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

2. 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

3. 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

4. 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

5. Cigarette smoking and emphysema

6. 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

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

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

9. 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

10. 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

11. 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.

12. 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

13. Mechanism of Asthma Allergy Inflammation of Bronchi Obstruction
Mucous Plugs

14. 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

15. 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

16. 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