Pathology of Smoking-COPD

7/30/2019 Pathology of Smoking-COPD

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Whether you think that you

can, or that you can't.,

you are usually right! Henry Ford


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Normal Lung


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Normal Lung


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Normal Lung Tissue


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Chronic ObstructivePulomary Diseases

(COPD)

Dr. Venkatesh M. ShashidharAssociate Professor of Pathology

Fiji School of Medicine

Commitment to Excellence


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Obstructive Airway Disease:

Localised

Mechanical Tumours, Trauma, Foreign body collapse

Diffuse Distal airway diseases.

COPD

chronic

COPD Definition:

Progressive ir revers ib le airway obs truct ion

w i th destruct ion of parench yma. Chronic obstructive bronhitis

Emphysema

Mucous plugging.


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COPD Introduction.

Chronic Slow progress (FEV1


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Pathology of Smoking

Irrefutable evidence - smoking

disease

>4000 chemicals, 43 carcinogens.

Range of non-neoplastic and neoplastic dis.

Chronic bronchitis, emphysema common.

Ca bladder, Pancreas, cervix, larynx.

Gastritis, PUD, IHD, HPTN, atherosclerosisrisk factor.

Arteriosclerosis Bergers


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Smoking - Pathology

Alveolar marcrophage

CD8 Lymphocytes

Neutrophils

Proteases

Bronchitis.

Alveolar destruction.


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Pathogenesis Smoke - Lung Dis.

Carcinoma

Irritation

Inflammation

Mucous - Infections


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Chronic Bronchitis

Productive Cough >3 months in 2 years.

Smoking / pollution - major cause.

Acute & Chronic inflammation of mucosa

Lack of cilia - retention of secretions

Increased mucous glands & viscid mucous.

Frequent secondary infections

inflammation retention infectionobstruction cycle.


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COPD


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COPD


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Chronic Bronchitis


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smokers lung Normal Lung


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Emphysema:

Alveolar wall destruction, Dyspnoea, RHF. Pink Puffers normal ABG pattern.

Types:

Centrilobular smoking

Panlobular congenital - 1 antitrypsin deficiency Paraseptal & irregular subpleural, scarring

Other

Interstitial emphysema Air leak.

Senile Emphysema


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smokers lung Emphysema


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Emphysema:


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Emphysema


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Centrilobular Emphysema:


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Emphysema Ruptured alveloli.


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Centrilobular Emphysema:


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Centrilobular Emphysema (smoking):

P l b l b ll


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Pan lobular bullousemphysema


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Local Bullous Emphysema:


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Bronchitis Emphysema

Blue Bloater Mild dyspnoea, late

Infections common

Cor-pulmonale

Increased resistance

Prominent BV, large

heart.

Pink Puffer Dyspnoea severe, early

Occassional

Rare, late

Mild increase

Hyperinflation small

heart.


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Complications of COPD:

1. Cor Pulmonale syncope, hypoxia, pedal edema, passive hepatic

congestion, and death.

2. Acute Exacerbations.

3. End-stage lung disease.

4. Polycythemia hypoxia.

5. Pneumothorax, Infections,

Bronchectasis.


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Bronchiectasis:

Permanent dilatation of bronchi.

Cough, copious purulent sputum.

Lower lobes common

Complications;

Pneumonia, empyema, septicemia, meningitis.

Types:

Cylindrical, Saccular, Fusiform (no significance)


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Pathogenesis - Bronchiectasis

COPD/Obstruction/Infection. Excess Mucous secretion

Retention of secretion

Secondary infection

Destruction of bronchial wall

Irregular, fixed inflamed dilated bronchus filledwith pus.


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Bronchiectasis:


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Bronchiectasis


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Bronchiectasis


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Bronchiectasis - Adhesions


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Saccular Bronchiectasis:


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Summary - COPD

Progressive, irreversible, obstruction,destruction.

3 etiology

Smoking, pollution, Alpha1 AT Deficiency.

3 symptoms

Cough, Dyspnoea, Hypoxemia

3 Diseases: Chronic Bronchitis, Emphysema, Asthma


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COPD summary:

3 Complications: Exacerbations, Cor-pulmonale, End stage

lung disease.

3 Investigations: Spirometry (FEV1/VC), PaO2, PCO2.

3 grades

Mild

69-80 FEV1

cough, exertional dysp. Mod 40-60 FEV1 - + Wheeze, cough,

sputum.

Sev - < 40 FEV1 - + Right Heart Failure.


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"Troubles are often the toolsby which God fashions usfor better things."

- Henry Ward Beecher

Pathology of Smoking-COPD

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