1. Obstructive and restrictive respiratory diseases

2. Lung volumes

3. Total Lung Capacity (TLC) - the total volume of the lung, the volume of air contained in the lung at the end of maximal inspiration
Inspiratory Reserve Volume (IRV) - volume, which can be inspired beyond a restful inspiration
Tidal Volume (TV) – volume of a single breath, usually at rest
Functional Residual Capacity (FRC) - The amount of air left in the lungs after a tidal breath out, the amount of air that stays in the lungs during normal breathing
Vital Capacity (VC) – maximum volume which can be ventilated in a single breath
Inspiratory Capacity (IC) - the maximal volume that can be inspired following a normal expiration
Expiratory Reserve Volume (ERV) – volume, which can be expired beyond a restful expiration
Residual Volume (RV) – volume remaining in the lungs after a maximum expiration

4. Volumes
Forced Vital Capacity (FVC) - the volume of air that can forcibly be blown out after full inspiration, measured in litres
Forced Expiratory Volume in 1 Second (FEV1) - the maximum volume of air that can forcibly blow out in the first second during the FVC manoeuvre, measured in liters
FEV1/FVC (FEV1%) - in healthy adults this should be approximately 75–80%.
In obstructive diseases (asthma, COPD, chronic bronchitis, emphysema) FEV1 is decreased because of increased airway resistance to expiratory flow and the FVC may be increased (for instance by air trapping in emphysema). FEV1/FVC is decreased (<80%, often ~45%).
In restrictive diseases (such as pulmonary fibrosis) the FEV1 and FVC are both reduced proportionally and the FEV1/FVC value may be normal or even increased as a result of decreased lung compliance

5. Obstructive lung diseases
airway obstruction
restricted expiration
 FEV1,  FEV1/FVC
 compliance, elasticity
Chronic bronchitis
Bronchiolitis
Asthma
Emphysema
Bronchiectasia
Cystic fibrosis
normal
Asthma
COPD

6. Condition Major changes Causes Symptoms
Chronic Hyperplasia Tobacco smoking Productive
bronchitis and hypersecretion and air pollutants cough
of mucus glands
Bronchiectasis Dilation and scarring Persistent severe Cough, purulent of airways infections sputum and fever
Asthma Smooth muscle Immunologic Episodic wheezing
hyperplasia or idiopathic cough and dyspnea
Excessive mucus
Inflammation
Emphysema Airspace enlargement Tobacco smoking Dyspnea
Genetic and wall destruction

7. Restrictive lung diseases
restricted lung expansion
restricted inspiration + expiration
 FEV1,  FVC, FEV1/FVC normal
 compliance, elasticity
Interstitial diseases – pneumonia
Fibrosis of lungs – asbestosis, silicosis
Restriction to breathing – pneumothorax, malformities, fracturae
Signs
dyspnea
hypoxemia
cor pulmonale

8. Flow volume curves

9. Spirogram in restriction
Normal spirogram
Spirogram in restriction
Spirogram in obstruction
Normal spirogram and lung volumes. ERV = FRC - RV; VC = TLC - RV; RV ~= 25% of TLC; FRC ~= 40% of TLC; FEV1 >= 75% of FVC.
Spirogram and lung volumes in obstructive disease. RV and FRC are increased.TLC is also increased but to a lesser degree, so that VC is decreased. Expiration is prolonged. FEV1 <= 75% of FVC. Note the emphysematous notch.

10. Asthma
Chronic inflamatory disease of bronchi leading to spasmatic occlusion and hyperproduction of viscous mucus
Causes
allergic
allergens
infection
non-allergic
neurogenic
psychogenic

12. Asthma atack acute exacerbation of asthma Signs and symptoms
dyspnea, wheezing, catching for air
cough – viscous sputum
cyanosis
tachycardia
chest pain

15. Chronic bronchitis chronic inflammation of bronchi Causes smoking
air pollutions
Signs and symptoms
expectorating cough (productive cough, produces sputum)
dyspnea, wheezing
chest pain
fever
fatigue and malaise

16. Chronic bronchitis Smoking impairs ciliary movement
inhibits function of alveoli macrophages
hypertrophy and hyperplasia of mucus-secreting gland
causes smooth muscle constriction
Air pollutions
ozone CO
SO2

18. Emphysema
Abnormal, permanent enlargement and destruction of theair spaces distal to the terminal bronchioles withou obvious fibrosis, progressively lose elasticity and eventual rupture of alveoli
Panacinar (or panlobular) emphysema: The entire respiratory acinus, from respiratory bronchiole to alveoli, is expanded. Occurs more commonly in the lower lobes, especially basal segments, and anterior margins of the lungs.Typical for alpha-1-antitrypsin deficiency.
Centroacinar (or centrilobular) emphysema: The respiratory bronchiole (proximal and central part of the acinus) is expanded. The distal acinus or alveoli are unchanged. Occurs more commonly in the upper lobes. Typical for smokers.

19. Emphysema Causes Inherited alpha 1-antitrypsin deficiency Acquired
cigarette smoking
air pollution
Signs and symptoms
Dyspnea upon exertion, wheezing, coughing
Pursed lips to maximize ventilation
Right heart failure
Hypoxia, respiratory acidosis

20. Emphysema Alpha 1-antitrypsin deficiency (A1AD)
inflammatory enzymes (such as elastase) destroy the alveolar tissue
most A1AD patients do not develop clinically significant emphysema
smoking and severely
decreased A1AT levels
(10-15%) can cause
emphysema at a young
age

23. Chronic obstructive pulmonary disease
combination of chronic brnchitis + emphysema + asthma
Cause
Smoking
Occupational exposures
coal mining, gold mining, silicosis
Air pollution
Genetics
alpha 1-antitrypsin deficiency
Other risk factors
a tendency to sudden airway constriction in response to inhaled irritants (asthma)
repeated lung infections
COPD as an autoimmune disease
sustained inflammation mediated by autoantibodies and autoreactive T cells

24. Chronic obstructive pulmonary disease
Signs and symptoms
dyspnea, wheezing
mucous sputum
respiratory failure
cyanosis
cor pulmonale
peripheral oedema (RV failure)
tachypnea