Chronic ObstructivePulmonary DiseaseCOPD

Chronic ObstructivePulmonary DiseaseCOPD

COPDTypes

Emphysema

Chronic Bronchitis

Asthma

Emphysema

Chronic Bronchitis

Asthma

COPDDefinition

Persistent, largely irreversible airwayobstruction

COPDGeneral

Male:female 10:1

Cigarette smoking most importantetiologic factor

Also pollution, childhood infections,heredity, extremes of climate

Emphysema

Emphysema

EmphysemaDefinition

Defined pathologically

Abnormal permanent enlargement ofairspaces distal to terminal bronchiole

Destruction of air space walls

EmphysemaPathophysiology

Unchecked enzymatic destruction ofthe elastic and collagen framework oflung

Proteolytic enzymes secreted byneutrophils and alveolar macrophagesnormally inhibited by serum a-1antitrypsin

Not inhibited in emphysema

EmphysemaTwo Main Types

Centrilobular emphysema (CLE)

AKA centriacinar emphysema

Panlobular emphysema (PLE)

AKA panacinar emphysema

Centrilobular EmphysemaGeneral

Slightly more common than PLE

Involves upper lobes

Found in heavy smokers

Centrilobular EmphysemaPathology

Major pathology in respiratory bronchioles

Become dilated

Alveolar ducts and sacs spared

More centrally located

Panlobular EmphysemaGeneral

Usually affects lower lobes

More common in women than CLE

More common in aged patients than CLE

Type associated with a-1 antitrypsindeficiency

Panlobular EmphysemaPathology

Involves overinflation and destruction ofalveolar sacs

Distal to terminal bronchiole

EmphysemaRoentgenographic Patterns

Arterial Deficiency pattern (AD)

More common and easily recognized

Increased Markings pattern (IM)

Less common and more difficult torecognize

Arterial Deficiency PatternX-ray

Overinflation

Flattened or inverted diaphragm

Blunting of costophrenic angles

By insertion of muscle slips on ribs

Oligemia

Bullous disease

Increased Marking PatternX-ray

Less or no overinflation

Prominent pulmonary vasculature

All have pulmonary hypertension

Heart is usually enlarged

Patterns and Types

Centrilobular emphysema usuallyassociated with Increased Marking pattern“CLEIM”

Panlobular emphysema usually associatedwith Arterial Deficiency pattern “PLEAD”

IM are Blue Bloaters

AD are Pink Puffers

EmphysemaAssociated Cardiovascular findings

Pulmonary arterial hypertension

Increased thickness of intima and media

Reflex vasoconstriction

Cor pulmonale

Associated more often with IM form

Chronic Bronchitis

Chronic Bronchitis

Chronic BronchitisDefinition

Clinical diagnosis based onexcessive mucous expectoration

Not an x-ray diagnosis

Chronic BronchitisRoentgenographic Patterns

Cannot be diagnosed radiographically

More than half are normal

Thickened bronchial walls

Tramlines or doughnuts

Prominent lung markings

The “Dirty Chest”

Asthma

Asthma

Asthma

Reversible bronchoconstriction due toa variety of stimuli

Technically not COPD

AsthmaTypes

Intrinsic

Extrinsic

Intrinsic AsthmaGeneral

Middle aged

Probably due to auto-immune mechanism

Extrinsic AsthmaGeneral

From antigens producing type I (immediate)hypersensitivity rx

Reagin sensitizes mast cells to secretehistamine

Increased vascular permeability

Edema

Smooth muscle contraction

Bronchoconstriction

Extrinsic AsthmaAllergens

Pollen, dog and cat fur

Wood dust, flour, grain

Castor bean, grain weevil

Aspirin

Nickel, platinum

AsthmaPathology

Bronchial plugging with

Mucus

Eosinophils

Charcot-Leyden crystals

Hypertrophy of mucus glands andsmooth muscle

AsthmaAcute X-ray Changes

Overaeration

Flattening of diaphragm

Increase in retrosternal clear space

Peribronchial thickening

AsthmaChronic X-ray Changes

Most have normal chest x-ray (3/4)

Abnormal chest x-ray more likely if onsetearly and disease severe

Bronchiectasis

Scarring from multiple infections

AsthmaComplications

Pneumonia

Twice as frequent as in non-asthmatics

Atelectasis

From mucous plugs

Pneumomediastinum, pneumothoraxand subcu emphysema

Mostly in children

AsthmaComplications-Continued

Emphysema

Aspergillosis