Chronic Bronchitis , Pulmonary Emphysema Flashcards
(17 cards)
Chronic bronchitis definition?
A chronic productive cough lasting at least 3 months per year for 2 consecutive years, caused by persistent airway inflammation.
Chronic bronchitis Epidemiology in terms of gender and age ?
Occurs more often in men > 45
Etiology of chronic bronchitis ?
Smoking ( main cause )
External factors :
Cold and humid climate
Allergic factors , dust pollen
Occupational exposure ( dust chemicals )
• IgA deficiency → Weakened mucosal immunity → Recurrent infections → Chronic bronchitis. • A1AT ( antitrypsin h deficiency → Lack of lung protection → Lung damage → Emphysema + Chronic bronchitis (COPD).
Pathogenesis of chronic bronchitis ?
Irritants (smoke, pollutants) → chronic inflammation of bronchi → goblet cell hyperplasia → excess mucus production → airway obstruction.
• Ciliary dysfunction reduces mucus clearance → recurrent infections.
The pathomorphology of chronich bronchitis ?
Mucosal hypertrophy and goblet cell hyperplasia
• Thickened bronchial walls due to fibrosis • Inflammatory cell infiltration (lymphocytes, macrophages) • Reid index > 0.5 (increased mucus gland thickness)
Clinical symptoms of chronic bronchitis ?
Normal Co2 levels ?
Chronic productive cough (worse in morning)
• Dyspnea (progressive)
• Wheezing, rhonchi
• Cyanosis (“blue bloater”) – due to hypoxia and hypercapnia
• Frequent respiratory infections
35–45 mmHg (normal range)
Chronic bronchitis diagnosis ?
Spirometry – FEV1/FVC < 70% (obstructive pattern)
Fev = forced expiratory vol , the amount of air exhaled in the first second of a forced breath
Forced vital capacity = total air exhaled after a full deep breath
• Chest X-ray – increased bronchial markings • Sputum culture – detects bacterial infections • ABG – shows hypoxemia, hypercapnia • CBC – possible polycythemia due to chronic hypoxia
Chronic bronchitis treatment?
Smoking cessation (most important)
• Bronchodilators (β₂-agonists, anticholinergics) Salbutamol 1-2 puff every 6 hours 100-200 mcg
Long acting Salmetorol 50mcg twice daily
• Inhaled corticosteroids (reduce inflammation) Fluticasone 250-500 mcg usually combined with salmeterol • Oxygen therapy (if SpO₂ < 88%) • Antibiotics (for infections)
First-line: Amoxicillin-clavulanate (Augmentin) 625 mg 3 times daily for 5–7 days
• Alternative: Doxycycline 100 mg once daily for 5 days (if penicillin allergy)
• Severe cases: Levofloxacin 500 mg once daily for 7 days
• Pulmonary rehabilitation
What is pulmonary emphysema?
Irreversible destruction of alveolar walls leading to permanent enlargement of air spaces and loss of elastic recoil.
Can lead to airway collapse on expiration also hyperinflation
Pulmonary emphysema classification?
Pulmonary emphysema is classified based on the pattern of alveolar destruction:
1. Centriacinar (Centrilobular) Emphysema • Common in smokers • Affects upper lobes, primarily the proximal parts of the acinus (respiratory bronchioles). 2. Panacinar (Panlobular) Emphysema • Associated with alpha-1 antitrypsin deficiency • Affects lower lobes, involves the entire acinus. 3. Paraseptal (Distal Acinar) Emphysema • Affects distal parts of the acinus, near the lung periphery. • Can lead to bullae (large airspaces). 4. Irregular Emphysema • Often associated with scarring from previous lung diseases or infections.
Epidemiology in pulmonary emphysema? In terms of gender and age ?
Men > 45
Etiology pulmonary emphysema?
Smoking (most common)
• Alpha-1 antitrypsin (AAT) deficiency (genetic cause) • Air pollution, chronic bronchitis
Pathogenesis pulmonary emphysema?
Smoking → chronic inflammation → increased protease activity (elastase) → destroys alveolar walls.
• AAT deficiency → unopposed elastase activity → alveolar destruction.
• Loss of elastic recoil → air trapping → hyperinflation.
Pathomorhology of pulmonary emphysema?
Centriacinar emphysema (smoking-related, upper lobes)
• Panacinar emphysema (AAT deficiency, lower lobes) • Enlarged alveolar spaces, destroyed septa • Decreased capillary density • “Barrel chest” appearance due to hyperinflation
Clinical symptoms of pulmonary emphysema?
Progressive dyspnea (hallmark symptom)
• Minimal cough, scant sputum
• Pursed-lip breathing (to prevent airway collapse) • Barrel chest (increased AP diameter) • Pink puffer appearance (due to hyperventilation and maintained oxygenation)
Diagnosis for pulmonary emphysema?
Spirometry – FEV1/FVC < 70% (obstructive pattern)
• DLCO – reduced (due to alveolar damage)
The diffusing capacity of the lungs for carbon monoxide (DLCO), also known as the transfer factor for carbon monoxide (TLCO), measures the amount of carbon monoxide (CO) transferred per minute from alveolar gas to red blood cells
• Chest X-ray – hyperinflated lungs, flattened diaphragm • CT scan – bullae, destruction of alveolar walls • AAT levels – if genetic deficiency suspected
Treatment for pulmonary emphysema ?
Smoking cessation (critical)
• Bronchodilators (β₂-agonists, anticholinergics) • Inhaled corticosteroids (if severe) • Oxygen therapy (if hypoxic) • Lung volume reduction surgery (in selected cases) • Alpha-1 antitrypsin therapy (for AAT deficiency)
