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Pulmonary pathology copd
- 1. Two major lung diseases 1. Obstructive – airway disease a) limitations of airflow i) partial or complete obstruction at any level major causes a) asthma – obstructive b) emphysema – loss of elastic recoil c) chronic bronchitis d) Bronchiectasis e) cystic fibrosis f) bronchiolitis www.freelivedoctor.com
- 4. b) clinically i ) dyspnea ii) cough iii) wheezing (expiratory) - triggered via bronchospasm iv) 5% adults and 10%children v) status asthmaticus – fatal outcome vi) between attacks asymptomatic www.freelivedoctor.com
- 5. Classification a) extrinsic asthma – initiated by type I hypersensitivity reaction induced by exposure to extrinsic antigen b) 3 types of extrinsic asthma i) atopic (most common); 1st 2 decades; increased IgE; CD4 and T cells - type I hypersensitivity ii) occupational (many forms) iii) allergic bronchopulmonary aspergillus’s (bacterial colonization followed by IgE antibodies) www.freelivedoctor.com
- 10. iv) thickening of basement membrane v) edema vi) size of submucosal glands vii) muscular hypertrophy viii) inflammatory infiltrate in bronchial walls (eosinophils and Mast cells) www.freelivedoctor.com
- 13. g) acute phase begins within minutes of exposure i) edema ii) mucus secretion iii) hypotension (rare occurrence) h) Mast cells release other mediators i) other leukocytes - neutrophils - lymphocytes - monocytes - basophils - eosinophils (mainly – IL-5) i) these inflammatory cells set stage for “late phase reaction” (12-24 hrs) www.freelivedoctor.com
- 24. Types of emphysema a) Panacinar (panlobular) emphysema i) uniformly enlarged acini ii) lower lung zones iii) 1-antitrypsin definciency b) Centrilacinar emphysema i) dilation upstream with normal distal portions ii) more common than panacinar (~ 95% of cases) iii) more common/severe in upper lobes - contain black pigment www.freelivedoctor.com
- 25. Centriacinar (con’t) iv) in severe disease distal acini may be involved differentialte from panacinar difficult v) seen in heavy smokers, often in association with chronic bronchitis c) Distal Acinar (paraseptal) emphysema i) proximal acini normal and distal part most involved ii) upper half of lungs/near pleura iii) associated with spontaneous pneumothorax in the young www.freelivedoctor.com
- 42. c) necrotizing pneumonia (S. aureus, K. pneumoniae) i) post tubercular bronchiectasis significant cause of morbidity www.freelivedoctor.com