COPD - MedPath

What does this refer to

• _________ is characterized by chronic airflow limitation and a mixture of small airway disease (obstructive bronchiolitis) and parenchymal destruction (emphysema).

• Airflow limitation is not fully reversible

COPD

What does this refer to

• Airway obstruction that is worse with expiration

• Common signs and symptoms

  • Dyspnea and wheezing

Obstructive Pulmonary Disease

What does this refer to

• Tobacco smoke

• Occupational dusts and chemicals

• Indoor air pollution from biomass fuel used for cooking and heating

• Outdoor air pollution

• Any factor that affects lung growth during gestation and childhood

• Genetic susceptibilities - Alpha-1 antitrypsin deficiency.

Risk factors for Chronic Obstructive Pulmonary Disease

What does this refer to

• Abnormal permanent enlargement of thegas-exchange airways accompanied by the destruction of the alveolar walls without obvious fibrosis

• Loss of elastic recoil

Emphysema

What does this refer to

• Destruction of alveolar walls reduces surface area for gas exchange.

• Loss of elastic recoil leads to air trapping.

Pathophysiology of Emphysema

What does this refer to

• Triggered by noxious particles/gases.

• Leads to infiltration by neutrophils, macrophages, and CD8+ T-cells.

Airway Inflammation

What does this refer to

• Release proteases such as neutrophil elastase.

• Contributes to alveolar wall destruction and mucus hypersecretion.

Role of Neutrophils

What does this refer to

• Cigarette smoke and inflammation increase oxidative burden.

• Leads to cellular injury and impaired antiprotease defense.

Oxidative Stress

What does this refer to

• Increased proteases (e.g., elastase) and decreased antiproteases (e.g., alpha-1 antitrypsin).

• Results in alveolar destruction and emphysema.

Protease-Antiprotease Imbalance

What does this refer to

• Increased mucus production and impaired clearance.

• Contributes to chronic cough and airway obstruction.

Goblet Cell Hyperplasia

What does this refer to

• Chronic inflammation causes fibrosis, smooth muscle hypertrophy, and narrowing of airways.

Airway Remodeling

What does this refer to

• Structural damage and inflammation impair mucociliary clearance.

• Leads to mucus stasis and infection risk.

Ciliary Dysfunction

What does this refer to

• Septal destruction occurs in the respiratory bronchioles and alveolar ducts, usually in the upper lobes.

• Alveolar sac (alveoli distal to the respiratory bronchiole) remains intact.

• Tends to occur in smokers with chronic bronchitis

Centriacinar (Centrilobular)

What does this refer to

• Involves the entire acinus.

• Damage is more randomly distributed.

• Involves lower lobes of the lung.

Panacinar

What does this refer to

• During expiration, airflow obstruction causes incomplete lung emptying.

• Increases work of breathing and contributes to dyspnea.

Dynamic Hyperinflation

What does this refer to

• V/Q mismatch due to destroyed capillary beds and blocked airways.

• Leads to hypoxemia and, later, hypercapnia.

Gas Exchange Abnormalities

What does this refer to

• Infection or inflammation of the large airways or bronchi; self-limiting

• Caused by viruses

• Clinical manifestations

  • Cough

  • Fever

  • Pain behind sternum that is aggravated by coughing

• Treatment

• Antitussive agents

Chronic bronchitis

What does this refer to

• Chronic hypoxia leads to vasoconstriction and vascular remodeling.

• Elevates pulmonary arterial pressure.

Pulmonary Hypertension Mechanism

What does this refer to

• Increased afterload on right ventricle causes cor pulmonale.

• Leads to peripheral edema and jugular venous distention.

Right-Sided Heart Failure

What does this refer to

• COPD is associated with systemic cytokine release.

• Leads to muscle wasting, osteoporosis, and cardiovascular risk.

Systemic Inflammation

What does this refer to

• Macrophages release TNF-α, IL-8; T-cells contribute to alveolar damage.

• Chronic inflammation persists even after cessation of exposure.

Immune Cell Involvement

What does this refer to

• Airway narrowing, mucus plugging, alveolar wall destruction, capillary loss, and fibrosis.

Pathological Changes Summary

What does this refer to

• Initially asymptomatic, followed by chronic cough, dyspnea, and frequent exacerbations.

Progression of Disease

What pleural abnormalities does this refer to

• Presence of air or gas in the pleural space

• Primary (spontaneous) pneumothorax

  • Occurs unexpectedly in healthy individuals

Pneumothorax

What pleural abnormalities does this refer to

• Is caused by chest trauma, rupture of bleb/bulla, or mechanical ventilation.

Secondary pneumothorax

What pleural abnormalities does this refer to

• Is caused by medical treatments, especially transthoracic needle aspiration.

Iatrogenic pneumothorax

What pleural abnormalities does this refer to

• Air pressure in the pleural space equals barometric pressure, because air that is drawn into the pleural space during inspiration is forced back out during expiration.

Open pneumothorax

What pleural abnormalities does this refer to

• Site of pleural rupture acts as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing up during expiration.

• Is life-threatening.

Tension pneumothorax

What does this refer to

• Clinical manifestations

  • Sudden pleural pain, tachypnea, and dyspnea

  • Tension

    • Severe hypoxemia, tracheal deviation away from the affected lung, and hypotension

• Treatment

  • Chest tube

  • If persistent air leak: Surgery, pleurodesis (instillation of a caustic substance, such as talc, into the pleural space), or thoracoscopic surgical techniques

Pneumothorax

What pleural abnormalities does this refer to

• Infected pleural effusion

• Pus in the pleural space

• Clinical manifestations

  • Cyanosis, fever, tachycardia (rapid heart rate), cough, and pleural pain

• Treatment

  • Administration of antimicrobial medications

  • Drainage of the pleural space with a chest tube

  • Severe cases: Ultrasound-guided pleural drainage, instillation of fibrinolytic agents, or deoxyribonuclease (DNase) injected into the pleural space

  • Surgical debridement

Empyema

What does this refer to

• Fluid in the pleural space that is watery and diffuses out of the capillaries.

Transudative effusion

What does this refer to

• Fluid in the pleural space that is less watery and contains high concentrations of white blood cells and plasma proteins.

Exudative effusion

What does this refer to

• Presence of fluid in the pleural space

Pleural effusion

What does this refer to

• Chyle exudate

Chylothorax

What does this refer to

• Blood exudate

Hemothorax

What does this refer to

• Pus

Empyema

What does this refer to

• Clinical manifestations: Dyspnea and pleural pain

• Treatment: Thoracentesis, chest tube, and surgery

Pleural effusion