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Chronic obstructive pulmonary diseases (COPD) Chronic obstructive pulmonary diseases (COPD) By By Dr. Abdelaty Shawky Dr. Abdelaty Shawky Assistant professor of pathology Assistant professor of pathology
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Page 1: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Chronic obstructive pulmonary diseases (COPD)Chronic obstructive pulmonary diseases (COPD)

ByBy

Dr. Abdelaty ShawkyDr. Abdelaty ShawkyAssistant professor of pathology Assistant professor of pathology

Page 2: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

• COPD is a group of lung diseases characterized by increased resistance to air flow due to airway obstruction.

• Includes;1. Chronic bronchitis.1. Chronic bronchitis.2. Emphysema. 2. Emphysema.

Page 3: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

1. Chronic bronchitis1. Chronic bronchitis

Page 4: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

* Definition: persistent productive cough for at least 3

consecutive months in at least 2 consecutive years.

* Causes:

Chronic irritation of the bronchial mucosa by:

1.Cigarette smoking.

2.Environmental pollution.

3.Chronic inflammation of upper respiratory tract.

Page 5: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

* Pathogenesis: Chronic irritation of the bronchial

epithelium by cigarette smoke, environmental chemical…etc

leads to:

a. Epithelial changes: Hyperplasia, squamous metaplasia and

dysplasia.

b. Subepithelial changes:

•Hyperplasia of the mucous glands (increase mucin secretion)

•Hypertrophy of smooth muscle (leading to bronchial spasm).

•In old standing cases, marked fibrosis.

Page 6: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

* Gross features: The mucosa is hyperaemic, swollen and

covered by mucus or muco-pus.

* Microscopic examination: Bronchi & bronchioles show:

a.Epithelial changes:

•Hyperplasia, squamous metaplasia and dysplasia.

b. Subepithelial changes:

•Hyperplasia of the mucous glands,

•Chronic inflammatory cells and fibrosis.

•Hypertrophy of the smooth muscle.

Page 7: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

* Clinical types of chronic bronchitis:

1. Simple chronic bronchitis: 1. Simple chronic bronchitis: patients have a productive

cough but no physiologic evidence of airflow obstruction.

2. Asthmatic chronic bronchitis: 2. Asthmatic chronic bronchitis: in individuals demonstrating

hyper-reactive airways with intermittent bronchospasm and

wheezing.

3. Obstructive chronic bronchitis: 3. Obstructive chronic bronchitis: in some patients,

especially heavy smokers, who develop evidence of associated

emphysema.

Page 8: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

* Complications:

1.Emphysema.

2.Bronchopneumonia.

3.Pulomonary hypertension and core pulmonale

resulting in Rt. sided heart failure.

4.Bronchogenic carcinoma

Page 9: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

2. Emphysema2. Emphysema

Page 10: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

* Definition:•Permanent dilatation of air spaces distal to the terminal bronchioles accompanied by damage of their walls without obvious fibrosis.

Page 11: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Respiratory acinus = Respiratory bronchioles + alveolar ducts + alveolar sacs.

Page 12: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

* Types 1. Centriacinar (centrilobular) emphysema.2. Panacinar (panlobular) emphysema.

Page 13: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.
Page 14: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.
Page 15: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Centriacinar (centrilobular) Centriacinar (centrilobular) emphysemaemphysema

Panacinar (panlobular) Panacinar (panlobular) emphysemaemphysema

1. Site of involvement

Central part of the respiratory acinus

(respiratory bronchiole)

the whole respiratory acinus

(RB+AD+alveoli)

Page 16: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema

Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema

2. Pathogenesis2. Pathogenesis - Common (95% of cases).- Affects middle and old ages.- Related to cigarette smoking,

explained by;1. Elastase-antielastase imbalance

theory:Smoking weaken the wall of air spaces by

increasing elastase and decreasing antielastase via;

1. Accumulation of macrophages and neutrophils in the walls of air spaces which are the source of elastase enzyme.

2. Inhibit anti-elastase (α 1 antitrypsin) by oxidants (oxygen free radicals) secreted from neutrophils.

- Rare (5% of cases).- Affects young ages.- Related to congenital deficiency of anti-elastase (congenital α 1 antitrypsin deficiency). Therefore the action of elastase secreted from neutrophils and macrophages becomes unopposed.

Page 17: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema

Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema

2. Chronic bronchitis theory: - It causes emphysema by:Accumulation of macrophages and neutrophils in the walls of air spaces with release of elastase.Bronchial obstruction by the mucous plugs leads to increased intraluminal pressure.

Page 18: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema

Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema

3. Gross features3. Gross features• Upper lobes are first

affected.• Moderate lung

enlargement.• C/S: clusters of dilated air

spaces.

1. Chest: Barrel-shaped chest: Increased antero-posterior diameter. Horizontal ribs. Wide subcostal angle.2. Lungs: Lower lobes of the lungs are first affected. Markedly enlarged lungs. Very light. Pale. (due to vascular compression). Dry.

Page 19: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema

Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema

Consistency: feathery and pit on pressure. (due to loss of elastic tissue) 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.

Page 20: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Centriacinar emphysema

Page 21: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Panacinar emphysema

Page 22: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Emphysematous bollus

Page 23: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema

Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema

4. Microscopic Picture4. Microscopic Picture Dilated respiratory bronchioles only

with normal alveolar ducts and alveoli.

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.

Page 24: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema

Panacinar Panacinar (panlobular) (panlobular) emphysema emphysema

5. Complications5. Complications I. Respiratory system:1. Chronic bronchitis.2. Air embolism.3. Spontaneous pneumothorax (due to rupture of

emphysematous bulla).4. Respiratory failure.

II. C.V.S: Pulmonary hypertension & Rt. sided heart failure.

Page 25: Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

The The endend


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