Chronic Obstructive Lung Diseases (COPD) Lecture Qassim University, Faculty of Medicine Year II , 201 DENM Pathology Department Presented by Dr. Ola Omran

Obstructive diseases Emphysema Chronic Bronchitis Bronchial Asthma Decreased expiratory flow rate Loss of elastic recoil as in emphysema Anatomic airway narrowing as in asthma Emphysema Chronic Bronchitis Bronchial Asthma COPD

EMPHYSEMA Abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis. Overinflation : enlargement of air spaces without destruction Four major types (1) Centriacinar (2) Panacinar (3) Distal acinar (4) Irregular

Morphology MP: EMPHYSEMA Thinning and destruction of alveolar walls With advanced disease, adjacent alveoli create large airspaces Terminal and respiratory bronchioles may be deformed. With the loss of elastic tissue alveoli tend to collapse during expiration The number of alveolar capillaries is diminished Ruptured alveloli Alveoli are larger and fewer

Cigarette smoking and emphysema

Chronic bronchitis Prolonged lymphocytic inflammation of bronchial tree with hypertrophic mucosal glands that leads to productive cough Chronic bronchitis as a clinical definition, requires all of:     1. Persistent cough and sputum production     2. Present for at least 3 months     3. Present for at least 2 consecutive years

Bronchitis Emphysema Mild dyspnea, late. Infections common Prominent BV Large heart. Severe dyspnea, early. Infections occasional Hyperinflation Small heart.

Emphysema is morphologic feature & restricted to the acinus Chronic bronchitis is clinical feature & involve large and small airways

Complications Secondary pulmonary hypertension Pulmonary failure with respiratory acidosis, hypoxia, and coma. hypoxia-> Polycythemia Right-sided heart failure (cor pulmonale). Infections, Bronchectasis. Bulla-Pneumothorax, collapse

3. Bronchial Asthma Chronic inflammatory disorder of the airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, & cough, particularly at night and/or early in the morning

MP: Bronchial Asthma 1- Hypertrophy of submucosal mucous glands 2- Accumulation of mucus in the bronchial lumen 3- Intense chronic inflammation (eosinophils, macrophages) 4- Thickened basement membrane 5- Hypertrophy and hyperplasia of smooth muscle cells.

Bronchial Asthma Extrinsic : Association with atopy (allergies) mediated by type 1 hypersensitivity, and asthmatic attacks are precipitated by contact with inhaled allergens. This form occurs most often in childhood Intrinsic : Asthmatic attacks are precipitated by respiratory infections, exposure to cold, exercise, stress, inhaled irritants, and drugs such as aspirin. Adults are most often affected

Mechanism of Asthma Allergy Inflammation of Bronchi Obstruction Mucous Plugs

asthma is stimulated by: Occupational Asthma asthma is stimulated by: fumes (plastics) organic and chemical dusts (wood, cotton, platinum) gases (toluene) Develop after repeated exposure to the inciting antigen(s). Drug-Induced Asthma Pharmacologic agents provoke asthma, aspirin Mechanism remains unknown

The bronchial lumen filled with mucus CHRONIC ASTHMA The bronchial lumen filled with mucus Submucosa widened by smooth muscle hypertrophy, edema, inflammation (mainly eosinophils) Hypertrophy of submucosal mucous glands 15

Sputum smear CHRONIC ASTHMA CURSCHMANN'S SPIRAL, Spiral shaped mucous plug+shedded epithielium. Charcot-Leyden crystals Eosinophilic needle-shaped crystalline structures. Represents breakdown products of eosinophils