Chronic Obstructive Lung Diseases(COPD)

Lecture

Qassim University, Faculty of MedicineYear II , 201 DENM

Pathology DepartmentPresented by Dr. Ola Omran

Obstructive diseases

• Decreased expiratory flow rate• Loss of elastic recoil as in emphysema• Anatomic airway narrowing as in asthma

COPD

1. Emphysema 2. Chronic Bronchitis 3. Bronchial Asthma

EMPHYSEMA• Abnormal permanent enlargement of the air spaces

distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis.

• Overinflation : enlargement of air spaces without destruction

Four major types (1) Centriacinar (2) Panacinar (3) Distal acinar (4) Irregular

Ruptured alveloli

Alveoli are larger and fewer

• Thinning and destruction of alveolar walls

• With advanced disease, adjacent alveoli create large airspaces

• Terminal and respiratory bronchioles may be deformed.

• With the loss of elastic tissue alveoli tend to collapse during expiration

• The number of alveolar capillaries is diminished

MorphologyMP: EMPHYSEMA

Cigarette smoking and emphysema

Chronic bronchitis

Prolonged lymphocytic inflammation of bronchial tree with hypertrophic mucosal glands that leads to productive coughChronic bronchitis as a clinical definition, requires all of: 1. Persistent cough and sputum production 2. Present for at least 3 months 3. Present for at least 2 consecutive years

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Bronchitis Emphysema

Mild dyspnea, late.Mild dyspnea, late.

Infections commonInfections common

Prominent BV Prominent BV

Large heart.Large heart.

• Severe dyspneaSevere dyspnea, , earlyearly..

• Infections occasionalInfections occasional

• Hyperinflation Hyperinflation

• Small heart.Small heart.

Emphysema is morphologic feature & restricted to the acinusChronic bronchitis is clinical feature & involve large and small airways

Complications

1. Secondary pulmonary hypertension 2. Pulmonary failure with respiratory acidosis,

hypoxia, and coma. 3. hypoxia-> Polycythemia4. Right-sided heart failure (cor pulmonale).5. Infections, Bronchectasis.6. Bulla-Pneumothorax, collapse

3. Bronchial Asthma

Chronic inflammatory disorder of the airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, & cough, particularly at night and/or early in the morning

1- Hypertrophy of submucosal mucous glands

2- Accumulation of mucus in the bronchial lumen

3- Intense chronic inflammation (eosinophils, macrophages)

4- Thickened basement membrane5- Hypertrophy and hyperplasia of

smooth muscle cells.

MP: Bronchial Asthma

Extrinsic : Association with atopy (allergies) mediated by type 1 hypersensitivity, and asthmatic attacks are precipitated by contact with inhaled allergens. This form occurs most often in childhood

Intrinsic : Asthmatic attacks are precipitated by respiratory infections, exposure to cold, exercise, stress, inhaled irritants, and drugs such as aspirin. Adults are most often affected

Bronchial Asthma

• AllergyAllergy• Inflammation of BronchiInflammation of Bronchi• ObstructionObstruction• Mucous PlugsMucous PlugsEpidemiology/pathology

AsthmaNormal

Barnes PJ

Mechanism of Asthma

Occupational Asthma • asthma is stimulated by:

– fumes (plastics) – organic and chemical

dusts (wood, cotton, platinum)

– gases (toluene)

• Develop after repeated exposure to the inciting antigen(s).

Drug-Induced Asthma

• Pharmacologic agents provoke asthma, aspirin

• Mechanism remains unknown

• The bronchial lumen filled with mucus

Submucosa widened by 1. smooth muscle

hypertrophy, 2. edema, 3. inflammation (mainly

eosinophils)

• Hypertrophy of submucosal mucous glands

CHRONIC ASTHMA

Charcot-Leyden crystals Eosinophilic needle-shaped crystalline structures. Represents breakdown products of eosinophils

CHRONIC ASTHMA Sputum smear

CURSCHMANN'S SPIRAL, Spiral shaped mucous plug+shedded epithielium.