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  • 1.COPD-Asthma

2. Risk Factors for COPDNutritionInfectionsSocio-economicstatusAging Populations 3. Percent Change in Age-AdjustedDeath Rates, U.S., 1965-1998Proportion of 1965 Rate3.0CoronaryStrokeOther CVDCOPDAll Other2.5 Heart Causes Disease2. +163%7% 01965 - 19981965 - 1998 1965 - 19981965 - 1998 1965 - 1998 Source: NHLBI/NIH/DHHS 4. Prevalence of allergies and asthma in PakistanM.Y. Noori, S.M. Hasnain, and M.A. Waqar.World Allergy Organization Journal & November 2007 The frequency of wheezing was found to be 15.2%, while the diagnosed cases of asthma were 9.5%. The frequency of allergic rhinitis was found to be 34.3%. The frequency of those having allergic rhinitis as well aswheezing episodes was 8%. There was no statistically significant difference betweenasthmatics and non-asthmatics by sex (P-value:0.402). Socioeconomic status was found to affect significantly (pvalue 0.001) as the prevalence of diagnosed asthma caseswas 6.17% in high socioeconomic class,13.11% in themiddle-class and 2.4% in the low socioeconomic class. Family history of atopy was also found to be significantlyhigher in asthmatics. 5. NOCTURNAL ASTHMA IN SCHOOL CHILDREN OF SOUTH PUNJAB,PAKISTANGhulam Mustafa, Pervez Akber Khan, Imran IqbalJ Ayub Med Coll Abbottabad 2008;20(3) The parents reported nocturnal asthma in 177(6%) of their children with an equalprevalence in boys and girls, 6. Anatomy 7. Pathogenesis ofCigarette smoke COPDBiomass particles Particulates Host factorsAmplifying mechanismsLUNG INFLAMMATIONAnti-oxidantsAnti-proteinasesOxidative stress Proteinases Repair mechanisms COPD PATHOLOGY Source : Peter J. Barnes, 8. Differences in Inflammation and its Consequences: Asthma and COPDASTHMA COPDAllergens Cigarette smokeY YY Ep cellsMast cell Alv macrophage Ep cellsCD4+ cell Eosinophil CD8+ cell Neutrophil(Th2)(Tc1)BronchoconstrictionSmall airway narrowing AHR Alveolar destructionAirflow LimitationReversibleIrreversible Source : Peter J. Barnes, 9. COPD airway 10. Asthma airway 11. Changes in Large Airways of COPD Patients Mucus hypersecretionNeutrophils in sputumSquamous metaplasia of epitheliumNo basement membrane thickeningGoblet cellhyperplasia Macrophages CD8+ lymphocytes Mucus gland hyperplasiaLittle increase in airway smooth muscle Source : Peter J. Barnes, MD 12. Air Trapping in COPDNormal Mild/moderate SevereInspiration COPD COPDsmallairwayalveolar attachmentsloss of elasticity loss of alveolar attachmentsExpirationclosure Health Dyspnea Air trappingstatus Exercise capacity Hyperinflation Source : Peter J. Barnes, 13. Changes in Small Airways in COPD Patients Inflammatory exudate in lumen Disrupted alveolar attachments Thickened wall with inflammatory cells- macrophages, CD8+ cells, fibroblastsPeribronchial fibrosisLymphoid follicleSource : Peter J. Barnes,MD 14. Changes in the Lung Parenchyma in COPDPatients Alveolar wall destructionLoss of elasticity Destruction of pulmonary capillary bed Inflammatory cells macrophages, CD8+ lymphocytes Source : Peter J. Barnes, MD 15. Inflammatory Cells Involved in COPDCigarette smoke(and other irritants)Epithelial Alveolar macrophagecells Chemotactic factors CD8+ Fibroblast lymphocyte Neutrophil Monocyte Neutrophil elastasePROTEASES Cathepsins MMPs Fibrosis Alveolar wall destruction Mucus hypersecretion (Obstructive (Emphysema) bronchiolitis)Source : Peter J. Barnes, MD 16. Oxidative Stress in COPDMacrophage Neutrophil Anti-proteasesSLPI 1-ATNF- BProteolysis IL-8 TNF- HDAC2 O2-, H202Neutrophil OH., ONOO- recruitmentInflammation Steroidresistance Isoprostanes Plasma leak Bronchoconstriction Mucus secretionSource : Peter J. Barnes,MD 17. Pulmonary Hypertension in COPD Chronic hypoxiaPulmonary vasoconstriction Muscularization Pulmonary hypertensionIntimal hyperplasia Fibrosis Cor pulmonale Obliteration EdemaDeath Source : Peter J. Barnes, MD 18. Asthma 19. Emphysema- CT scan 20. Emphysema 21. Chronic bronchitis 22. PEF meters 23. Spirometry: Normal andPatients with COPD 24. Lung Volumes and Capacities 25. PFTs ASTHMA COPDFEV1 Decreased in active asthma Decreased-stage of diseaseFVCDecreasedDecreasedFEV1/FVC DecreaseddecreasedTLCNormal or increasedNormal or increasedFRCNormal or increasedNormal or increasedRV Normal or IncreasedNormal or increasedDLCO Normal or IncreasedDecreased in Emphysema 26. Therapy at Each Stage of COPD I: Mild II: ModerateIII: Severe IV: Very Severe FEV 1 /FVC < 70% FEV 1 /FVC < 70% FEV 1 < 30% FEV 1 /FVC < 70% predicted FEV 1 /FVC < 70% 30% < FEV 1 80% predictedchronic respiratoryActive reduction of risk factor(s); influenza vaccinationpredictedfailureAdd short-acting bronchodilator (when needed) Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation Add inhaled glucocorticosteroids if repeated exacerbationsAdd long termoxygen if chronicrespiratory failure.Consider surgicaltreatments