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(C.O.P.D) (C.O.P.D) Ch.Bronchitis Ch.Bronchitis Emphysema Emphysema
AISHA M SIDDIQUIAISHA M SIDDIQUI
C.O.P.DC.O.P.D PathologyPathology PathophysiologyPathophysiology TypesTypes Clinical featuresClinical features Acute complicationsAcute complications Chronic complicationsChronic complications InvestigationsInvestigations Differential diagnosisDifferential diagnosis TreatmentTreatment ReferencesReferences
Ch.BronchitisCh.Bronchitis
Normal mechanism of cough.Normal mechanism of cough.
Ch.irritation>>>>ch.bronchitisCh.irritation>>>>ch.bronchitis
Smoking, industries & pollution.Smoking, industries & pollution.
Mortality ^ with infectionMortality ^ with infection
More in winter & autumnMore in winter & autumn
More in low socioeconomic class.More in low socioeconomic class.
EmphysemaEmphysema
Pathology:Pathology:
Enlarged air spaces distal to Enlarged air spaces distal to terminal bronchioles with terminal bronchioles with destruction to the walls.destruction to the walls.
Centrilobular(U.Z)>>>>>BullaeCentrilobular(U.Z)>>>>>Bullae
Panacinar(L.Z)----Panacinar(L.Z)---->>>>>>>>
EmphysemaEmphysema
Pathogenesis:Pathogenesis:
Smoking,air Smoking,air pollution,infection,Intrinsic.pollution,infection,Intrinsic.
- Alpha 1 Antitrypsin def: inhibits - Alpha 1 Antitrypsin def: inhibits proteolytic enzymes released from proteolytic enzymes released from macrophages and neutrophils.macrophages and neutrophils.
Increases in smokers Increases in smokers
Basal segments.Basal segments.
EmphysemaEmphysema Pathophysiology:Pathophysiology: Airway dis.(narrowing)>>>limitation of air Airway dis.(narrowing)>>>limitation of air
flow>>> poorly ventillated.flow>>> poorly ventillated. VENTILLATION PERFUION MISMATCHVENTILLATION PERFUION MISMATCH Extensive dis.>>>Resp. Failure(type 2)Extensive dis.>>>Resp. Failure(type 2) ELASTIC RECOIL OF THE LUNG LOSTELASTIC RECOIL OF THE LUNG LOST Expansion of lung >>> increase T.L.CExpansion of lung >>> increase T.L.C Earlier closure of airways >>> inc. R.V (air Earlier closure of airways >>> inc. R.V (air
trapping)trapping) Reduction of surface area for gas Reduction of surface area for gas
exchange>>>decrease in transfer factor.exchange>>>decrease in transfer factor.
TYPESTYPES
Blue bloatersBlue bloaters Pink puffersPink puffers
Clinical FeaturesClinical Features
BreathlessnessBreathlessness Insidiuos onsetInsidiuos onset Increase graduallyIncrease gradually Irritation of Irritation of
mucosa>>>mucous>>>cough>>mucosa>>>mucous>>>cough>>> bronchoconstriction.> bronchoconstriction.
Clinical FeaturesClinical Features
Physical signs:Physical signs: Mild- Moderate >>> No abnormalityMild- Moderate >>> No abnormality Tachypnea.Tachypnea. Prolonged expiration, pursed lips.Prolonged expiration, pursed lips. Xssory ms. Of resp.Xssory ms. Of resp. Posture; mechanical advantage.Posture; mechanical advantage. Chest:Chest:
ComplicationsComplications
CHRONIC: Type 2 resp. failure.CHRONIC: Type 2 resp. failure.
Polycythemia.Polycythemia.
Corpulmonale.Corpulmonale. ACUTE: Infections.ACUTE: Infections.
L.V.F.L.V.F.
P.E.P.E.
Pneumothorax.Pneumothorax.
Differential DiagnosisDifferential Diagnosis
CHRONIC BRONCHITIS: B.asthmaCHRONIC BRONCHITIS: B.asthma
BronchiectasisBronchiectasis
Ch.sinusitisCh.sinusitis
AspirationAspiration
T.B/ NeoplasmT.B/ Neoplasm EMPHYSEMA: C.O.P.D/ B.asthmaEMPHYSEMA: C.O.P.D/ B.asthma
Obstructive/ RestrictiveObstructive/ Restrictive
Large airways obstruc/ smallLarge airways obstruc/ small
InvestigationsInvestigations
C.X.R/C.TC.X.R/C.T
Bld. GasesBld. Gases
Pulm. Function tests: FEV1/ FVCPulm. Function tests: FEV1/ FVC
PEFRPEFR
DL coDL co
SputumSputum
ECGECG
CBCCBC
TreatmentTreatment
STOP SmokingSTOP Smoking Domociliary O2 therapy: 15 hrs. 2L 28%Domociliary O2 therapy: 15 hrs. 2L 28% Bronchodilators: B2 agonistsBronchodilators: B2 agonists Anticholinergics Anticholinergics
(Ipratropium Bromide)(Ipratropium Bromide) Methylxanthines?Methylxanthines? Corticosteroids: Acute exacerbationsCorticosteroids: Acute exacerbations Stable dis.?Stable dis.? InhalersInhalers
TreatmentTreatment
Antibiotics: FEV1<50%, More strong Antibiotics: FEV1<50%, More strong A/BA/B
DiureticsDiuretics VasodilatorsVasodilators Chest physiotherapyChest physiotherapy N.I.V: C.P.A.PN.I.V: C.P.A.P VenesectionVenesection VaccinationsVaccinations
ReferencesReferences
Scientific American Medicine 9/01Scientific American Medicine 9/01 NEJM : June 26, 2003. Vol. 348(26)NEJM : June 26, 2003. Vol. 348(26) NEJM : June 24, 2004. Vol. 350(26)NEJM : June 24, 2004. Vol. 350(26) DavidsonDavidson’’s Principles and Practice s Principles and Practice
of Medicineof Medicine Uptodate 2008Uptodate 2008
BRONCHIAL ASTHMABRONCHIAL ASTHMA
DefinitionDefinition Cardinal pathophysiological features:Cardinal pathophysiological features: Airflow limitation (reversible)Airflow limitation (reversible) Airway hyperresponsivenessAirway hyperresponsiveness Airway inflammationAirway inflammation Types and aetiologyTypes and aetiology Clinical featuresClinical features InvestigationsInvestigations ManagementManagement