COPD英文课件留学生授课内科学.ppt
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1、Chronic BronchitisDefinition:Chronic and unspecific inflammation of bronchi and the surrounding tissue.A clinical syndrome defined -chronic sputum production -Persistent cough -for at least 3 months -in at least 2 consecutive years Anatomic site -Bronchus 3PathogenesisChronic irritation of airwaysSm
2、okingDust Air pollutants The major risk factor for the development of chronic bronchitis is cigarette smokingInfective agents-secondary factornChronic inflammation nHypertrophy&hyperplasia of bronchial glands that secrete mucusnIncrease number of goblet cellsnCilia are destroyedChronic Bronchitis Pa
3、thophysiologyCilia DamagedInflammatory Cells Studies show that smokers with symptoms of chronic bronchitis have an increased number of inflammatory cells in their bronchial glands when compared with asymptomatic smokers.This inflammatory process consists predominantly of neutrophils and macrophages,
4、and of an increased proportion of CD8+T-lymphocytes.MacrophagesNeutrophilsMast cellsLymphocytes7Chronic Bronchitis-pathological sectionNarrowing of airway airflow resistancework of breathChronic Bronchitis Pathophysiology9Chronic Bronchitis PathophysiologyBronchospasm often occursEnd resultHypoxemia
5、HypercapneaPolycythemia(increase RBCs)Clinical manifestation Main symptoms:cough:chronic,long term,repeatedly expectoration:mucoid sputum,purulent sputum when infection wheezing:seen in some patientsClinical manifestation Sign:1.no obvious sign in early stage2.sometimes moist rales and rhonchi Diagn
6、osis Chronic cough and sputum production for 3 consecutive months in at least 2 successive years(3m/y2y)excluding other chronic lung diseasesEmphysema15Definition Pulmonary emphysema is described in clinical,radiological and physiologic terms,but the condition is best defined morphologically.It mean
7、s abnormal enlargement of airspaces distal to the terminal bronchioles with destruction of their wall.It is characterized by destruction and enlargement of alveoli.Etiology Environment FactorsCigarette smoking(In industrialized countries,cigarette smoking accounts for most cases of COPD)environmenta
8、l pollutantsOccupational dusts and chemicalsHost FactorsGenes:Alpha1-antitrypsin deficiencyLow birth weight is also a risk of COPDIn old person,the ability of the immune system is decrease,therefore bronchitis is more common in old people.Emphysema:PathophysiologyStructural changesHyperinflation of
9、alveoliDestruction of alveolar&alveolar-capillary wallsLung elasticity decreases18Loss of Lung Surface Area for Gas Exchange and Oxygen TransportLoss of Lung Surface area is due to death of Lung Endothelial CellsCigarette Smoke and Environmental Pollution may cause endothelial cell deathEmphysema:Pa
10、thophysiology19Pathology feature Alveolar walls become thinnerAlveolar sacs enlargementRupture of alveoli and formation of bleb20 Severe destruction of small airways can lead to the formation of large air pockets-known as bullae-that replace lung tissue.This form of disease is called bullous emphyse
11、mamicroscope21Bullous Emphysema Univ of AL at Birmingham,Dept.of Path.Dissection22A lateral chest x-ray of a person with emphysema.Note the barrel chest and flat diaphragm23CT image of the lung of a person with bullous emphysema.24Types of Emphysemacentrilobular emphysema panacinar emphysemaIn centr
12、ilobular emphysema,respiratory bronchioles are selectively and dominantly involved.26In panacinar emphysema,the enlargement and destruction of air space involve the acinus more or less uniformly.27emphysema is only a description of lung changes rather than a disease itself28Chronic Obstructive Pulmo
13、nary Disease(COPD)What is COPD?Global Strategy for Diagnosis,Management and Prevention of COPDnDefinitionnDiagnosis and AssessmentnTherapeutic OptionsnManage Stable COPDnManage ExacerbationsnManage ComorbiditiesREVISED 2011What is COPD?COPD,a common preventable and treatable disease,is characterized
14、 by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response to noxious particles or gases.COPD is a type of obstructive lung disease in which chronic incompletely reversible poor airflow(airflow limitation)and inability to breathe out f
15、ully(air trapping)exist.The poor airflow is the result of breakdown of lung tissue(known as emphysema)and small airways disease(known as obstructive bronchiolitis).The relative contributions of these two factors vary between people.33Relationship of COPD and Chronic bronchitis,Asthma or Emphysema34W
16、hy COPD is Important?COPD is the chronic disease that is showing progressive upward trend in both mortality and morbidityWHO predicts that COPD will become the third leading cause of death worldwide by 2030.Worldwide,COPD affects 329 million people or nearly 5 percent of the population.In 2013,it re
17、sulted in 2.9 million deaths,up from 2.4 million deaths in 1990.The number of deaths is projected to increase because of higher smoking rates and an aging population in many country.EconomicsGlobally,as of 2010,COPD is estimated to result in economic costs of$2.1 trillion,half of which occurring in
18、the developing world.Of this total an estimated$1.9 trillion are direct costs such as medical care,while$0.2 trillion are indirect costs such as missed workGlobal Strategy for Diagnosis,Management and Prevention of COPDRisk Factors for COPDLung growth and development肺的生物自然过程 Gender性别Age 年龄Respirator
19、y infections呼吸系统感染Socioeconomic status社会经济地位Asthma/Bronchial hyperreactivity哮喘/气道高反应性Chronic Bronchitis慢性支气管炎Genes遗传因素Exposure to particles粉尘暴露 Tobacco smoke吸烟 Occupational dusts,organic and inorganic有机、无机职业粉尘 Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings室
20、内空气污染(尤其是在通风不良的室内燃烧生物燃料做饭)Outdoor air pollution室外空气污染Risk Factors for COPDPathogenesisTobacco smoking is the most common cause of COPD,with a number of other factors such as air pollution and genetics playing a smaller role.In the developing world,one of the common sources of air pollution is poorly
21、 vented cooking and heating fires.Long-term exposure to these irritants causes an inflammatory response in the lungs resulting in narrowing of the small airways and breakdown of lung tissue,known as emphysema.41PathogenesisInflammationsImbalance of proteinases and antiproteinases in the lungsOxidati
22、ve stress are also important in the pathogenesis of COPD.Noxious particles and gasesLung inflammationHost factorsCOPD pathologyProteinasesOxidative stressAnti-proteinasesAnti-oxidantsRepair mechanisms43Mechanisms Underlying Airflow Limitation in COPDSmall Airways Disease小气道病变Airway inflammation气道炎症A
23、irway fibrosis纤维化Increased airway resistance气道阻力增大Parenchymal Destruction肺实质的破坏Loss of alveolar attachments肺泡减少Decrease of elastic recoil弹力下降AIRFLOW LIMITATION44On the left is a diagram of the lungs and airways of normal bronchioles and alveoli.On the right is lungs damaged by COPD,bronchiole loose
24、their shape and clogged by mucus.The walls of alveoli are destroyed forming larger alveoli.Pathological change46Airway in COPDNon-smokerCOPDSaetta.199847COPD PathophysiologyHypoventialtion-PaCO2 -Airflow obstruction/airway narrowingHyperinflation:air trappingGas exchange defects-PaO2 Destruction of
25、alveolar wall/alveolar-capillary membraneV/Q mismatch 49COPD PathophysiologySystemic effects of COPD Muscular weakness Impaired salt&water excretion leading to peripheral oedema.Altered fat metabolism contributing to weight lossIncreased prevalence of osteoporosis.Increased circulating inflammatory
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