Prof. dr. Bacani ByKazemi Mohammad Sadegh Dmd2ee 2013 RESPIRATORY DISEASE
Major Determinants of Disease• Diseases of one lung compartment tend to affect the others• The lungs are open to the environment, exposing them to infectious agents, allergens, irritants, & carcinogens• Most lung disease is caused by inhalation of material; the most common exception is autoimmune lung disease
• Lost pulmonary membrane is not recoverable• Smoking is a major cause of lung disease• The heart & lungs are a functional unit; lung disease usually affects the heart; & heart disease usually affects the lungs
Chronic Bronchitis• Chronic bronchitis is defined clinically. It ispresent in any patient who has persistentcough with sputum production for at least 3months in at least 2 consecutive years, in theabsence of any other identifiable cause.(1) Progress to chronic obstructive airwaydisease (2) Lead to cor-pulmonale and heart failure(3) Cause atypical metaplasia and dysplasia ofthe respiratory epithelium
Pathogenesis• Tobacco smoke– 90% of patients are smokers.• Grain, cotton, and silica dust• Air pollution• Infection– Bacterial and viral infections are importantintriggering acute exacerbation of the disease.• Others
Chronic bronchitis. The lumen of the bronchus is above. Note the markedthickening of the mucousgland layer (approximately twice normal) and squamous metaplasia of lungepithelium. (From the teaching collection of the Department of Pathology,University of Texas, Southwestern Medical School,Dallas, Texas.)
Clinical Course• Prominent cough• Production of sputum• Hypercapnia, hypoxemia, and cyanosis• Pulmonary hypertension and cardiac failure• Recurrent infections and respiratory failure
Emphysema• Definition– Emphysema is a condition of the lungcharacterized by abnormal permanentenlargement of the airspaces distal to theterminal bronchiole, accompanied bydestruction of their walls and withoutobvious fibrosis.
Pathogenesis• The genesis of emphysema is notcompletely understood.• A consequence of two critical imbalances– The protease-antiprotease imbalance– Oxidant-antioxidant imbalance
Pathogenesis of emphysema. The protease-antiproteaseimbalance andoxidant-antioxidant imbalance are additive in their effects andcontribute to tissue damage. α1-antitrypsin (α1-AT) deficiencycan be either congenital or "functional" as a result of oxidativeinactivation.
Types of Emphysema• According to its anatomic distribution withinthe lobule• Four major types– Centriacinar– Panacinar– Paraseptal– Irregular• Only the first two cause clinically significantairflow obstruction.
A, Centriacinar emphysema. Central areas showmarked emphysematous damage (E), surrounded byrelatively spared alveolar spaces.B, Panacinar emphysema involving the entirepulmonary architecture.
Microscopically at high magnification, the loss ofalveolar walls with emphysema is demonstrated.Remaining airspaces are dilated.
Clinical Course• Dyspnea is usually the first symptom• Steadily progressive• Cough and wheezing• Weight loss• Pulmonary function tests– The ratio of FEV1 to FVC is reduced
Anatomic distribution of pure chronic bronchitis and pure emphysema. Inchronic bronchitis the small-airway disease (chronic bronchiolitis) results inairflow obstruction, while the large-airway disease is primarily responsible forthe mucus hypersecretion.
Bronchiectasis• The permanent dilation of bronchi andbronchioles caused by destruction of themuscle and elastic supporting tissue.
Pathogenesis• Obstruction• Chronic persistent infection– Damage to bronchial walls, leading toweakening and dilation.– Obstructive secretions, inflammationthroughout the wall
Morphology• Affects the lower lobes bilaterally• The airways dilated• Histologically– Intense acute and chronic inflammatoryexudate within the walls of the bronchi andbronchioles– The desquamation of lining epitheliumcause extensive areas of ulceration– Fibrosis of the bronchial and bronchiolarwalls and peribronchiolar fibrosis
This is the microscopic appearance of bronchiectasis.Bronchiectasis is not a specific disease, but aconsequence of another disease process that destroysairways.
Clinical Course• Severe, persistent cough with expectorationof mucopurulent– Fetid, sputum.– The sputum may contain flecks of blood• Hypoxemia, hypercapnia, pulmonaryhypertension, and (rarely) cor pulmonale.
Pathophysiology Asthma trigger- Inflammation & edema of the mucous membranes.- Accumulation of tenacious secretions from mucous glands.- Spasm of the smooth muscle of the bronchi & bronchioles decreases the caliber of the bronchioles.
• Coughing• Wheezing, a whistling sound• Shortness of breath• Chest tightness• Sneezing & runny nose• Itchy and inflamed eyes
Asthma Therapeutic Drug therapy: management B- adrenergic, Theophyllin, & corticosteroids- Allergic control preparations + chest to prevent physiotherapy (only attacks. in between attacks).
Clinical Anatomic Major Etiology Signs/ Term Site Pathologic Symptoms ChangesChronic Bronchus Mucous gland Tobacco Cough,bronchitis hyperplasia, smoke, air sputum hypersecretion pollutants productionBronchiectasis Bronchus Airway dilation Persistent or Cough, and scarring severe purulent infections sputum, feverEmphysema Acinus Airspace Tobacco Dyspnea enlargement; smoke wall destructionAsthma Bronchus Smooth Immunologic Episodic muscle or undefined wheezing, hyperplasia, causes cough, excess mucus, dyspnea inflammation
Lower Respiratory Tract Infections: Bronchiolitis (RSV Infection)• 2-12 month• Caused by syncytial virus• Transmitted by oral droplet• Predisposing factors (asthma, smoking)• Causes necrosis and inflammation of small bronchi and bronchioles• Signs and dyspnea – Wheezing – Rapid, shallow respirations – Cough – Rales – Chest retractions – Fever• Treatment and symptomatic – Supportive
Pulmonary Infections• Pneumonia can resultwhenever these defensemechanisms are impairedor whenever theresistance of the host ingeneral is lowered.• Most deadly infectious disease in the U.S. • 6th leading cause of death
Pulmonary Infections or Pneumonia• Pneumonia can be very broadly definedas any infection in the lung. It maypresent as acute, fulminant clinicaldisease or as chronic disease with amore protracted course.
