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Henry Ford

Normal Lung

Normal Lung

Normal Lung Tissue

Chronic Obstructive Pulomary Diseases

(COPD)

Dr. Venkatesh M. Shashidhar

Associate Professor of Pathology Fiji School of Medicine

Commitment to Excellence

Obstructive Airway Disease:

Localised Mechanical
Tumours, Trauma, Foreign body collapse

Diffuse Distal airway diseases.

COPD chronic

COPD Definition:
Progressive irreversible airway obstruction with destruction of parenchyma. Chronic obstructive bronhitis Emphysema Mucous plugging.

COPD Introduction.
Chronic Slow progress (FEV1<80%, FEV1/CV <70%) Stable over several months. (chronic) 15% of smokers likely to develop COPD. Etiology smoking, pollution. Low birth wt. Smoke irritation mucosal hyperplasia excess mucous obstruction, inflammation.

Metaplasia, lack of defense / clearance mech.

Obstruction, lack of elastic recoil, collapse.

Pathology of Smoking
Irrefutable evidence - smoking disease >4000 chemicals, 43 carcinogens. Range of non-neoplastic and neoplastic dis. Chronic bronchitis, emphysema common. Ca bladder, Pancreas, cervix, larynx. Gastritis, PUD, IHD, HPTN, atherosclerosis risk factor. Arteriosclerosis Bergers

Smoking - Pathology
Alveolar marcrophage CD8 Lymphocytes Neutrophils Proteases Bronchitis. Alveolar destruction.

Pathogenesis Smoke - Lung Dis.

Irritation Inflammation Mucous - Infections

Carcinoma

Chronic Bronchitis
Productive Cough >3 months in 2 years. Smoking / pollution - major cause. Acute & Chronic inflammation of mucosa Lack of cilia - retention of secretions Increased mucous glands & viscid mucous. Frequent secondary infections inflammation retention infection obstruction cycle.

COPD

COPD

Chronic Bronchitis

smokers lung Normal Lung

Emphysema:
Alveolar wall destruction, Dyspnoea, RHF. Pink Puffers normal ABG pattern. Types:
Centrilobular smoking

Panlobular congenital - 1 antitrypsin deficiency

Paraseptal & irregular subpleural, scarring

Other
Interstitial emphysema Air leak. Senile Emphysema

smokers lung Emphysema

smokers lung Pigmentation

Emphysema:

Emphysema

Centrilobular Emphysema:

Emphysema Ruptured alveloli.

Centrilobular Emphysema:

Centrilobular Emphysema (smoking):

Pan lobular bullous emphysema

Local Bullous Emphysema:

Bronchitis
Blue Bloater Mild dyspnoea, late Infections common Cor-pulmonale

Emphysema
Pink Puffer Dyspnoea severe, early Occassional Rare, late

Increased resistance
Prominent BV, large heart.

Mild increase
Hyperinflation small heart.

Complications of COPD:
1. Cor Pulmonale
syncope, hypoxia, pedal edema, passive hepatic congestion, and death.

2. Acute Exacerbations.

3. End-stage lung disease.

4. Polycythemia hypoxia.

5. Pneumothorax, Infections, Bronchectasis.

Bronchiectasis:
Permanent dilatation of bronchi. Cough, copious purulent sputum. Lower lobes common Complications;
Pneumonia, empyema, septicemia, meningitis.

Types:
Cylindrical, Saccular, Fusiform (no significance)

Pathogenesis - Bronchiectasis
COPD/Obstruction/Infection.

Excess Mucous secretion

Retention of secretion Secondary infection Destruction of bronchial wall Irregular, fixed inflamed dilated bronchus filled with pus.

Bronchiectasis:

Bronchiectasis

Bronchiectasis

Bronchiectasis - Adhesions

Saccular Bronchiectasis:

Summary - COPD
Progressive, irreversible, obstruction, destruction.

3 etiology
Smoking, pollution, Alpha1 AT Deficiency.

3 symptoms
Cough, Dyspnoea, Hypoxemia

3 Diseases:
Chronic Bronchitis, Emphysema, Asthma

COPD summary:
3 Complications:
Exacerbations, Cor-pulmonale, End stage lung disease.

3 Investigations:
Spirometry (FEV1/VC), PaO2, PCO2.

3 grades
Mild 69-80 FEV1 cough, exertional dysp. Mod 40-60 FEV1 - + Wheeze, cough, sputum. Sev - < 40 FEV1 - + Right Heart Failure.

"Troubles are often the tools by which God fashions us for better things."
- Henry Ward Beecher