【COPD英文精品课件】Chronic Obstructive pulmonary Disease (33p)

Epidemiology of COPD
30% of smokers develop COPD 20% of adult males have COPD 15% of COPD patients are severely symptomatic 4 th leading cause of death (USA) Mortality rate still rising prevalence in low birth weight and low
COPD
SS Visser, Pulmonology Internal Medicine UP
Def: Emphysema
Permanent abnormal distention of air spaces distal to the terminal bronchiole with destruction of alveolar septa (containing alveolar capillaries) and attachments to the bronchial walls.
Hypertrophy and hyperplasia of mucus secreting glands secretions
Pathogenesis-3
Air pollution exacerbations of CB related to heavy pollution with SO2 and NO2
the p53 gene locus epithelial dysplasia and lung cancer
ciliary function retained secretions; airway resistance vagal-mediated smooth muscle coБайду номын сангаасtraction
Classification: 1. Centriacinar ( centrilobular) emphysema 2. Panacinar emphysema 3. Paraseptal emphysema 4. Senile emphysema
Def: COPD
Chronic obstruction to airflow due to chronic bronchitis and/or emphysema.
Genetic factors: - -1-antitrypsin deficiency PIZZ, PISZ, PI00 (PI null null), susceptibility to effects of smoking
Pathophysiology
Air trapping- RV and FRC elevated Hyperinflation –TLC elevated
Degree of obstruction may be less when the patient is free from respiratory infection and may improve with bronchodilator drugs
Significant obstruction is always present
Chemoattractant, upregulation of adhesion molecules neutrophil sequestration in lungs
expression of pro-inflammatory mediators: IL-8, NF-B recruitment of N, B, E and T lymphocytes
Occupation exposure to organic and inorganic dust or noxious gases accelerated decline in lung function
Infection even mild viral respiratory infections ( rhino virus) may be a major factor associated with etiology as well as progression of disease; severe viral pneumonia early in life may lead to COPD
Elastin breakdown- activated neutrophils neutrophil elastases and oxidants; -1-AT and metalloproteinase inhibitors (lung defenses) inactivated by smoke
socioeconomic status Tuberculosis in smokers predisposes to COPD
Pathogenesis:Effects of Smoking -1
Oxidative stress: O2-, OH-,H2O2, HOCl; source of Fe2+ catalizes production of OH- by neutrophils, eosinophils, alveolar macrophages; tar (cigarettes) contains NO and induces iNOStoxic peroxynitrites
Effects of smoking -2
levels of myeloperoxidase and eosinophilic cationic
protein bronchoconstriction
levels of TGF- (transforming growth factor)
fibrogenesis Lipid peroxidation and DNA damage point mutations 0f