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

C.O.P.D Pathology Pathology Pathophysiology Pathophysiology Types Types Clinical features Clinical features Acute complications Acute complications Chronic complications Chronic complications Investigations Investigations Differential diagnosis Differential diagnosis Treatment Treatment References 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 Pathology: Pathology: Enlarged air spaces distal to terminal bronchioles with destruction to the walls. Enlarged air spaces distal to terminal bronchioles with destruction to the walls. Centrilobular(U.Z)>>>>>Bullae Centrilobular(U.Z)>>>>>Bullae Panacinar(L.Z)----  >>>> Panacinar(L.Z)----  >>>>

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

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

TYPES Blue bloaters Blue bloaters Pink puffers

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

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

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

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

Investigations C.X.R/C.T Bld. Gases Pulm. Function tests: FEV1/ FVC PEFR PEFR DL co DL coSputumECGCBC

Treatment STOP Smoking STOP Smoking Domociliary O2 therapy: 15 hrs. 2L 28% Domociliary O2 therapy: 15 hrs. 2L 28% Bronchodilators: B2 agonists Bronchodilators: B2 agonists Anticholinergics (Ipratropium Bromide) Anticholinergics (Ipratropium Bromide) Methylxanthines? Methylxanthines? Corticosteroids: Acute exacerbations Corticosteroids: Acute exacerbations Stable dis.? Stable dis.? Inhalers Inhalers

Treatment Antibiotics: FEV1<50%, More strong A/B Antibiotics: FEV1<50%, More strong A/B Diuretics Diuretics Vasodilators Vasodilators Chest physiotherapy Chest physiotherapy N.I.V: C.P.A.P N.I.V: C.P.A.P Venesection Venesection Vaccinations Vaccinations

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

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