Chapter three
? Chronic Obstructive Pulmonary
Diseases
(COPD)
? Chronic Bronchitis
? Obstructive Pulmonary Emphysema
Definition of COPD
? Including chronic bronchitis
and pulmonary emphysema
? Chronic airflow limitation
? progressing slowly
? Partial reversibility
? Abnormal inflammatory response of the
lungs to noxious particles or gases
Classification of COPD by Severity
? Stage 0 ( at risk)
– Chronic cough and sputum production
– Contact with harmful factors
– FEV1/FVC > 70%
? Stage I( mild)
– FEV1/FVC < 70%
– FEV1 ??80 % predicted
– usually,but not always,chronic cough
and
sputum production
Classification of COPD by Severity
? Stage II( moderate)
– IIA, FEV1/FVC < 70%
50%??FEV1 < 80% predicted
– IIB,FEV1/FVC < 70%
30%??FEV1 < 50% predicted
With or without symptom
Classification of COPD by Severity
? Stage III( Severe)
– FEV1/FVC < 70%??
– FEV1 ?30 % predicted
or with respiratory failure or cardiac
failure
一,Chronic bronchitis
? (一 ) Definition
Chronic nonspecific inflammation in
mucosa and its peripheral tissues of trachia
and bronchus
（二） Etiology
? 1.Smoking
– Epidemical information
– Pathological examination
– Effects of giving up smoking
– Animal experiment
（二） Etiology
? 2.Airway infection
– Virus
– Bacteria
– Mychoplasma
（二） Etiology
? 3.physical and chemical factors
– Air pollution
– Occupational contamination
– Indoor and outdoor fumes
? 4.Climate
– Cold weather
– Variation of atmospheric temperature
（二） Etiology
? 5.Atopy
? 6.Immunological and defensive disturbance
? 7.Imbalance between sympathetic and
parasympathetic nerves systems
? 8.Deficiency of Vit C and A
（三） Pathology
? Epithelial cells
? Mucosa and submucosa
? Goblet cells and mucous gland
? Smooth muscles
? Cartilage
? Fibrous tissues
(四 )Pathophysiological Changes
? 1.Early stage
Abnormal small airway function
CV CC V50 V25
? 2.Obstructive ventilatory defect
FVC<VC FEV1 FEV1/ FVC
MEF MVV RV RV/TLC
(五 )Clinical manifestation
? 1.Symptoms
– Cough
– Sputum production
– Wheeze
? 2.Physical sign
– Dry or moist rales
– Prolonged expiration
(六 )Laboratory examination
? 1.Blood cell account
– WBC N% E%
? 2.Sputum
– Bacteria
? 3.X-ray film
– Apparent marking on both lower fields
(七 )Diagnosis
? 1.Diagnostic standard
– Productive cough for 3 months or more in at
least 2 consecutive years
– Absence of any other disease that might
account for this symptom
? 2.Type
– Simple,Asthmatic
? 3.Stage
– Acute exacerbation,Chronic stage,Remission
(八 )Differential diagnosis
? Asthma
? Bronchoectasis
? Pulmonary tuberculosis
? Lung cancer
? Pneumoconiosis
? Pulmonary interstitial fibrosis
(九 )Treatment
? 1.Acute exacerbation and chronic stage
– Antibacterial agents
– Expectarants
– Bronchodilators
? 2.Remission
– Immunological modulator
(十 )Prevention
? Giving up smoking
? Physical exercise
? keeping warm
? Improving living and occupational circumstance
二,Obstructive pulmonary emphysema
(一 )Definition of pulmonary emphysema
Abnormal permanent enlargement of air
spaces distal to the terminal bronchiole with
destruction of their walls and without
obvious fibrosis
? Nonobstructive
? Obstructive
（二） Pathogenesis
1.Incomplete obstruction of bronchioles
2.Decreased elasticity of lung tissues
3.Destroyed bronchial cartilage
4.Imbalance between proteinase and antiproteinase
5.Congenital deficiency of ?1-antitrypsin
（三） Pathology
? Central acinous
? Panacinous
? Distal acinous
(四 )Pathophysiology
? 1.Hyperinflation
RV TLC RV/TLC
? 2.Airway obstruction
FEV1 FEV1/FVC MVV
? 3.Inappropriate VA/Q and DLCO
? 4.Blood gases analysis
PaO2 PaCO2
(五 )Clinical Manifestation
? 1.Symptoms
Dyspnea on heavy exertion (with mild activity,
at rest)
? 2.Physical signs
Inspection
Palpation
Percussion
Auscultation
(六 )Laboratory examination
? 1.X-ray film
Hyperinflation of lungs
Peribronchial and perivascular markings
Parenchymal bullae and subpleural blebs
Pulmonary hypertension
? 2.HRCT
? 3.Pulmonary function and blood gases analysis
(七 )Diagnosis
? Symptom
? physical examination
? pulmonary function
? X-ray film
(八 )Differential diagnosis
? Chronic bronchitis
? Bronchial asthma
? Pneumoconiosis
? Pulmonary tuberculosis
(九 )Treatment
? 1.General treatment
– Giving up smoking
– To control pollution
– Avoiding contamination with harmful gases
and fumes
– Pursed lip expiration
– Abdominal respiration
– Resistant breathing
– Nutritional therapy
– Physical exercise
2.Drug treatment
? Antibacterial agents
? Bronchodilator
– ?2-adrenergic stimulants
– anticholinergic
– aminophylline
? Steroid
? Expectarants
? Immunological modulator
3.Oxygen therapy
? (1)Acute exacerbation
When PaO2 <60 mmHg
Low oxygen flow (1-2L/min)
? (2)Remission (LTOT)
When PaO2 ≤ 55 mmHg
Low oxygen flow (1-2L/min)
For more than 15 hours per day
4.Operation
? (1)Lung transplantation
? (2)Lung volume reduction surgery
? (3)Bullectomy