The document discusses respiratory diseases, particularly chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis, asthma, emphysema, and bronchiectasis, emphasizing their interrelation and shared etiological factors like smoking and pollution. It outlines the definitions, classification, and management of conditions such as bronchial asthma, detailing various treatment options including long-term control medications and quick-relief inhalers. The text underscores the importance of understanding the underlying pathology and appropriate therapeutic approaches to mitigate symptoms and improve lung function.

1. The
Respiratory
Disease
Presented by :Jagruti
Marathe

2. PULMONARY VASCULAR DISEASE
• As stated before, diseases of the heart affect the lungs and diseases of the lungs affect the heart.
• This is because of the peculiar characteristics of pulmonary vasculature. The pressure in the pulmonary
arteries is much lower than in the systemic arteries.
• The pulmonary arterial system is466 SECTION III Systemic Pathology thinner than the systemic arterial
system.
• They are thin elastic vessels which can be easily distinguished from thick-walled bronchial arteries
supplying the large airways and the pleura.
• General diseases of vascular origin occurring in the lungs such as pulmonary oedema, pulmonary
congestion, pulmonary embolism and pulmonary infarction, have all been already discussed

3. COPD
CHRONIC OBSTRUCTIVE PULMONARY DISEASE :
Chronic obstructive pulmonary disease (COPD) or chronic obstructive airway disease (COAD) are
commonly used clinical terms for a group of pathological conditions in which there is chronic, partial
or complete, obstruction to the airflow at any level from trachea to the smallest airways resulting in
functional disability of the lungs i.e. they are diffuse lung diseases.

4. 03
01 02
04
The following 4 entities are included in
COPD:
Chronic bronchitis Bronchial asthma
Emphysema Bronchiectasis
Chronic bronchitis and emphysema are quite common and often occur together. Now, small airways
disease involving inflammation of small bronchi and bronchioles (bronchiolitis) has also been added to
the group of COPD.

5. ETIOPATHOGENESIS:
The two most important etiologic factors responsible for majority of cases
of chronic bronchitis are:
1. Smoking.
2. Atmospheric pollution
3. Occupation
4. Infection
5. Familial and genetic factors.

6. 1. Smoking. The most commonly identified factor implicated in causation of chronic bronchitis and in
emphysema is heavy smoking.
Heavy cigarette smokers have 4 to 10 times higher proneness to develop chronic bronchitis. Prolonged cigarette
smoking appears to act on the lungs in a number of ways:
i) It impairs ciliary movement.
ii) It inhibits the function of alveolar macrophages.
iii) It leads to hypertrophy and hyperplasia of mucussecreting glands.
iv) It causes considerable obstruction of small airways.
v) It stimulates the vagus and causes bronchoconstriction.
2. Atmospheric pollution. The incidence of chronic bronchitis is higher in industrialised urban areas where air is
polluted. Some of the atmospheric pollutants which increase the risk of developing chronic bronchitis are sulfur
dioxide, nitrogen dioxide, particulate dust and toxic fumes.

7. 3. Occupation. Workers engaged in certain occupations such as in cotton mills (byssinosis), plastic factories
etc. are exposed to various organic or inorganic dusts which contribute to disabling chronic bronchitis in such
individuals.
4. Infection:
Bacterial, viral and mycoplasmal infections do not initiate chronic bronchitis but usually occur secondary to
bronchitis. Cigarette smoke, however, predisposes to infection responsible for acute exacerbation in chronic
bronchitis.
5. Familial and genetic factors:
There appears to be a poorly-defined familial tendency and genetic predisposition to develop disabling
chronic bronchitis. However, it is more likely that nonsmoker family members who remain in the air-pollution
of home are significantly exposed to smoke (passive smoking) and hence have increased blood levels of
carbon monoxide

9. EMPHYSEMA
The WHO has defined pulmonary emphysema as combination of permanent dilatation of air spaces
distal to the terminal bronchioles and the destruction of the walls of dilated air spaces.
Thus, emphysema is defined morphologically, while chronic bronchitis is defined clinically. Since the
two conditions coexist frequently and show considerable overlap in their clinical features, it is usual to
label patients as ‘predominant emphysema’ and ‘predominant bronchitis’.

10. CLASSIFICATION.
As mentioned in the beginning of this chapter, a lobule is composed of about 5 acini distal to a terminal
bronchiole and that an acinus consists of 3 to 5 generations of respiratory bronchioles and a variable
number of alveolar ducts and alveolar sacs .
As per WHO definition of pulmonary emphysema, it is classified according to the portion of the acinus
involved, into 5 types:
centriacinar,
panacinar (panlobular),
para-septal (distal acinar),
irregular (para-cicatricial)
and mixed (unclassified) emphysema.
A number of other conditions to which the term ‘emphysema’ is loosely applied are, in fact, examples of
‘overinflation’.

