CHRONIC OBSTRUCTIVE
PULMONARY DISEASE ( COPD)
This isThis is dedicated to all those who can not breath due to COPD, and to those who help them breath better.
As per American Thoracic Society (ATS),
It is defined as
a disorder characterized by
abnormal expiratory air flow
of a structural/ functional nature,
that does not change markedly over
several months tQ. What does COPD include ?
betChronic Bronchitis
Emphysema
WHAT OTHER PULMONARY CONDITIONS MIMIC COPD ?
Bronchial Asthma
Bronchiectasis
Cystic Fibrosis
Hypersensitivity Pneumonitis
Severe Alpha-1 Antitrypsin Deficiency
CHRONIC BRONCHITIS: Characteristics
•chronic sputum production
•> 250 ml/ day
•for at least 3-months / year
•for 2 - consecutive years / more than one year
EMPHYSEMA: Characteristics
•It is destructive lung disease in which number of alveolar walls are reduced.
•It is characterized by dilatation and destruction of lung tissue distal to the terminal bronchioles
RISK FACTORS FOR COPD
ØEnvironmental Factors
ØCigarette Smoking (>80% cases)
ØPassive smoking
ØAmbient air pollution
ØOccupational Factors
ØRecurrent Infections ( British Hypothesis)
ØLower Socioeconomic Status
ØGenetic Factors
ØHyper responsive airways ( Dutch Hypothesis)
ØAlpha-1 Antitrypsin deficiency
ØMale gender
ØCaucasian race
EMPHYSEMA and Smoking
•Cigarette smoke – activated polys---elastolytic activity---- destroy cell wall
•Cigarette smoke- inhibition of alpha1-protease inhibitor
RISK OF DEATH FROM CHRONIC BRONCHITIS AND EMPHYSEMA IN PATIENTS SMOKING 30 CIGARETTES DAILY IS 20 TIMES THAT OF NON SMOKERS.
PATHOPHYSIOLOGY: Chronic Bronchitis
oHypertrophy of mucus secreting glands
oEvenly distributed throughout lung, mainly in larger bronchi
oNo. of mucus secreting goblet cells increase leading to increased mucus production
oIn advanced cases, bronchi are inflamed
oSmall airways are affected early in disease, which is reversible if one stops smoking
EMPHYSEMA: TYPES
oCentrilobular/ Centriacinar
nCommon
nCigarette smoking
oPan-lobular/ Pan- acinar
nLess common
nAlpha-1 antitrypsin
oIrregular Emphysema
NORMAL SECONDARY LOBULE:
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