Respiratory System
BY ME
Obstructive and Restrictive Pulmonary Diseases
Diffuse pulmonary diseases are divided into:
1- Obstructive disease:
characterized by limitation of airflow owing to partial or complete
obstruction at any level from trachea to respiratory bronchioles.
Pulmonary function test limitation of maximal airflow rate during forced
expiration (FEVI).
2- Restrictive Pulmonary Disease
Characteristics Occurrence
Characterized by reduced expansion of lung 1. Chest wall disorder
parenchyma with decreased total lung capacity
2. Acute or chronic, interstitial and infiltrative
while the expiratory flow rate is near normal.
diseases e.g. acute respiratory distress syndrome
(ARDS) and pneumoconiosis
Pathology of Chronic Obstructive
Pulmonary Diseases
Main Categories of (diffuse) Obstructive Diseases:
Asthma
Chronic obstructive pulmonary/airway/lung disease (COPD/COAD/COLD)
They are of two types:
a) Chronic bronchitis
b) Emphysema
Bronchiectasis
Chronic obstructive pulmonary disease
(COPD)
Irreversible airflow Cigarette smoking Prevalence
obstruction
Cigarette smoking is the Greater than 10% of the
principal cause of COPD population >45 years old has
airflow obstruction
Disease components Definitions
Majority of patients with COPD have both The definition of emphysema is morphologic,
emphysema (air space destruction) and chronic whereas chronic bronchitis is defined on the basis
bronchitis of clinical features
Chronic Bronchitis
Characteristics Forms
Definition: Persistent productive cough (with 1. Simple chronic bronchitis
sputum) for at least 3 consecutive months in at 2. Chronic mucopurulent bronchitis
least 2 consecutive years
3. Chronic asthmatic bronchitis
Common among cigarette smokers and urban
4. Chronic obstructive bronchitis
dwellers, age 40 to 65
The diagnosis of chronic bronchitis is made on
clinical grounds
Chronic Bronchitis: Causes and
Pathogenesis
1 Causative factors
Cigarette smoking and pollutants (Most patients are smokers)
Infection
Genetic factors e.g. cystic fibrosis
Often, there are features of emphysema as well
2 Pathogenesis
Chronic irritation of inhaled substances or microbial infection leads to hypersecretion of mucus that
starts in the large airways with associated hypertrophy of the sub-mucosal glands.
As chronic bronchitis persists the small bronchi and bronchioles also get affected. Inflammation and
irreversible fibrosis may occur in chronically inflamed segmental bronchi and bronchioles.
3 Morphology
Grossly: In bronchitis the larger airway mucosa is red and edematous with mucinous or mucopurulent
secretions.
M/E:
Inflammation of airways, fibrosis and resultant narrowing of bronchioles. enlargement of the
mucus-secreting glands in the trachea and larger bronchi.
Injury to cilia with loss of ciliated epithelial cells and Coexistent emphysema.
How do these changes differ from the changes seen in a typical case of allergic
asthma?
I n typical allergic asthma, which also has mucous gland hyperplasia, the bronchial wall has an inflammatory
infiltrate in which eosinophils are prominent. There is also hypertrophy and hyperplasia of smooth muscle cells
in asthma.
How do the changes differ from those seen in bronchiectasis?
Infection-related destruction of the bronchial wall is the characteristic appearance of bronchiectasis
Comparing Changes in Respiratory
Conditions
Bronchitis Allergic Asthma Bronchiectasis
Mucous gland hyperplasia Mucous gland hyperplasia Infection-related destruction
Different inflammatory Bronchial wall shows of the bronchial wall is the
pattern inflammatory infiltrate characteristic appearance of
bronchiectasis
No prominent eosinophils Prominent eosinophils present
No significant smooth muscle Hypertrophy and hyperplasia
changes of smooth muscle cells
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Clinical Course of Chronic Bronchitis
Symptoms
Prominent cough and the production of sputum.
COPD Complications
COPD with hypercapnia, hypoxemia and cyanosis. Patients with severe chronic bronchitis are termed blue
bloaters because they have:
Increased sleepiness reflects CO2 narcosis
Cyanosis reflects very poor oxygenation
Elevated red cell counts (secondary polycythemia) result from chronic hypoxemia
Cardiac Failure
Cardiac failure (Cor pulmonale): is right ventricular dilation and hypertrophy-(right heart failure)-
develops following pulmonary hypertension caused by diseases of the lung or pulmonary vasculature.
