Chronic Obstructive Pulmonary Disease

COPD: regroups several -Represent the 4th leading cause -Mostly due to smoking, When symptoms appear like dyspnea,
respiratory diseases of death in the US thus preventable. difficulties exercising, the disease is
characterized by a chronic - already far advanced.
obstruction of airflow.

2 main types of COPD:

Definition: A set of lung diseases that limit airflow and are not fully reversible.
–COPD patients report they are “hungry” for air Emphysema
–Usually progressive and is associated with inflammation of the lungs as they
respond to noxious particles or gases
Chronic Obstructive bronchitis
–Potentially preventable with proper precautions and avoidance of precipitating
factors
–Symptomatic treatment is available

•Chronic Bronchitis is characterized by •Emphysema is characterized by

–Chronic inflammation and excess mucus production –Damage to the alveoli
Presence of chronic productive cough Chronic cough

How common is COPD? What can cause COPD? Primary Symptoms

- About 13.9% of the •Smoking is the primary risk •Chronic Bronchitis •Emphysema Inflammation
U.S. adult population factor –Chronic cough –Chronic cough and fibrosis of
(25+ years) have been – Long-term smoking is –Shortness of breath –Shortness of bronchial wall
diagnosed with COPD* responsible for 80-90 % of –Increased mucus breath Hypertrophied
cases –Frequent clearing of –Limited activity mucus glands:
- An estimated 15-19% - Smoker, compared to a throat level excess mucus
of COPD cases are non-smoker, is 10 times Decreased surface - Obstructed
work-related** more likely to die of COPD area for gas airflow
exchange - Loss of
- 24 millions other adults •Prolonged exposures to - Loss of elastic alveolar tissue
have evidence of harmful particles and gases lung fibers -
troubled breathing, from: Airway collapse,
indicating COPD is –Second-hand smoke, obstructed
under diagnosed by up –Industrial smoke, exhalation, air
to 60%*** –Chemical gases, vapors, trapping
mists & fumes
–Dusts from grains, minerals
& other materials

Top: Normal airways with elastic A) Obstruction caused by B) Inflammation and C) Loss of elastic fibers that hold the
fibers that provide traction and hypertrophy of bronchial wall hypersecretion of mucus airways open.
hold the airways open

A) Emphysema
-Characterized by a loss of elastic -Abnormal enlargement of the -Destruction of alveolar walls Enlargement of the air spaces
fibers air spaces induces an increase in TLC

Emphysema is characterized by enlargement of air spaces: alveoli and bronchioles.

 Emphysema Diagnosis on CT Scan Emphysema Pathology
A-Normal,
B-Severe
C, D Milder

Emphysema Normal lung

What characterized emphysema pathogenesis? - Neutrophils in alveoli secrete trypsin (digestion enzyme)
Neutrophils disorder Increased neutrophil numbers due to inhaled irritants (smoke) can damage
alveoli
Alpha1-antitrypsin inactivates the trypsin before it can damage the alveoli

A genetic defect in 2 common types of emphysema:

alpha1-antitrypsin synthesis leads - Centriacinar: is the most common
also to alveolar damage - centriacinar: Terminal and Respiratory Bronchioles type of emphysema.
-Account for 1% of all COPD cases. -Predominantly in male smokers
-Most common in Scandinavian - panacinar: Alveolar bags
descent - Panacinar: Early phase involved
All person who develop emphysema alveoli and late phase affect
before 40 years old have bronchioles
a1-antitrypsin deficiency.
A recombinant human
a1-antitrypsin is a new treatment But it is possible to see a Panacinar
against emphysema type at the bottom of the lungs and a
Centriacinar type at the top of the
lungs.

- Smoking cessation drugs: bupropion hydrochloride (Zyban) and varenicline - Pulmonary rehab: exercise such as
(Chantix) the pursed-lip, many severe patients
 Treatment options: - Bronchodilators: Help relieve coughing and trouble breathing but not for need to gain weight
treatment ​- Supplemental oxygen: Often 24/7
- Inhaled steroids: Not for prolonged use (weaken bones) - Surgery: lung volume reduction,
- Antibiotics: to prevent infection like pneumonia removing the diseased tissue

Slide 98 B) Chronic Bro nchitis

Chronic Bronchitis: - This obstruction induces:

Inflammation respiratory disorder -Inflammation process
-This disease is seen mostly with smokers in -Goblet cells infiltration
middle age (compare to emphysema)
-Particularly characterized by hypersecretion of
mucus.

B) Chronic Bronchitis
-Differentiation emphysema vs. chronic bronchitis: mnemonics “Pink Puffer” vs. “Blue Bloater” (table 22.2 p504)

“Pink Puffer” is derived from the reddish complexion and the "puffing" “Blue Bloater” is derived from the bluish color of the
(hyperventilation) seen in patients suffering from emphysema. lips and skin commonly seen in patients suffering from
-Patients are able to over-ventilate to compensate for the loss of ventilated area chronic bronchitis.
(ratio ventilation- perfusion). - They are enable to compensate because of the
- hypersecretion of mucus.
-They are able to maintain normal blood gas concentrations (P02 and PCO2) until - Hypoxemia develop, blood is loaded with CO2, PCO2
late in the disease state. increased compare to normal subjects.
-Prognostic better than “Blue Bloater” Most blue bloaters die within 2 to 4 years.
Both of them are characterized with decrease exercise
tolerance