11. A. TRUE EMPHYSEMA :
1.Centriacinar (centrilobular) emphysema
2. Panacinar (panlobular) emphysema
3. Paraseptal (distal acinar) emphysema
4. Irregular (para-cicatricial) emphysema
5. Mixed (unclassified) emphysema
B. OVERINFLATION
1. Compensatory overinflation (compensatory emphysema)
2. Senile hyperinflation (aging lung, senile emphysema)
3. Obstructive overinflation (infantile lobar emphysema)
4. Unilateral translucent lung (unilateral emphysema)
5. Interstitial emphysema (surgical emphysema)
EMPHYSEMA

12. BRONCHIAL ASTHMA
Asthma is a disease of airways that is characterised by increased responsiveness of the
tracheobronchial tree to a variety of stimuli resulting in widespread spasmodic narrowing of the air
passages which may be relieved spontaneously or by therapy.
Asthma is an episodic disease manifested clinically by paroxysms of dyspnoea, cough and wheezing.
However, a severe and unremitting form of the disease termed status asthmaticus may prove fatal.
Bronchial asthma is common and prevalent worldwide; in the United States about 4% of population is
reported to suffer from this disease.
It occurs at all ages but nearly 50% of cases develop it before the age of 10 years. In adults, both
sexes are affected equally but in children there is 2:1 male female ratio.

13. ETIOPATHOGENESIS AND TYPES:
Based on the stimuli initiating bronchial asthma, two broad etiologic types are traditionally described:
extrinsic (allergic, atopic) and intrinsic (idiosyncratic, non-atopic) asthma.
A third type is a mixed pattern in which the features do not fit clearly into either of the two main types.
1 2
Intrinsic asthma.
(idiosyncratic, non-atopic)
Extrinsic asthma .
(atopic, allergic)
3
Mixed type.

15. CLINICAL FEATURES.
Asthmatic patients suffer from episodes of acute exacerbations interspersed with symptom
free periods.
Characteristic clinical features are paroxysms of dyspnoea, cough and wheezing. Most
attacks typically last for a few minutes to hours.
When attacks occur continuously it may result in more serious condition called status
asthmaticus. The clinical diagnosis is supported by demonstration of circulation eosinophilia
and sputum demonstration of Curschmann’s spirals and Charcot-Leyden crystals. More
chronic cases may develop cor pulmonale

16. Treatment:
Medications
The right medications for you depend on a number of things — your age, symptoms, asthma triggers and
what works best to keep your asthma under control.
Preventive, long-term control medications reduce the swelling (inflammation) in your airways that leads to
symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing.
In some cases, allergy medications are necessary.

17. Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment.
These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an
asthma attack. Types of long-term control medications include:
•Inhaled corticosteroids. These medications include fluticasone propionate (Flovent HFA, Flovent Diskus,
Xhance), budesonide (Pulmicort Flexhaler, Pulmicort Respules, Rhinocort), ciclesonide (Alvesco),
beclomethasone (Qvar Redihaler), mometasone (Asmanex HFA, Asmanex Twisthaler) and fluticasone furoate
(Arnuity Ellipta).
•You may need to use these medications for several days to weeks before they reach their maximum benefit.
Unlike oral corticosteroids, inhaled corticosteroids have a relatively low risk of serious side effects.
•Leukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate)
and zileuton (Zyflo) — help relieve asthma symptoms.
•Montelukast has been linked to psychological reactions, such as agitation, aggression, hallucinations,
depression and suicidal thinking. Seek medical advice right away if you experience any of these reactions.
•Combination inhalers. These medications — such as fluticasone-salmeterol (Advair HFA, Airduo Digihaler,
others), budesonide-formoterol (Symbicort), formoterol-mometasone (Dulera) and fluticasone furoate-vilanterol
(Breo Ellipta) — contain a long-acting beta agonist along with a corticosteroid.
•Theophylline. Theophylline (Theo-24, Elixophyllin, Theochron) is a daily pill that helps keep the airways open
by relaxing the muscles around the airways. It's not used as often as other asthma medications and requires
regular blood tests.

18. Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma
attack. They may also be used before exercise if your doctor recommends it. Types of quick-relief medications
include:
•Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease
symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol
(Xopenex, Xopenex HFA).
•Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer, a machine that
converts asthma medications to a fine mist. They're inhaled through a face mask or mouthpiece.
•Anticholinergic agents. Like other bronchodilators, ipratropium (Atrovent HFA) and tiotropium (Spiriva,
Spiriva Respimat) act quickly to immediately relax your airways, making it easier to breathe. They're mostly
used for emphysema and chronic bronchitis, but can be used to treat asthma.
•Oral and intravenous corticosteroids. These medications — which include prednisone (Prednisone Intensol,
Rayos) and methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol) — relieve airway inflammation caused by
severe asthma. They can cause serious side effects when used long term, so these drugs are used only on a
short-term basis to treat severe asthma symptoms.

19. Allergy medications may help if your asthma is triggered or worsened by allergies. These include:
•Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune system reaction
to specific allergens. You generally receive shots once a week for a few months, then once a month for a
period of three to five years.
•Biologics. These medications — which include omalizumab (Xolair), mepolizumab (Nucala), dupilumab
(Dupixent), reslizumab (Cinqair) and benralizumab (Fasenra) — are specifically for people who have severe
asthma.

20. Bronchial thermoplasty
This treatment is used for severe asthma that doesn't improve with
inhaled corticosteroids or other long-term asthma medications.
It isn't widely available nor right for everyone.
During bronchial thermoplasty, your doctor heats the insides of the
airways in the lungs with an electrode.
The heat reduces the smooth muscle inside the airways. This limits the
ability of the airways to tighten, making breathing easier and possibly
reducing asthma attacks.
The therapy is generally done over three outpatient visits.