C O P D Ch Bronchitis Emphysema AISHA

(C. O. P. D) Ch. Bronchitis Emphysema AISHA M SIDDIQUI

C. O. P. D n n n n n Pathology Pathophysiology Types Clinical features Acute complications Chronic complications Investigations Differential diagnosis Treatment References

Ch. Bronchitis Normal mechanism of cough. Ch. irritation>>>>ch. bronchitis Smoking, industries & pollution. Mortality ^ with infection More in winter & autumn More in low socioeconomic class.

Emphysema n Pathology: Enlarged air spaces distal to terminal bronchioles with destruction to the walls. Centrilobular(U. Z)>>>>>Bullae Panacinar(L. Z)---- >>>>

Emphysema n Pathogenesis: Smoking, air pollution, infection, Intrinsic. - Alpha 1 Antitrypsin def: inhibits proteolytic enzymes released from macrophages and neutrophils. Increases in smokers Basal segments.

Emphysema n Pathophysiology: Airway dis. (narrowing)>>>limitation of air flow>>> poorly ventillated. VENTILLATION PERFUION MISMATCH Extensive dis. >>>Resp. Failure(type 2) ELASTIC RECOIL OF THE LUNG LOST Expansion of lung >>> increase T. L. C Earlier closure of airways >>> inc. R. V (air trapping) Reduction of surface area for gas exchange>>>decrease in transfer factor.

TYPES n Blue bloaters n Pink puffers

Clinical Features n Breathlessness n Insidiuos onset n Increase gradually n Irritation of mucosa>>>mucous>>>cough>>> bronchoconstriction.

Clinical Features n Physical signs: n Mild- Moderate >>> No abnormality n Tachypnea. n Prolonged expiration, pursed lips. n Xssory ms. Of resp. n Posture; mechanical advantage. n Chest:

Complications n CHRONIC: Type 2 resp. failure. Polycythemia. Corpulmonale. n ACUTE: Infections. L. V. F. P. E. Pneumothorax.

Differential Diagnosis CHRONIC BRONCHITIS: B. asthma Bronchiectasis Ch. sinusitis Aspiration T. B/ Neoplasm n EMPHYSEMA: C. O. P. D/ B. asthma Obstructive/ Restrictive Large airways obstruc/ small n

Investigations C. X. R/C. T Bld. Gases Pulm. Function tests: FEV 1/ FVC PEFR DL co Sputum ECG CBC

Treatment n n STOP Smoking Domociliary O 2 therapy: 15 hrs. 2 L 28% Bronchodilators: B 2 agonists Anticholinergics (Ipratropium Bromide) Methylxanthines? Corticosteroids: Acute exacerbations Stable dis. ? Inhalers

Treatment n Antibiotics: FEV 1<50%, More strong A/B n Diuretics n Vasodilators n Chest physiotherapy n N. I. V: C. P. A. P n Venesection n Vaccinations

References n Scientific American Medicine 9/01 n NEJM : June 26, 2003. Vol. 348(26) n NEJM : June 24, 2004. Vol. 350(26) n Davidson’s Principles and Practice of Medicine n Uptodate 2008

BRONCHIAL ASTHMA n n n Definition Cardinal pathophysiological features: Airflow limitation (reversible) Airway hyperresponsiveness Airway inflammation Types and aetiology Clinical features Investigations Management