1. Diseases of
RESPIRATORY SYSTEM

2. Chronic Obstructive Pulmonary Diseases
Definition:
A group of pulmonary diseases characterized by increased resistance to air flow due to partial or complete obstruction at any level.
Types:
1. Chronic bronchitis.
2. Bronchial asthma.
3. Emphysema.

3. (l) Chronic Bronchitis
Definition:
It is persistent productive cough for at least 3 consecutive months in at least 2 consecutive years.
Common in middle-aged men
Causes:
1- Cigarette smoking.
2- Atmospheric pollution
3- Chronic inflammation of upper respiratory tract.

4. Pathology:.
N/E: Bronchial mucosa appears thick, opaque and covered by excess mucous.
M/P:
both bronchi and bronchioles show;
1) Epithelium:
- Goblet cell hyperplasia.
- Squamous metaplasia and dysplasia.
2) Subepithelial Tissue:
- Chronic inflammatory cell infiltrations.
- Hyperplasia of mucous glands.
- Fibrosis.

5. Complications:
1- Centrilobular emphysema.
2- Bronchopneumonia.
3- Malignancy: Bronchogenic carcinoma.
4- Pulmonary hypertension and corpulmonale.
5- Heart failure.

6. (2) Bronchial Asthma Definition:
episodes of reversible bronchospasm resulting from increased responsiveness of the bronchial tree to various types of stimuli.
Aetiology and Types:
1. Extrinsic (immunological, atopic, allergic) asthma.
2. Intrinsic asthma (non-immunological, non-allergic).

7. children & young adults.
Intrinsic asthma
Extrinsic asthma
1. Age
adults.
children & young adults.
2. Etiopathognesis
- Due to increased air ways reactivity to vagal stimulation in response to various types of stimuli e.g. infections (especially viruses), exposure to cold, physical exercise, anxiety, emotions, aspirin.
- No family history of similar cases.
- Atopy (type I hyperesensitivity reaction) due to exposure to exogenous non-bacterial antigens e.g. house dust, animal dandruff, pollens, food or spores of fungi.
- Positive family history of atopic diseases.
3. Prognosis
Bad
Good

8. * N/E: Small bronchi and bronchioles are spastic (thick and narrow).
Trachea & bronchi are hyperaemic and covered by mucus.
Lung tissue shows emphysematous changes (due to partial bronchial obstruction).

9. * M/P: The small bronchi and bronchioles show;
1. Thick basement membrane
2. Narrow lumens, contains mucus plugs which contain whorls of sheded epithelial cells (curschmann spirals), numerous eosinophils and charcot-leyden crystals (esinophil membranes).
3. The subepithelial tissue show;
Hyperplasia of mucous glands.
Hypertrophy of the smooth muscle.
Inflammatory infiltrate formed mainly of eosinophils.

10. Complications:
Pulmonary hypertension: causing Core pulmonale or heart failure.
Emphysema.
Bacterial infection causing persistent bronchitis, bronchiectasis or pneumonia.
Status asthmaticus: persistent attacks for days or weeks. May lead to respiratory failure.

11. (3) Emphysema Definition:
Permanent dilatation of air spaces distal to the terminal bronchioles accompanied by damage of their walls.

12. Respiratory acinus Respiratory bronchioles + alveolar ducts + alveoli.

13. * Types Centriacinar (centrilobular) emphysema
Panacinar (panlobular) emphysema

14. the whole respiratory acinus (RB+AD+alveoli)
Panacinar (panlobular) emphysema
Centriacinar (centrilobular) emphysema
1. Site of involvement
the whole respiratory acinus
(RB+AD+alveoli)
Central part of the respiratory acinus (respiratory bronchiole)

15. 2. Pathogenesis Panacinar (panlobular) emphysema
Centriacinar (centrilobular) emphysema
2. Pathogenesis
Releated to congential defeciency of antielastase (congenital α 1 antitrypsin defeciency).
Related to cigarette smoking, explained by;
Elastase-antielastase imbalance theory:
Chronic bronchitis theory:

16. 3. N/E Panacinar (panlobular) emphysema
Centriacinar (centrilobular) emphysema
3. N/E
1. Chest: Barrel-shaped chest: Increased anteroposterior diameter.Horizontal ribs.Wide subcostal angle.
2. Lungs:
Lower lobes of the lungs are first affected.
Markedly enlarged lungs.
Very light.
Pale.
Upper lobes are first affected.
Moderate lung enlargement.
C/S: clusters of dilated air spaces.

17. Panacinar (panlobular) emphysema
Centriacinar (centrilobular) emphysema
Consistency: soft and pit on pressure.
Smooth outer surface with evident rib markings.
Emphysematous bullae: coalescent wide air spaces along weak borders e.g. apex, anterior margin and free edge of the base).
C/S: diffuse areas of large air spaces.

18. 4. M/P Panacinar (panlobular) emphysema
Centriacinar (centrilobular) emphysema
4. M/P
1. Alveoli are:
- Few in number, increased in size, distorted in shape.
- Some alveolar septa rupture and the alveolar lumens coalesce to each other.
2. Alveolar walls are: thin with compressed capillaries and arterioles.
Dilated respiratory bronchioles only with normal alveolar ducts and alveoli.

19. II. C.V.S: Pulmonary hypertension & Rt.sided heart failure.
Panacinar (panlobular) emphysema
Centriacinar (centrilobular) emphysema
5. Complications
I. Respiratory system:
Chronic bronchitis.
Air embolism.
Spontinous pneumothorax (due to rupture of emphysematous bulla).
Respiratory failure.
II. C.V.S: Pulmonary hypertension & Rt.sided heart failure.