Chronic Obstructive Pulmonary Disease Discussion
Chronic Obstructive Pulmonary Disease Discussion
Patients have difficulty exhaling all the air from the lungs
Exhaled air comes out more slowly than normal
At the end of full exhalation, an abnormal amount of air may still linger in the lungs
Obstructive lung diseases
The most common causes of obstructive lung disease are:
Chronic Obstructive Pulmonary Disease (COPD), which can have two components:
Bronchitis and Emphysema
Asthma
Bronchiectasis
Cystic Fibrosis
Chronic obstructive pulmonary disease – Definition
When chronic bronchitis and emphysema appear together
Preventable and treatable, but not able to be cured
Characterized by airflow limitation that is not fully reversible
Progressive disease associated with abnormal inflammatory response of the lung to noxious particles or gases
Chronic bronchitis and emphysema can each develop alone; however, they often occur together as one disease complex. COPD refers to two lung diseases, chronic bronchitis and emphysema, which occurs simultaneously. Patients demonstrate a variety of clinical manifestations associated with both disorders and the relative contribution of each respiratory disorder is difficult to acertain.
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COPD – Chronic bronchitis
Anatomic Alterations
Chronic inflammation and swelling of the walls of the peripheral airways
Excessive mucous production and accumulation
Partial or total mucous plugging of the airways
Smooth muscle constriction of the bronchial airways (bronchospasm)
Air trapping and hyperinflation of alveoli (in the later stages)
Chronic Bronchitis Chronic Obstructive Pulmonary Disease Discussion
Diagnosed based on symptoms
Cough with excessive sputum for at least three months for two consecutive years
Emphysema
Anatomic Alterations
Permanent enlargement and destruction of the air spaces distal to the terminal bronchioles (alveoli)
Destruction of pulmonary capillaries
Weakening of the distal airways, primarily the respiratory bronchioles
Air trapping and hyperinflation
Emphysema
Diagnosed definitively only by lung biopsy or post-mortem exam
Two types
Centrilobular
Panlobular
Normal anatomy
Acinus: A grouping of alveoli distal to a terminal bronchiole.
Normal Acinus
Centrilobular Emphysema
Centrilobular (centriacinar) emphysema is characterized by enlargement and destruction of the central part of the acinus (the respiratory bronchioles) with the more distal parts (the alveoli) remaining intact.
The respiratory bronchioles enlarge, become confluent, and are then destroyed.
Most common form of emphysema.
Associated with cigarette smoking
Panlobular Emphysema
In panlobular emphysema, the entire acinus is involved.
The normal structure of the alveoli and alveolar ducts are lost along with the loss of pulmonary parenchyma.
Bullae (emphysematous spaces greater than one cm) are often present in this type of emphysema.
Emphysema
Panulobular Emphysema
Panulobular emphysema can also be genetic.
Caused by Alpha 1 Antitrypsin Deficiency
Protein that protects lung elastin from neutrophil elastase
Neutrophil elastase breaks down elastin during an inflammatory response, resulting in destruction of the alveolar walls
Alpha 1 Antitrypsin lab test
Normal range is 200-400 mg/dl
COPD
Precise incidence of COPD is not known.
10-15 million people have chronic bronchitis, emphysema, or a combination of both.
In 2004, the annual cost related to COPD was about $37.2 billion
4th leading cause of death
Since 2000, more women than men have died of COPD
The number one cause of COPD is cigarette smoking.
Mucocillary Escalator is damaged.
Paralyzed
Cilia
Excessive
mucus
Damaged Tissues
