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Obstructive Lung Diseases - 2024

This document provides an overview of obstructive lung diseases, including asthma, COPD, and bronchiectasis. It describes the pathophysiology, risk factors, clinical features, diagnosis, and complications of each condition. For asthma, it notes it is a chronic inflammatory airway disease characterized by variable airflow limitation caused by airway hyperresponsiveness. COPD is characterized by persistent respiratory symptoms and airflow limitation usually caused by significant exposure to noxious particles or gases like tobacco smoke. Bronchiectasis refers to permanent dilatation of the bronchi, often caused by recurrent infections beginning in childhood. Physical exams may reveal signs of respiratory distress, reduced breath sounds, and wheezing. Diagnosis involves clinical assessment and confirmation

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20 views26 pages

Obstructive Lung Diseases - 2024

This document provides an overview of obstructive lung diseases, including asthma, COPD, and bronchiectasis. It describes the pathophysiology, risk factors, clinical features, diagnosis, and complications of each condition. For asthma, it notes it is a chronic inflammatory airway disease characterized by variable airflow limitation caused by airway hyperresponsiveness. COPD is characterized by persistent respiratory symptoms and airflow limitation usually caused by significant exposure to noxious particles or gases like tobacco smoke. Bronchiectasis refers to permanent dilatation of the bronchi, often caused by recurrent infections beginning in childhood. Physical exams may reveal signs of respiratory distress, reduced breath sounds, and wheezing. Diagnosis involves clinical assessment and confirmation

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Obstructive lung diseases

Mohammad AlHajery MD,DRCPSC


Assistant Professor and Consultant
pulmonologist/Sleep medicine
Bronchial Asthma-1

Asthma is a chronic disease characterized by


variable airflow limitation that results from
airway hyperresponsiveness that leads to an
exaggerated contractile response and
inflammation of airways to a variety of
stimuli.
Pathophysiology
• Asthma is a chronic inflammatory airway disease that results in
narrowing of airway lumen (Largely reversible).

• The airway narrowing is caused by increased mucus secretion as


well as bronchial wall thickening due to edema, smooth muscle
hypertrophy, and subepithelial fibrosis.

• Mostly, inflammation is triggered by an immune response to


allergens.
Clinical features
Symptoms : Non specific , variable from time to
time , paroxysmal in nature
o Cough : usually non productive
o SOB
o Chest tightness
o Wheezing

Patient may be totally asymptomatic


between attacks
History
• Historical features that increase the probability of an asthma diagnosis:

 Episodic nature of symptoms that may worsen at night, with seasonal changes.
 May resolve spontaneously after removal of triggering stimulus.
 Presence of characteristic triggers, including cold air, exercise, environmental allergens,
chemical irritants, viral and bacterial infections, or exposure to certain medications (aspirin).
 Symptoms usually occur within 30 minutes after exposure and resolve either with treatment
or cessation of exposure.
 Personal history of environmental allergies, including presence of runny nose or watery eyes
with changes in seasons or exposure to allergens.
 Family history of allergies or asthma.
 History of asthmatic symptoms as a child.
Precipitating factors :
o Infection
o Cold air exposure
o Tobacco smoke
o Perfume , dust
o Abrupt change in weather
o Exercise
o stress
o Drugs : NSAID , Aspirin, Beta-Blockers
Physical Examination
• Expiratory wheezing is a characteristic feature but is not specific for
the diagnosis of asthma.
• Characteristics of wheezing in asthma: High-pitched and widespread;
most commonly present during expiration but can also occur during
inspiration.
• May be absent between attacks/exacerbations.
• Should be differentiated from other sounds such as rhonchi (low-
pitched, usually clears with cough, present due to increased airway
secretions) and stridor (high-pitched inspiratory sound caused by
upper airway narrowing).
Diagnosis of Asthma
• Diagnosis is made by combination of history, physical examination and
spirometry.
• History is very important to label the patient as probable asthmatic patient.
• Spirometry is necessary to confirm the diagnosis by which typically shows
obstructive disease and +ve bronchodilator response. (Note: Normal
spirometry does not R/O asthma)
• Serial PEFR monitoring over 1-2 weeks can be used alternatively. (>20% drop
between time to time is significant)
• With probable asthma by history, improvement with use of ICS and
bronchodilator can be used to diagnose asthma if spirometry is not
available.
Chronic obstructive lung disease-2
(COPD)
• Chronic Obstructive Pulmonary Disease (COPD) is a common,
preventable and treatable disease that is characterized by persistent
respiratory symptoms and airflow limitation that is due to airway
and/or alveolar abnormalities usually caused by significant exposure
to noxious particles or gases.
Risk factors
o Tobacco smoke (The most important cause) , Nearly 80 % of cases
are attributed to tobacco smoking) , Typically >20 packs year.
o Other types of smoking like pipe , cigar , Shisha ..
o Passive smoking
o Air pollution
o Biomass fuel exposure
o Alpha 1 antitrypsin deficiency:Decreased anti elastase lead to
alveolar wall destruction by elastase.
Pathophysiology
COPD pathologically and clinically
Chronic bronchitis Emphysema

Productive cough >3 month in > =2 Dilatation/destruction of respiratory Definition


year ( clinical definition) bronchioles and alveoli
(pathology definition)
Sever hypoxemia and hypercarbia , mild hypoxemia Pathophysiology
corpulmonal, PHT

Intermittent dyspnoea Sever dyspnoea Clinical manifestation


Copious sputum cough Mild cough

Blue bloater Pink puffer Physical exam


Clinical features of COPD
Examination: ( Note: Patient usually will not have all the signs )
Inspection:
 Patient is in respiratory distress
 Using of accessory muscle
 cyanosis
 Barrel shape chest : increase anterior-posterior diameter
 yellow stain in nail
Palpation:
 Chest expansion decrease

Auscultation:
Vitals :  Breath sound decrease
 Normal vesicular sound with prolonged
 Tachycardia
 Tachypnoeic expiration
 Coarse crepitation
 Hypoxaemia
 Wheezing
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
: Complications
o Pulmonary hypertension
o Cor pulmonale
o Respiratory failure
o Secondary polycythemia
o Pneumothorax

The most common causes of death are lung


cancer and cardiac complications
Bronchiectasis -3
• Bronchiectasis refers to: inflammation , destruction and permanent
dilatation of bronchi.
• Mostly the onset occurs in childhood.
• Generally , infections are the most common cause.
Bronchiectasis is a chronic illness with a wide range of symptoms.
Common features include:
• Chronic cough with thick, foul-smelling mucus
• Hemoptysis
• Dyspnea
• Weight loss
• Recurrent lung infections
Diagnosis confirmed by CT after clinical
assessment
End of the lecture
Thank you

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