Pathogenesis• Streptococcus Pneumoniae– The most common cause of acute pneumonia.– Examination of Gram-stained sputum is an important stepin the diagnosis of acute pneumonia.– Pneumococcal pneumonias respond readily to penicillintreatment, but there are increasing numbers ofpenicillinresistantstrains of pneumococci.• Haemophilus Influenzae– A major cause of life-threatening acute lower respiratorytractinfections and meningitis in young children.• Moraxella Catarrhalis
Lung cancer•Lung cancer is currently the mostfrequently diagnosed major cancer in theworld and the most common cause ofcancer mortality worldwide.• Cancer of the lung occurs most oftenbetween ages 40 and 70 years, with apeak incidence in the fifties or sixties.• The 5-year rate for all stages combined isonly 15%.
• Cigarette smoking– Passive smokingincreases the risk ofdeveloping lung cancer toapproximately twicethat of nonsmokers.• Industrial Hazards• Air Pollution• Molecular Genetics
• Squamous cellcarcinoma (25% to40%)• Adenocarcinoma(25% to 40%)• Small cell carcinoma(20% to 25%)• Large cell carcinoma(10% to 15%)
• Insidious onset• Normally metastized before diagnosis• 4 possible categories of signs of lung cancer –Direct effects of tumor –Systemic effects of cancer –Paraneoplastic syndromes –Metastizes at other sites
• Chest X-rays• Bronchoscopy• Pulmonary function tests
• Surgery on localized lesions• Chemotherapy and radiation• Poor prognosis unless tumor in early stages of development
What is tuberculosis (TB)? Tuberculosis (TB) is a disease caused bybacteria called Mycobacterium tuberculosis. The TB bacteria can affect any part of thebody, but usually affects the lungs. If not treated properly, a person who has TBinfection can develop TB disease. If a person develops TB disease and doesnot get appropriate medical treatment he/shecan die.
• Mycobacterium tuberculosis• Chronic granulomatous inflammation with caseous necros
What are the symptoms of TB? Symptoms of TB disease include:feelings of sickness or weakness,weight loss, fever, and night sweats. When TB disease affects the lungs,additional symptoms may include: a badcough that lasts longer than 2 weeks,shortness of breath, pain in the chest andcoughing up blood.
Remember… TB infection occurs when a person hasbreathed in the TB germ, but the person is notsick. TB disease can develop in a person withTB infection if they do not get medicaltreatment. A person with TB disease is sick and mayhave several symptoms of the disease. If left untreated, persons with TB diseasecan die from TB.
How is TB treated? TB disease can usually be curedby taking several medicines for 6-12 months. It is very important that people who have TBdisease take the medication exactly asprescribed. If you stop taking the medication too soon,you can become sick again. Also, if you do not take the medicationcorrectly, the germs may become resistant tothose medications and become more difficult totreat.
An inflammation of the larynx.It causes hoarse voice or thecomplete loss of the voicebecause of irritation to thevocal folds.
Colds or flu. This is the most common causeWhat are the symptoms?The main symptom of laryngitisis hoarseness. Your voice maysound raspy, be deeper thannormal, or break now and then.You may lose your voicecompletely. Other symptomsmay include a dry or sorethroat, coughing, and troubleswallowing.
How is it treated?With most cases of laryngitis, home treatment isall that you need. Try to rest your voice, addmoisture to the air in your home with ahumidifier or vaporizer, and drink plenty offluids. Dont smoke, and stay away from otherpeople’s smoke.Chronic laryngitis may need more treatment. Ifyou keep getting laryngitis because of a problemwith the way you talk or sing, you may needspeech training. This can help you changehabits that can cause laryngitis. It can also helpyour larynx heal.You may need surgery if your vocal cords havebeen damaged, such as by sores or polyps.
Bronchitis•Bronchitis is an inflammation of the main airpassages to the lungs•Most prevalent in winter •Generally part of an acute URI •It may develop after a common cold or other viral infection of the nasopharynx, throat, or bronchi •Often with secondary bacterial infection
1.Malaise2.Chilliness3.Slight fever4.Back and muscle pain5.Sore throat6.Onset of a distressing cough usually signals onset of bronchitis7.Cough starts off dry and later produces mucous.
TonsillitisWhat is tonsillitis?• Tonsillitis is a viral or bacterial infection in the throat that causes inflammation of the tonsils. Tonsils are small glands (lymphoid tissue) in the pharyngeal cavity.• In the first six months of life tonsils provide a useful defense against infections. Tonsillitis is one of the most common ailments in pre-school children, but it can also occur at any age.
Tonsillitis• Palatine tonsils(Visible during oral examination)
Tonsillitis is caused by a variety of contagious viral and bacterial infections. It is spread by close contact with other individuals and occurs more during winter periods. The most common bacterium causing tonsillitis is streptococcus.
Tonsillitis caused by bacteriaAntibiotics are prescribed fortonsillitis caused by strepbacteria. A strep infection willusually go away on its own,but antibiotic treatment isneeded because untreatedstrep throat can causeserious complications
SurgerySurgical removal of thetonsils (tonsillectomy) isstill a common procedure,particularly for children