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COPD (Definitions (Includes chronic bronchitis and emhpysema, Progressive…
COPD
Definitions
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Emphysema = Enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls (larger distance between alveoli and capillaries)
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Investigations
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Chest X-ray: hyperinflation, flat hemidiaphragm, large central pulmonary arteries, bullae
CT: Bronchial wall thickening, scarring, air space enlargement
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Aetiology
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Another risk factor is having frequent lower respiratory tract infections as a child as these precipitate acute exacerbations
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Pathophysiology
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Cigarette Smoke
There is release of inflammatory mediators that attract inflammatory cells - amplifies the process as well as inducing structural changes and breaking down connective tissue
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There is an increase in neutrophils, macrophages and lymphocytes in airway walls
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Chronic Bronchitis
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Epithelial cell layer ulcerates. In healing, squamous epithelium may replace columnar epithelium = squamous metaplasia
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Signs
Blue Bloaters
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Relies on hypoxic drive as their respiratory centres are insensitive to CO2 - take care when giving oxygen
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