Chronic obstructive pulmonary disease
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Chronic Obstructive Pulmonary Disease. Hou-haifeng. LUNG STRUCTURE. NORMAL VENTILATORY FUNCTION. Diaphragm contracts and descends, rib cage moves upwards and outward. Pressure in the thorax is less than in the mouth so air flow into the lungs occurs.

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Chronic Obstructive Pulmonary Disease

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Chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease

Hou-haifeng


Chronic obstructive pulmonary disease

LUNG STRUCTURE


Normal ventilatory function

NORMAL VENTILATORY FUNCTION

  • Diaphragm contracts and descends, rib cage moves upwards and outward.

  • Pressure in the thorax is less than in the mouth so air flow into the lungs occurs.

  • In expiration diaphragm relaxes and moves upwards, the rib cage moves inward.

  • Expiration is passive so no muscular contraction is needed.

  • Lung tissue is intrinsically elastic and has a natural ability to recoil.

  • During exercise expiration is aided by the contraction of abdominal and thoracic expiratory muscles.

  • Contractions generate positive pressure in the thorax pushing air out.


Copd disorders

COPD DISORDERS

  • Chronic Bronchitis

  • Emphysema

  • Asthma (?)

    Although not strictly a COPD disorder ASTHMA is often

    linked with being a COPD disorder.


Definition

DEFINITION

  • Progressive, non-reversible, obstructive airway disease leading to damaged alveolar walls and inflammation of the conducting airways

  • Some part of the airway becomes obstructed or no longer functions efficiently


Chronic obstructive pulmonary disease1

CHRONIC OBSTRUCTIVE PULMONARY DISEASE:


Chronic obstructive pulmonary disease

Pathogenesis of COPD

NOXIOUS AGENT(tobacco smoke, pollutants, occupational agent)

COPD

Genetic factors

Respiratory infection

Other


Mechanisms

MECHANISMS

Bronchial glands / cells inflame

Increased secretions

Inflammation spreads to smooth muscle (bronchiole)

Airway obstruction, decreased ciliary action

Air trapping / Collapse of small airways

Further air trapping

Hyperventilation

Increased pressure in airways

Weakened airway walls / wall destruction

Alveolar destruction

Overstressed right ventricle


Mechanisms ii

MECHANISMS II

Increases in RBC, Blood viscosity, BP

Ventilation / Perfusion imbalances

Hypoxemia

Carbon dioxide retention

Bronchial hyperreactivity

Hyperinflation


Chronic bronchitis

CHRONIC BRONCHITIS

  • Chronic bronchitis is defined as "persistent cough with sputum production for at least 3 months in at least two consecutive years".

  • The most important cause of chronic bronchitis is recurrent irritation of the bronchial mucosa by inhaled substances, as occurs in cigarette smokers.

  • The pathological hallmarks of chronic bronchitis are congestion of the bronchial mucosa and a prominent increase in the number and size of the bronchial mucus glands. Copious mucus may be seen within airway lumens. The terminal airways are most susceptible to obstruction by mucus.


Chronic bronchitis1

CHRONIC BRONCHITIS

Aetiology

  • Characterised by a chronic cough and excessive sputum production.

  • There is an enlargement and an increased density of mucous glands.

  • The airway becomes thickened and the surface irregular

  • Bronchial inflammation. (ACSM, 1998)

  • Reduced number of ciliated cells

  • Causes an increase in air flow resistance

  • In chronic severe cases right heart failure occurs

  • Plugged airways and decreased ciliary action encourages

    stagnant bronchial secretions and an increased risk of

    infection.


Chronic bronchitis2

CHRONIC BRONCHITIS

  • Inflammatory cells produce elastase

  • Destroys connective tissue of alveolar walls

  • Alpha-1 anti-trypsin (or alpha-1 protease inhibitor) is a protein produced by the liver that circulates in the blood and limits the action of elastase


Mucus production

MUCUS PRODUCTION


Mucus production1

MUCUS PRODUCTION


Changes in lung volumes

CHANGES IN LUNG VOLUMES


Ventilation cost

VENTILATION COST

  • In COPD work of breathing is greater for any given level of ventilation than normal.

SEVERE COPD

The cost of work at a given ventilation for ‘normal’ and COPD patients (ACSM, 1998)

WORK OF BREATHING

MODERATE COPD

NORMAL COPD

VENTILATION


Emphysema

EMPHYSEMA

AETIOLOGY

  • Can be caused by smoking, air pollution and environmental and occupational hazards

  • Main characteristic is loss of lung elasticity and reduction of elastic recoil due to alveolar destruction

  • Destruction of elastic tissue leads to loss of elastic recoil of lungs during expiration and forced expiration necessitated

  • Eventual destruction of airway / capillary membranes

  • Destruction due to increased protease production or a deficiency in anti-protease


Effects of emphysema on health

EFFECTS OF EMPHYSEMA ON HEALTH

  • Reduction in expiratory flow level

  • Patients are thin with general muscle wastage.

  • Lung diffusion capacity is reduced due to loss of alveolar capillary units

  • Lactic acid threshold is much lower in COPD patients

  • Exercise tolerance impaired


Chronic obstructive pulmonary disease

Diagnosis of COPD

EXPOSURE TO RISK

FACTORS

SYMPTOMS

cough

tobacco

sputum

occupation

dyspnea

indoor/outdoor pollution

è

SPIROMETRY


Chronic obstructive pulmonary disease

Spirometry: Normal and COPD


Medical therapy

MEDICAL THERAPY

  • BRONCHODILATORS

    Adrenergic agents

  • Beta-agonists bind to B2 receptors on airway and result in smooth muscle relaxation and bronchodilation

  • Inhaled route is preferred

  • Acute relief of symptoms

    Anti-cholinergic agents

  • Bind to acetylcholine receptors and result in bronchodilation (of mostly larger airways)

  • Reduces sputum production

  • Inhaled route is preferred

    Methylxanthines (i.e. theophylline)

  • Weak bronchodilator

  • Delays respiratory muscle fatigue

  • Reduces trapped lung gas

  • Improves respiratory muscle mechanics


Medical therapy1

MEDICAL THERAPY

  • Corticosteroids

  • Reduce airway inflammation

  • Mucolytics

  • Alter viscosity of sputum

  • May reduce symptoms in some patients

  • Must be used carefully (i.e. avoiding hypotension)


Exercise

EXERCISE

  • Increase exercise tolerance

  • Increase quality of life

  • Improve co-ordination and efficiency of movement

  • Improve strength particularly respiratory muscles

  • Encourage relaxation

  • Confidence in physical abilities

  • Flexibility


What we want to do

What we want to do

  • As we all know there is so much data on the patients deposited in the hospital,however,that is not well exploited

  • So we want to use these data to make a disease model to help doctors to make a appropriate diagnostic and therapeutic scheme for the patients with COPD

  • We also can use this model to predict the progress of the disease and the prognosis


Chronic obstructive pulmonary disease

mathematics, statistics, cybernetics, system theory, computer science

COPD

Disease Model

The information from the data base in the hospital

The information from the data base in the hospital

Disease progress prognosis

The knowledge of medicine(Pathology

Physiology Pharmacology…)

therapeutic scheme

doctor


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