of obstacles to the outgoing air flow in the respiratory
tract.BO syndrome is a complex of symptoms of obstructive respiratory failure.
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Respiratory diseases with bronchial obstruction
Содержание
- 1. Respiratory diseases with bronchial obstruction
- 2. Definition of BOBO - condition develops due
- 3. Types of BOBy prevalence:1. Local:tumorforeign bodydiseases with intrathoracic LAP2. Diffuse:Chronic obstructive bronchitisEmphysema of the lungsBronchial asthma
- 4. Types of BOBy duration:1.Reversible (BA);2. Irreversible (COB,
- 5. Mechanisms 1. Reversible:spasm of SMCwall edemaimpaired mucus secretion
- 6. 2. Irreversible:fibrosis of the wallpathological expiratory
- 7. BA is a disease characterized by chronic
- 8. Pathomorphologymast cell
- 9. