RESPIRATORY SYSTEM: BRONCHIAL ASTHMA AND BRONCHIECTASIS
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This document summarizes bronchial asthma and bronchiectasis. Bronchial asthma is a chronic inflammatory airway disease characterized by airway hyperresponsiveness and reversible airway obstruction. It has various types defined by triggers. Bronchiectasis is a permanent dilation of the bronchi due to destruction of muscle and elastic tissue from chronic necrotizing infections. It is now uncommon but causes cough and foul sputum. Both involve inflammation and infection of the airways leading to structural changes.
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RESPIRATORY SYSTEM: BRONCHIAL ASTHMA AND BRONCHIECTASIS
- 1. BRONCHIAL ASTHMA BRONCHIECTASIS Dr Vijay Shankar S
- 2. Overview โข Bronchial asthma, โข types โข Pathogenesis and pathology โข Bronchiectasis โข Etiopathogenesis โข Pathology
- 4. โข Defn: โข Asthma is a chronic inflammatory disorder of the airways that is characterized by increased responsiveness of tracheobronchial tree to a variety of stimuli โข Manifested physiologically by โข Widespread narrowing of airways which may be releived spontaneously or as a result of therapy.
- 5. โข Manifested clinically by โข Paroxysms of dyspnea , cough and wheezing
- 10. โข A very common disease โข immense social impact โข All ages โข 50% before age of 10 โข 2:1::M:F in childhood โข 1:1::M:F in adults
- 11. โข World Asthma Day โข is an annual event organized by the Global Initiative for Asthma (GINA) to โข improve asthma awareness and care around the world. โข World Asthma Day takes place on the first Tuesday of May. โข The theme of World Asthma Day 2014 isโYou Can Control Your Asthma./ "It's Time to Control Asthma,".โ โข 2015: 5th May: The theme will continue
- 12. Etiopathogenesis & Types โข Types 1) Extrinsic asthma,( atopic or allergic) - MC 2) Intrinsic asthma ( Non atopic) In either types, the triggers of bronchospasm: -respiratory infections -irritants -cold air, stress & excercise
- 13. โข Seasonal โข Drug induced โข Exercise induced โข Occupational
- 14. Pathogenesis โข Genetic predisposition to type 1 hypersensitivity!
- 15. Atopic asthma
- 16. Pathogenesis of non atopic asthma โข Viral infection: lowers the threshold of subepithelial vagal receptors to irritants โข Drugs like aspirin- inhibits COXpathway without affecting lipoxygenase pathway โข Occupational asthma- various mechanisms
- 17. Gross
- 18. Hyperinflated lungs of status asthmaticus
- 19. Curschmann spirals result either from mucus plugging in subepithelial mucous gland ducts which later become extruded or from plugs in bronchioles
- 20. Charcot-Leyden crystals crystalloid made up of an eosinophil lysophospholipase binding protein called galectin-10
- 23. Clinical features โข Episodes of acute exacerbations interspered with symptom free periods. โข Dyspnoea โข Cough โข & wheezing.
- 27. Bronchiectasis
- 28. Bronchiectasis โข Defn โ ABNORMAL & PERMANENT dilation of bronchi and bronchioles โ caused by destruction of the muscle and elastic tissue, โ resulting from or associated with chronic necrotizing infections
- 29. โข Now Uncommon! โข Cough, fever & expectoration of foul smelling, purulent sputum
- 31. OBSTRUCTION Impairment of mucociliary clearance Pooling of secretions distal to obstruction inflammation Destruction of bronchial wall, smooth muscle and elastic tissue Weakening of the wall Dilatation INFECTION
- 32. 1. Hereditary & congenital factors. 2. Obstruction, 3. Infections 4. Secondary complication
- 33. Gross โข Characteristically affects distal bronchi & bronchioles beyond the segmental bronchi. โข Involve diffuse or segmentally โข B/L lower lobes more common. โข Pleura is usually fibrotic & thickened with adesion to chest wall.
- 34. REID subclassification โข Brochographic appearance โ Cylindrical; โ Fusiform โ Saccular โ varicose
- 41. Microscopy โข Bronchial epithelium may be normal, ulcerated or show squamous metaplasia. โข Wall show infiltration by acute & chronic inflammatory cells
- 43. Clinical features โข Severe persistent cough โข Expectoration of foul smelling sputum โข Dyspnea and orthopnea in severe cases โข Occasional life threatening hemoptysis โข Systemic febrile reaction
- 44. Complications โข Lung abscess โข Pulmonary fibrosis โข Chronic cor pulmonale- RHF โข Reactive systemic amyloidosis
- 45. Summary!
- 46. Thank you
Editor's Notes
- Prevalance world wideโฆ adults 4-5%, children as high as 14% http://www.globalasthmareport.org/burden/burden.php ( based on globalm asthma report 2014)) Indiaโฆ adults various studiesโฆ s 1.8% to 2.05% โฆ social aspects of asthma: Each person's asthma experience is unique, but there are some feelings that many people with asthma experience at one time or another. Fear and Anxiety Hypervigilance Loss of Control Denial Anger Guilt Embarrassment Confusion
- As expected from pathogenesis of bronchiectasis, histologically there is marked inflammation of the bronchi and bronchiolar walls as shown here. The inflammatory cells are seen as dark blue nuclei around the mucosal lining. The right portion of this bronchiole demonstrates epithelial erosion. There is exudate in the lumen. What type of inflammatory cells might you expect? Compare with asthma. Answer