions are more common and severe in the upper lobes This type of emphysema is most common in cigarette smokers, often in association with chronic bronchitis.

13. Panacinar ( P anlobular) emphysema In panacinar ( P anlobular) emphysema, the acini are uniformly enlarged, from the level of the respiratory bronchiole to the terminal blind alveoli In contrast to centriacinar emphysema, panacinar emphysema occurs more commonly in the lower lung zones and is associated with α1- anti-trypsin deficiency.

14. Distal acinar ( P araseptal) emphysema In this form of emphysema, the proximal portion of the acinus is normal but the distal part is primarily involved . The cause of this type of emphysema is unknown; it comes to attention most often in young adults who present with spontaneous pneumothorax.

15. Irregular emphysema Irregular emphysema, so named because the acinus is irregularly involved, is almost invariably associated with scarring, such as that resulting from healed inflammatory diseases. Although clinically asymptomatic, this may be the most common form of emphysema.

16. Pathogenesis of Emphysema

17. Clinical Features of Emphysema Dyspnea usually is the first symptom Weight loss is common and may be severe enough to suggest an occult malignant tumor Barrel-chested Pulmonary hypertension Cardiac failure Recurrent infections Respiratory failure

18. Chronic Bronchitis Chronic bronchitis is diagnosed on clinical grounds: it is defined by the presence of a persistent productive cough for at least 3 consecutive months in at least 2 consecutive years. It is common among cigarette smokers and urban dwellers in smog-ridden cities

19. Pathogenesis of Chronic bronchitis The distinctive feature of chronic bronchitis is hypersecretion of mucus, beginning in the large airways. Although the most important cause is cigarette smoking, other air pollutants, such as sulfur dioxide and nitrogen dioxide, may contribute.

20. Pathogenesis of Chronic bronchitis cont… These environmental irritants induce hypertrophy of mucous glands in the trachea and bronchi as well as an increase in mucin -secreting goblet cells in the epithelial surfaces of smaller bronchi and bronchioles. These irritants also cause inflammation marked by the infiltration of macrophages, neutrophils , and lymphocytes

21. Pathogenesis of Chronic bronchitis The airflow obstruction in chronic bronchitis results from: Small airway disease, induced by mucous plugging of the bronchiolar lumen, inflammation, and bronchiolar wall fibrosis, and Coexistent emphysema.

22. Clinical Features of Chronic bronchitis Productive cough Hypercapnia Hypoxemia Cyanosis Pulmonary hypertension Cardiac failure Recurrent infections Respiratory failure

23. Bronchiectasis Bronchiectasis is the permanent dilation of bronchi and bronchioles caused by destruction of smooth muscle and the supporting elastic tissue; it typically results from or is associated with chronic necrotizing infections. It is not a primary disorder, as it always occurs secondary to persistent infection or obstruction caused by a variety of conditions.

24. Predisposing factors of Bronchiectasis Bronchial obstruction Congenital or hereditary conditions Cystic fibrosis Immunodeficiency states Primary ciliary dyskinesia (also called the immotile cilia syndrome). Necrotizing, or suppurative, pneumonia, particularly with virulent organisms such as Staphylococcus aureus or Klebsiella spp., predispose affected patients to development of bronchiectasis. Post-tuberculosis bronchiectasis continues to be a significant cause of morbidity in endemic areas.

25. Pathogenesis of Bronchiectasis Two intertwined processes contribute to bronchiectasis: obstruction and chronic infection. Either may be the initiator. For example, obstruction caused by a foreign body impairs clearance of secretions, providing a favorable substrate for superimposed infection.

26. Pathogenesis of Bronchiectasis cont… The resultant inflammatory damage to the bronchial wall and the accumulating exudate further distend the airways, leading to irreversible dilation. Conversely, a persistent necrotizing infection in the bronchi or bronchioles may lead to poor clearance of secretions, obstruction, and inflammation with peribronchial fibrosis and traction on the bronchi, culminating again in full-blown bronchiectasis .

27. Clinical Features of Bronchiectasis Bronchiectasis is characterized by severe, persistent cough associated with expectoration of mucopurulent, sometimes fetid, sputum. Dyspnea Rhinosinusitis and Hemoptysis Hypoxemia, hypercapnia, pulmonary hypertension, and cor pulmonale.

28. Investigations History taking Clinical examination Spirometry Chest x-ray Alpha -1 testing CT scan Oximetry or arterial blood gas Others ( lung volume test, diffusion capacity test, exercise testing e.t.c )

29. Managements There is currently no cure for COPD, but treatments can help slow the progression of the condition and control the symptoms The various treatments include: Stopping smoking Inhalers and tablets Pulmonary rehabilitation Surgery or a lung transplant

30. Any Question(s)?

31. Summary Emphysema is characterized by permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls without significant fibrosis There are four major types of emphysema: centriacinar , panacinar , distal acinar, and irregular Chronic bronchitis is diagnosed on clinical grounds: it is defined by the presence of a persistent productive cough for at least 3 consecutive months in at least 2 consecutive years . It is common among cigarette smokers and urban dwellers in smog-ridden cities

32. Summary Bronchiectasis is the permanent dilation of bronchi and bronchioles caused by destruction of smooth muscle and the supporting elastic tissue Two intertwined processes contribute to bronchiectasis: obstruction and chronic infection.

33. THE END