Chronic ObstructivePulmonary DiseaseCOPD
Chronic ObstructivePulmonary DiseaseCOPD

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COPDTypes
Emphysema
Chronic Bronchitis
Asthma
Emphysema
Chronic Bronchitis
Asthma

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COPDDefinition
Persistent, largely irreversible airwayobstruction

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COPDGeneral
Male:female 10:1
Cigarette smoking most importantetiologic factor
Also pollution, childhood infections,heredity, extremes of climate

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Emphysema
Emphysema

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EmphysemaDefinition
Defined pathologically
Abnormal permanent enlargement ofairspaces distal to terminal bronchiole
Destruction of air space walls

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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

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EmphysemaTwo Main Types
Centrilobular emphysema (CLE)
AKA centriacinar emphysema
Panlobular emphysema (PLE)
AKA panacinar emphysema

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Centrilobular EmphysemaGeneral
Slightly more common than PLE
Involves upper lobes
Found in heavy smokers

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Centrilobular EmphysemaPathology
Major pathology in respiratory bronchioles
Become dilated
Alveolar ducts and sacs spared
More centrally located

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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

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Panlobular EmphysemaPathology
Involves overinflation and destruction ofalveolar sacs
Distal to terminal bronchiole

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EmphysemaRoentgenographic Patterns
Arterial Deficiency pattern (AD)
More common and easily recognized
Increased Markings pattern (IM)
Less common and more difficult torecognize

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Arterial Deficiency PatternX-ray
Overinflation
Flattened or inverted diaphragm
Blunting of costophrenic angles
By insertion of muscle slips on ribs
Oligemia
Bullous disease

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Increased Marking PatternX-ray
Less or no overinflation
Prominent pulmonary vasculature
All have pulmonary hypertension
Heart is usually enlarged

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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

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EmphysemaAssociated Cardiovascular findings
Pulmonary arterial hypertension
Increased thickness of intima and media
Reflex vasoconstriction
Cor pulmonale
Associated more often with IM form

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Chronic Bronchitis
Chronic Bronchitis

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Chronic BronchitisDefinition
Clinical diagnosis based onexcessive mucous expectoration
Not an x-ray diagnosis

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Chronic BronchitisRoentgenographic Patterns
Cannot be diagnosed radiographically
More than half are normal
Thickened bronchial walls
Tramlines or doughnuts
Prominent lung markings
The “Dirty Chest”

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Asthma
Asthma

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Asthma
Reversible bronchoconstriction due toa variety of stimuli
Technically not COPD

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AsthmaTypes
Intrinsic
Extrinsic

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Intrinsic AsthmaGeneral
Middle aged
Probably due to auto-immune mechanism

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Extrinsic AsthmaGeneral
From antigens producing type I (immediate)hypersensitivity rx
Reagin sensitizes mast cells to secretehistamine
Increased vascular permeability
Edema
Smooth muscle contraction
Bronchoconstriction

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Extrinsic AsthmaAllergens
Pollen, dog and cat fur
Wood dust, flour, grain
Castor bean, grain weevil
Aspirin
Nickel, platinum

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AsthmaPathology
Bronchial plugging with
Mucus
Eosinophils
Charcot-Leyden crystals
Hypertrophy of mucus glands andsmooth muscle

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AsthmaAcute X-ray Changes
Overaeration
Flattening of diaphragm
Increase in retrosternal clear space
Peribronchial thickening

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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

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AsthmaComplications
Pneumonia
Twice as frequent as in non-asthmatics
Atelectasis
From mucous plugs
Pneumomediastinum, pneumothoraxand subcu emphysema
Mostly in children

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AsthmaComplications-Continued
Emphysema
Aspergillosis

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