CHRONIC OBSTRUCTIVE PULMONARY DISEASES PPT

COPD

1. Pulmonary Disease
Obstructive Disease
Restrictive Disease
Vascular Disease
Malignancy

2. Lung Disease
Restrictive vs. Obstructive
Lung Disease

3. Restrictive Lung Disease: Reduced
expansion of the lung parenchyma with 
TLC (FVC) & FEV
1. Normal FEV
1 (FVC)
Ratio.
Obstructive Lung Disease: Decreased air
inflow usually because of obstruction at any
level with FEV
1 with normal TLC (FVC).
Decreased FEV
1 (FVC) Ratio.

11. A = Terminal +
Lobule Bronchiole

3-5 ACINI
Functional
Respiratory
Bronchiole
Alveolar Duct
Alveolar Sac
Alveolus

18. Alveolar Wall & O
2
/CO
2
Diffusion
Blood Capillary Interstitial Alveolar Air
Endothelium Cell Epithelium
Type I & II
O
2
(~40mm)
CO
2
(~50mm)
O
2
(~100mm)
CO
2
(~0 mm)

23. Diffuse Lung
Disease
Obstructive
(Airway)
Restrictive
(Parenchymal)
 Expansion
 FEV
1
 TLC (FVC)
FEV
1 Ratio ~N
 Air Flow
 FEV
1
 TLC (FVC)
  FEV
1
Ratio

24. Lung
Disease
Obstructive
Ratio 
Restrictive
Ratio ~ N
Airway 
Asthma
Recoil 
Emphysema
Chronic Bronchitis
Extrapulmonary
Obesity
Chest Wall Deformity
Interstitial
ARDS (acute)
Pneumoconioses (chronic)

25. Obstructive Lung Disease
Asthma - Acute
Chronic Obstructive Pulmonary Disease
(COPD)
–Emphysema
a. Smoking b. A
1AT Deficiency
–Chronic Bronchitis
Bronchiectasis

26. Asthma: Episodic, reversible bronchospasm
resulting from an exaggerated bronchoconstrictor
response to various stimuli which affects 10% of
children & 5%-7% adults

27. Clinical Sxs of Asthma
Dyspnea
Cough
Wheezing

28. Extrinsic (Immune Antigens)
Atopic Asthma - Most Common
Occupational Asthma
Asthma Allergic Aspergillus
Intrinsic (Non-Immune)
Aspirin Exercise
Cold ( temp) Irritants
Stress Pollutants

29. Asthma Pathogenesis
Extrinsic (Atopic) Or Intrinsic
Type I
Hypersensitivity
or --------------------------------------------->
Pollutants,
Exercise, etc.
Bronchial
Inflammation
Bronchial
Constriction

30. Asthma: Common denominator is an
exaggerated acute reversible
bronchoconstriction (increased bronchial
reactivity)due to chronic inflammation.

31. Atopic (Extrinsic) Asthma
Most Common Type of Asthma
First 2 Decades of Life
Other Allergic Manifestations
Serum IgE 
Blood Eosinophil Count 

34. Asthma - Intrinsic: Pathogenesis
Viral Infections
Air Pollutants
Exercise
Aspirin
???

35. Intrinsic Asthma
Infections (viral) Bronchial Bronchial
Pollutants (NO
2, SO
2)------>Hyperreactivity------> Spasm
Exercise
Dyspnea Edema
Cough Mucus
Wheeze

36. Asthma - Morphologic Pathology
Gross Hyperinflation with small areas of
atelectasis.
Mucus plugs in bronchi & bronchioles
Microscopic - Curschmann's spiral
Charcot - Leyden crystals

40. Asthma - Micropathology
Edema, hyperemia, & inflammation of bronchioles
Eosinophils > mast cells;
lymphocytes (CD4)
Patchy necrosis
 Basement membrane ( collagen)
 Size of submucosal glands
Hypertrophy & hyperplasia of bronchial smooth
muscle

42. Asthma - Clinical Course
Dyspnea with wheezing
Lasts 1 to several hours
Bronchodilators, steroids
Status Asthmaticus
 Deaths in last decade

43. Obstructive Lung Disease
Asthma
Chronic Obstructive Pulmonary Disease
(COPD)
–Emphysema
a. Smoking b. A
1AT Deficiency
–Chronic Bronchitis
Bronchiectasis

44. Emphysema vs. Chronic Bronchitis
Emphysema (a morphologic dx): permanent
enlargement of the air spaces distal to the
terminal bronchioles accompanied by
DESTRUCTION of their walls.
Chronic Bronchitis (a clinical dx): a persistent
productive cough for at least 3 consecutive
months in at least 2 consecutive years.
?? WHAT IS THE MOST COMMON CAUSE FOR BOTH ??

47. Inflammation
Fibrosis of
Bronchi
Obstruction
Emphysema

48. Brochiectasis
Bronchial Obstruction
Congenital or Hereditary Conditions
Immunodeficiency states
Kartagener’s Syndrome

49. Bronchiectasis
Staphylococci
H.Staphyloccocci
Pseudomonas aeruginosa

52. Types of Emphysema
Proximal
Respiratory
Bronchioles
Distal
Alveoli
Lung
Lobes
Centriacinar
(Centrilobular)
-95%-
Affected Spared Upper Lobes
Apices
Panacinar
(Panlobular)
Affected AffectedLower
Distal Acinar
(Paraseptal)
Normal AffectedUpper,
Cysts, Bullae
Smoking
Uniformly enlarged
A
1
-AT + Smoking
Adjacent to pleura & scars
Spontaneous pneumothorax

53. Emphysema: Incidence
50% of autopsy patients
Most asymptomatic
Centriacinar (respiratory bronchioles) more
common
More severe in men than women
!! SMOKING !!
Ventilatory deficits earlier on than disability

55. Emphysema - Pathogenesis
Excess Protease Elastic
or Unopposed Tissue
Excess Elastase By Destruction
Activity
Appropriate
Antiprotease
Regulation
---------------------------->

57. Smoking & Emphysema
(Centriacinar)
 PMNS & macrophages in alveoli
 Release of elastase from macrophages
 Release of elastase from macrophages
(not inhibited by A
1AT)
Oxidants in cigarette smoke  A
1AT activity

60. Emphysema: Gross Pathology
Panacinar; pale voluminous lungs
Centriacinar; less voluminous
upper 2/3's of lung
bullae

65. Emphysema: Histopathology
Thinning & destruction of alveolar walls
Confluent adjacent alveoli
Deformation of fibrosis of respiratory
bronchioles

Reduced radial traction of small airways

Obstruction (collapse) during expiration

69. Emphysema - Clinical Symptoms
Dyspnea
Wheezing
Weight Loss
FEV
1  But FVC ~ Normal
 FEV
1
/FVC Ratios

70. Pink Puffers
No bronchitic
component
Barrel-chest*
Dyspnea early*
Hunched-over
Hyperventilation*
Adequate oxygenation
Weight loss*
Blue Bloaters
Bronchitic component
cough, mucus
No barrel chest
Dyspnea late
No air hunger
Ventilation - OK
Cyanosis*
Cor Pulmonale
Obese*
Emphysema vs. Chronic Bronchitis

74. COPD

O2 (Hypoxemia)

Pulmonary Hypertension

Cor Pulmonale
Consequences of COPD

75. Death from Emphysema
A. Pulmonary Failure
*Respiratory Acidosis
*Hypoxia
*Coma
B. Cor Pulmonale