Clinical presentations• Dyspnoea• Recurrent respiratory infections• Right heart failure
Main pulmonary changeIncreased air space in the lungs
EmphysemaDefinition: Abnormal permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of their walls and without obvious fibrosis.Spaces in parenchyma > 1mm = Abnormal
Emphysema Emphysema causes dilation of airspaces by destruction of alveolar wall, leading to collapse of alveoli during expiration
Emphysema & Overinflation• Emphysema: Increased air space with destruction• Overinflation: Increased air space without destruction
Posteroanterior (PA) and lateral chest radiograph in a patientwith severe chronic obstructive pulmonary disease (COPD).Hyperinflation, depressed diaphragms, increased retrosternalspace, and hypovascularity of lung parenchyma is demonstrated.
A lung with emphysema shows increasedanteroposterior (AP) diameter, increasedretrosternal airspace, and flatteneddiaphragms on lateral chest radiograph.
Severe bullous disease observed on CT scan in a patient with COPD
Obstructive Pulmonary diseases• Disorders Associated with Airflow Obstruction• Chronic bronchitis, Emphysema, Asthma, Bronchiectasis & Bronchiolitis come under this category
Venn diagram of chronic obstructive pulmonary disease (COPD). Chronic obstructive lung disease is a disorder in which subsets of patients may have dominant features of chronic bronchitis,emphysema, or asthma. The result is irreversible airflow obstruction.
COPD• COPD: Comprises Emphysema and chronic bronchitis• Many patients have overlapping features of damage at both the acinar level (emphysema) and bronchial level (bronchitis)• Common extrinsic trigger— cigarette smoking — is implicated in both the diseases
Figure 15-9 Schematic representation of evolution of chronic bronchitis (left) and emphysema (right).
Natural history of COPD• Pathological process (for years) > clinical symptoms• Survival is variable• Respiratory failure > terminal phase of disease• 2/3 dead < 2 years• DEATH: - Respiratory acidosis and coma - Chronic cor pulmonale - Spontaneous pneumothorax