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Chronic bronchitis
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  • 1. CHRONICBRONCHITIS Dr.CSBR.Prasad, M.D. CSBRP-Nov-2012
  • 2. Chronic Bronchitis - gist Damage to air ways caused mainly by chemicals Sources: Cigarette smoke, Industrial gases, Motor vehicle exhaust et.c.Definition: Persistent productive cough for at least 3 months in at least 2 consecutive years with out any identifiable cause. CSBRP-Nov-2012
  • 3. Chronic Bronchitis Damage to air ways caused mainly by chemicals Sources: Cigarette smoke, Industrial gases, Motor vehicle exhaust et.c. CSBRP-Nov-2012
  • 4. Chronic BronchitisImportance: CB may progress to COLD Result in cor pulmonale & heart failure Result in metaplasia / dysplasia > Carcinoma CSBRP-Nov-2012
  • 5. CHRONIC BRONCHITISDEFINITION: Persistent productive cough for at least 3 months in at least 2 consecutive years with out any identifiable cause. Chronic asthmatic bronchitis – intermittent bronchospasm and wheezing. CSBRP-Nov-2012
  • 6. CHRONIC BRONCHITISPathogenesis: Chronic irritation by inhaled substances (Tobacco smoke-90%, grain, cotton, Si dust) Microbiologic infections – trigger exacerbations Middle-aged men – more common Smokers – 4 to 10x more common CSBRP-Nov-2012
  • 7. CHRONIC BRONCHITISFeatures of CB:Initially: Hypersecretion of mucus (Proteases from PMNs) Hypertrophy of submucosal glands in trachea and bronchiWith chronicity: Marked increase in goblet cells of small airwaysIncrease in globlet cells and hypertrophy of submucosal glands are of protective metaplastic reaction against the irritantsIrritants > EGF receptor stimulation > up regulation of MUC 5AC gene (a mucin gene) CSBRP-Nov-2012
  • 8. CHRONIC BRONCHITISHypersecretion of mucus is the basis for smaller air way obstruction CSBRP-Nov-2012
  • 9. CHRONIC BRONCHITISCigarette smoke: Plays primary initiating roleRole of infection: Plays a secondary role CSBRP-Nov-2012
  • 10. CHRONIC BRONCHITISAction of Cigarette smoke:1. Interferes with ciliary motility2. Direct damage to epithelium3. Inhibits alveolar leucocytes to clear bacteria CSBRP-Nov-2012
  • 11. Figure 15-9 Schematic representation of evolution of chronic bronchitis (left) and emphysema (right).CSBRP-Nov-2012
  • 12. CHRONIC BRONCHITISMorphology: Hyperemia and edema of mucus membranes Excessive mucus / mucopurulent secretion layers the epithelial surfaces CSBRP-Nov-2012
  • 13. CHRONIC BRONCHITISSMALL AIRWAYS SHOW: Goblet cell metaplasia with mucous plugging Clustering of pigmented alveolar MØ Inflammatory cell infiltration Fibrosis of the bronchiolar wall Bronchiolitis obliterans Bronchial epithelium may exhibit squamous metaplasia and dysplasia CSBRP-Nov-2012
  • 14. CHRONIC BRONCHITISCharacteristic histological feature: Lymphocytic infiltration Enlargement of mucin secreting glands of trachea and bronchi i.e. Increased size of mucous glands REID Index: Normal is 0.4 Ratio of the thickness of the mucous gland layer to the thickness of the wall between the epithelium and the cartilage CSBRP-Nov-2012
  • 15. CSBRP-Nov-2012Chronic inflammatory cells infiltration in submucosa of bronchus
  • 16. CSBRP-Nov-2012
  • 17. CSBRP-Nov-2012
  • 18. Reid’s Index REID Index bc/adCSBRP-Nov-2012
  • 19. CSBRP-Nov-2012
  • 20. CSBRP-Nov-2012
  • 21. CSBRP-Nov-2012
  • 22. CHRONIC BRONCHITISClinical feature: Persistent productive cough Over the period the patient develops dyspnea on exertion With further progression – patient develops hypercapnea, hypoxemia and mild cyanosis They may land in emphysema Long standing cases – cor pulmonale and cardiac failure Death may occur due to respiratory infections CSBRP-Nov-2012
  • 23. E N Dgoto Bronchiectsis CSBRP-Nov-2012