CHRONIC INFLAMMATION in COPD Large Small Alveolar airway alrway space Mucous Excess mucous ECM gland edema destruction enlargement Fibrosis Emphysema Goblet cell Destruction of elastic hy perplasia fibers Impaired Small airway narrowing collapse muco-CIllary clearance Airflow Air Hyper obstruction trapping inflation Cough Sputum Progressive Dyspnea
Large airway Mucous gland enlargement Goblet cell hyperplasia Impaired muco-ciliary clearance Cough Sputum Small airway Excess mucous & edema Fibrosis Destruction of elastic fibers CHRONIC INFLAMMATION in COPD Small airway narrowing & collapse Airflow obstruction Air trapping Hyperinflation Alveolar space ECM destruction Emphysema Progressive Dyspnea
COPD and Co-Morbidities Spilled Inflammation COPD patients are at increased risk for Myocardial infarction angina Osteoporosis Respiratory infection Depression Diabetes Lung cancer COPD has significant extrapulmonary(systemic) effects including Weight loss Nutritional abnormalities Skeletal muscle dysfunction MBBS project, Zhongshan Hospital
MBBS project, Zhongshan Hospital COPD and Co-Morbidities —Spilled Inflammation COPD patients are at increased risk for: • Myocardial infarction, angina • Osteoporosis • Respiratory infection • Depression • Diabetes • Lung cancer COPD has significant extrapulmonary (systemic) effects including: • Weight loss • Nutritional abnormalities • Skeletal muscle dysfunction
Physical findings In early stages of COPD, patients may have an entirely normal physical examination Increased forced expiratory time Expiratory wheezing Signs for emphysema--a barrel chest and enlarged lung volumes with poor diaphragmatic excursion Advanced stage--use of accessory muscles of respiration, cyanosis, systemic wasting(weight loss) Signs of overt right heart failure--patients with advanced disease MBBS project, Zhongshan Hospital
MBBS project, Zhongshan Hospital Physical findings • In early stages of COPD, patients may have an entirely normal physical examination • Increased forced expiratory time • Expiratory wheezing • Signs for emphysema--a barrel chest and enlarged lung volumes with poor diaphragmatic excursion • Advanced stage--use of accessory muscles of respiration, cyanosis, systemic wasting (weight loss) • Signs of overt right heart failure--patients with advanced disease
a group of heterogeneity diseases blue bloaters pink puffers chronic bronchitis lack of cyanosis fluid retention use of accessory muscles cyanosis pursed-lip breathing a dramatic decrease in breath sounds MBBS project, Zhongshan Hospital
MBBS project, Zhongshan Hospital A group of heterogeneity diseases "blue bloaters" chronic bronchitis fluid retention cyanosis "pink puffers― lack of cyanosis use of accessory muscles pursed-lip breathing a dramatic decrease in breath sounds
Forced expiratory flow rates↓ FEV1↓ Residual volume↑ RVITLC↑ TLc↑ FEWW/FVC↓ Airflow Air Hyper- obstruction trapping inflation Non-uniform ventilation V/Q mismatching Destruction of gas-exchanging airspace and decreased diffusing capacity Pao2↓+-PaCO2↑ Pulmonary hypertension Cor pulmonale Right ventricular failure
Forced expiratory flow rates ↓ FEV1 ↓ FEV1/FVC ↓ Residual volume ↑ RV/TLC ↑ Airflow obstruction Air trapping Hyperinflation TLC ↑ • Non-uniform ventilation • V/Q mismatching • Destruction of gas-exchanging airspace and decreased diffusing capacity PaO2 ↓ +/- PaCO2 ↑ • Pulmonary hypertension • Cor pulmonale • Right ventricular failure