EMPHYSEMACHRONIC BRONCHITIS

Dr Vijay Shankar S

Plan • Obstructive Vs restrictive diseases• Chronic obstructive pulmonary diseases( COPD)• Emphysema

• Definition• Types• Pathogenesis• Morphology• Clinical course

• chronic bronchitis• Definition• Pathogenesis• Morphology• Clinical course

• Emphysema Vs chronic bronchitis

Pretest !!

1

1 Which disease among the following is an example of restrictive lung disease

A. Chronic bronchitisB. BronchiectasisC. Bronchial asthmaD. pneumoconiosis

2. The type of emphysema associated with alpha 1 antitrypsin deficiency

A. Centriacinar emphysemaB. Panacinar emphysemaC. Paraseptal emphysemaD. Irregular emphysema

• 3. The normal Reid index is

A. 0.4B. 0.5C. 0.6D. 0.7

BASED ON PULMONARY FUNCTION TESTS

OBSTRUCTIVEDISEASE

RESTRICTIVEDISEASE

Increase in the resistanceTo airflow

Due to partial or complete obstruction at any

level

Reduced expansion of lung parenchyma,

with decreasedtotal lung capacity

1. Chronic bronchitis

2. Emphysema

3. Bronchial asthma

4. Bronchiectasis

1. Chest wall disorders

2. Acute/chronic interstitial & infiltrative diseases.

Emphysema

• Definition– irreversible enlargement of airspaces

distal to terminal bronchiole.• Classification

Overinflation??

Incidence

• 4th leading cause of morbidity and mortality in the UNITED STATES!!

• Worldwide India ranks 2nd!! In prevalance

• M> F ?

Etiology• Tobacco smoking• Atmospheric pollution• Infection • Genetic factor

PATHOGENESIS

Protease Anti -Protease

Elastase : derived from neutrophils

Digests the lung parenchyma!!

Alpha 1 – AT: synthesized by liver.

Present in serum, tissue fluids & macrophages.

PROTEASE – ANTIPROTEASE HYPOTHESIS

PACK YEARS

• (Packs smoked per day) x (years as a smoker)

or

• (number of cigarettes smoked per day x number of years smoked)/20

Gross

Bullous emphysema with large subpleural bullae

Centriacinar emphysema. Central areas show marked emphysematous damage (E), surrounded by relatively spared alveolar spaces.

Panacinar emphysema involving theentire pulmonary architecture.

This lung, from a patient with alpha 1-antitrypsin deficiency, shows large, irregular airspaces and a markedly reduced number of alveolar walls.

section of normal lung at the same magnification

CLINICAL FEATURES

EMPHYSEMA

•Hyperventilates and less hypoxemia(Pink)•Minimal cyanosis•Purse lip breathing•Dyspnea•Hyperresonance on chest percussion•Orthopneic•Barrel chest•Extertional dyspnea•Prolonged expiratory time•Speaks in short jerky sentences•Anxious•Use of accessory muscles to breathe•Thin appeance

“PINK PUFFER”

CHRONIC BRONCHITIS

Chronic Bronchitis

• Defn\• Etiology

a) smokingb) Atmospheric pollutionc) occupationd) Infectione) Familial & Genetic factor

Normal and chronic bronchitis

REID INDEX

It is a ratio

bc / ad

Normal : 0.4

Chronic bronchitis: increased

CHRONIC BRONCHITIS

•Color dusky to cyanotic•Recurrent cough with sputum•Hypoxia•Hypercapnia•Acidosis•Edematous•Increased respiratory rate•Exertional dyspnea•Corpulmonale•Use of accessary muscles to breathe

“BLUE BLOATER”

Emphysema and Chronic Bronchitis Predominant Bronchitis Predominant Emphysema

Age (yr) 40–45 50–75

Dyspnea Mild; late Severe; early

Cough Early; copious sputum Late; scanty sputum

Infections Common Occasional

Respiratory insufficiency Repeated Terminal

Cor pulmonale Common Rare; terminal

Airway resistance Increased Normal or slightly

Elastic recoil Normal Low

Chest radiograph Prominent vessels; large heart Hyperinflation; small heart

Appearance Blue bloater Pink puffer

Post test !!

1

1 Which disease among the following is called as restrictive lung disease

A. Chronic bronchitisB. BronchiectasisC. Bronchial asthmaD. pneumoconiosis

D

2. The type of emphysema associated with alpha 1 antitrypsin deficiency

A. Centriacinar emphysemaB. Panacinar emphysemaC. Paraseptal emphysemaD. Irregular emphysema

B

• 3. The normal Reid index is

A. 0.4B. 0.5C. 0.6D. 0.7

A