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OBSTRUCTIVE AIRWAYS DISEASE

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OBSTRUCTIVE AIRWAYS DISEASE & SMOKING-ASSOCIATED INTERSTITIAL LUNG DISEASE OBSTRUCTIVE AIRWAYS DISEASE Chronic bronchitis Chronic bronchiolitis (Small Airways Disease ... – PowerPoint PPT presentation

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Title: OBSTRUCTIVE AIRWAYS DISEASE


1
OBSTRUCTIVE AIRWAYS DISEASE
  • SMOKING-ASSOCIATED INTERSTITIAL LUNG DISEASE

2
OBSTRUCTIVE AIRWAYS DISEASE
  • Chronic bronchitis
  • Chronic bronchiolitis (Small Airways Disease)
  • Emphysema
  • Bronchiectasis
  • Bronchial asthma

3
OBSTRUCTIVE AIRWAYS DISEASE
  • All characterized by airflow limitation, but
    involve
  • different mechanisms and parts of the respiratory
  • tree
  • Chronic bronchitis - hypersecretory
  • Chronic bronchiolitis - obstructive
  • Emphysema - destructive
  • NB Cigarette smoking
  • Frequently co-exist but 2 clinical syndromes
  • Blue bloater vs. Pink puffer

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OBSTRUCTIVE AIRWAYS DISEASE Chronic Bronchitis
  • Persistent or recurrent excess of secretion in
    the bronchial tree on most days for at least 3
    months in the year, over 2 years
  • Middle-aged elderly, M gt F
  • Mucoid sputum H. Inf, Strep pneum., Bran. Cat
  • Cigarette smoke, air pollution, dust exposure
    cadmium, smog
  • At PM - bronchi filled with mucous / pus
  • Enlargement of submucosal glands (Reid Index)
  • shift to pure mucous from mixed
    sero-mucinous type
  • Inceased nos of goblet cells in epithelium, at
    expense of ciliated cells and Clara cells

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OBSTRUCTIVE AIRWAYS DISEASE
Acute on chronic bronchitis
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OBSTRUCTIVE AIRWAYS DISEASE
Loss of airway tapering in chronic bronchitis
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OBSTRUCTIVE AIRWAYS DISEASE Small Airway Disease
  • Airways lt 2mm small bronchi, proximal
    bronchioles
  • Bronchiolar goblet cell metaplasia loss of
    clara cells loss of protease inhibitor
  • Chronic inflammation fibrosis focal stenoses
  • Hypoxic pulmonary vasoconstriction hypertension
    cor pulmonale
  • Compensatory polycythaemia

10
OBSTRUCTIVE AIRWAYS DISEASE Emphysema
  • Emphysema is a condition of the lung
    characterized by abnormal, permanent enlargement
    of the airspaces distal to the terminal
    bronchioles, accompanied by destruction of their
    walls and without obvious fibrosis
  • Airflow limitation is due to premature closure of
    airways because of diminished elastic recoil

11
OBSTRUCTIVE AIRWAYS DISEASE Emphysema
  • Morphologic types according to part of acinus
    affected
  • Centriacinar cigs, UL
  • Panacinar - ?1-AT defficiency, LL
  • Paraseptal - septal / subpleural

12
OBSTRUCTIVE AIRWAYS DISEASE
CENTRILOBULAR EMPHYSEMA
SEPTAL EMPHYSEMA
13
OBSTRUCTIVE AIRWAYS DISEASE
PARASEPTAL EMPHYSEMA Large solitary bullae These
may grow large enough to cause respiratory
failure by compressing adjacent normal lung.
Corrective bullectomy or lung reduction may
return pulmonary function to normal
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OBSTRUCTIVE AIRWAYS DISEASE
PANACINAR EMPHYSEMA
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OBSTRUCTIVE AIRWAYS DISEASE
PANACINAR EMPHYSEMA
17
OBSTRUCTIVE AIRWAYS DISEASE Emphysema -
pathogenesis
  • Proteases (elastase) vs. Antiproteases
  • Neutrophils macrophages - sources of elastase
    increased in smokers / infection / inflamm
  • Smoking stimulates release and enhances activity
    of elastase
  • Oxidants in cig smoke inhibit native ?1-AT
    activity
  • ?1-AT defficiency - unopposed elastase activity
  • ?1-AT specified by proteinase inhibitor (Pi)
    locus chrom 14, polymorphism 70 different
    variants
  • PiMM normal, Z and S mutants NB medical
    relevance

