【COPD英文精品课件】Chronic Obstructive Pulmonary Disease (COPD)

Oxidative stress
Proteinases
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Repair mechanisms
COPD PATHOLOGY
Source: GOLD 2007
Changes in Small Airways in COPD Patients
Lymphoid follicle
Sou20rc20e/:6/2C8OLD 2007
Number Deaths x 1000
70
60
50
Men
40 Women
30
20
10
0 1980
1985
1990
1995
2000
2020/S6/o2u8rce: US Centers for Disease Control and Prevention, 2002 – cited in GOLD 2007
➢ Increase in proteinases compared to antiproteinases and in free radicals leading to parenchymal destruction
➢ Changes in pulmonary vasculature leading to ventilation-perfusion mismatching, pulmonary hypertension, cor pulmonale
Chronic Obstructive Pulmonary Disease (COPD)
PGY-1 Seminar
David Thom, MD, PhD
2020/6/28
Definition of COPD*
➢COPD is a preventable and treatable chronic lung disease characterized by airflow limitation that is not fully reversible.
Pulmonary Hypertension in COPD
Chronic hypoxia
Pulmonary vasoconstriction
Pulmonary hypertension Cor pulmonale
Muscularization
Risk Factors for COPD
Nutrition Infections
Socio-economic status
2020/6/28
Aging Populations
8
Pathophysiology of COPD
➢ Chronic inflammation, bronchial wall edema, mucous secretion, hyperinflation and air trapping
Epidemiology of COPD
➢ COPD is a leading cause of mortality worldwide and projected to increase in the next several decades.
➢ COPD mortality trends generally track several decades behind smoking trends.
Changes in Lung Parenchyma inO8LD 2007
Alveolar wall destruction
Loss of elasticity Destruction of pulmonary capillary bed ↑ Inflammatory cells macrophages, CD8+ lymphocytes
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2020/6/28
Cigarette smoke
Biomass particles Particulates
Pathogenesis of COPD
Host factors Amplifying mechanisms
Anti-oxidants
LUNG INFLAMMATION
Anti-proteinases
Inflammatory exudate in lumen
Disrupted alveolar attachments
Thickened wall with inflammatory cells - macrophages, CD8+ cells, fibroblasts
Peribronchial fibrosis
➢The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung.
*20A2d0/a6/p2t8ed from the Global Initiative for Chronic Obstructive Lung Disease 2007
➢ In the US and Canada, COPD mortality for both men and women have been increasing.
➢ In the US in 2000, the number of COPD deaths
was greater among women than men.
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Percent Change from 1965 in AgeAdjusted Death Rates, U.S., 1965-1998
Coronary
2.5
3H.e0art
Disease
2.5
2.0
2.0
1.5 1.5
1.0
1.0
Stroke Other CVD COPD
All Other Causes
0.5
0.5
–05.09%
0
1965 - 1998
2020/6/28
–64% 1965 - 1998
–35%
+163%
–7%
1965 - 1998 1965 - 1998 1965 - 1998
Source: NHLBI/NIH/DHHS
COPD Mortality by Gender,
U.S., 1980-2000