18
OBSTRUCTIVE AIRWAYS DISEASE Bronchial Asthma
  • Asthma - characterized by hyperreactive airways
    leading to episodic, reversible
    bronchconstriction, owing to increased
    responsiveness of the tracheobronchial tree to
    various stimuli
  • Extrinsic / Atopic / Allergic allergy to
    exogenous substances
  • Intrinsic / idiosyncratic / Non-atopic no
    exogenous factors identified

19
OBSTRUCTIVE AIRWAYS DISEASE Atopic Asthma
  • Commoner
  • Childhood, MgtF
  • Less severe as age but 30 symptoms as adults
  • Assoc eczema, rhinitis
  • Environmental triggers
  • Type I (IgE-mediated) hypersensitivity reaction

20
OBSTRUCTIVE AIRWAYS DISEASE Nonatopic Asthma
  • Adult onset
  • Chronic, tending to worsen with age
  • Triggered by respiratory tract infxn viral
  • Family hx uncommon
  • Serum IgE normal
  • Virus-induced inflammation may lower threshold of
    receptors to irritants

21
OBSTRUCTIVE AIRWAYS DISEASE Asthma
  • Sputum yellow MPO
  • Eosinophils, Charcot-Leyden crystals,
    Curschmanns spirals and Creola bodies
  • Lungs at PM Status Asthmaticus
    overdistension, mucous plugging
  • Micro luminal mucous eo, goblet cell
    hyperplasia, infiltration by eosinophils, BM
    thickening, bronchial smooth muscle hyperplasia,
    hypertrophy

22
(a) Curschmann spiral
OBSTRUCTIVE AIRWAYS DISEASE
(b) Creola body
b
a
23
OBSTRUCTIVE AIRWAYS DISEASE
Hyperinflated lungs in status asthmaticus
24
OBSTRUCTIVE AIRWAYS DISEASE
Sticky mucus plugs in status asthmaticus
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SMOKING-ASSOCIATED INTERSTITIAL LUNG DISEASE
  • Respiratory-bronchiolitis (RB)
  • Desquamative interstitial pneumonia (DIP)
  • Langerhans cell histiocytosis (LCH) Eosinophilic
    granuloma (EG) Histiocytosis X (HX)

32
RESPIRATORY (SMOKERS) BRONCHIOLITIS (RB) and DIP
  • Cough dyspnoea
  • LL interstitial infiltrates, restrictive PFTs
  • Patchy disease
  • Accumulation of macrophages containing
    yellow-brown pigment in lumens of distal
    bronchioles, alveolar ducts spaces
  • Mild interstitial thickening
  • DIP diffuse filling of alveolar spaces
  • ?different ends of the spectrum of one disease

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LANGERHANS CELL HISTIOCYTOSIS (LCH)
EOSINOPHILIC GRANULOMA (EG)
HISTIOCYTOSIS X (HX)
  • Pulmonary LCH smokers
  • Cough, dyspnoea, fever, malaise, spontaneous
    pneumothorax
  • Imaging UL, cysts and nodules
  • Micro discrete stellate nodules, bronchocentric
  • Langerhans cells, histiocytes, eosinophils,
  • Langerhans cells large histiocytes groovy
    nuclei
  • Cysts, stellate or starfish-shaped scars
  • HE diagnosis, IHC has replaced EM as a
    diagnostic tool

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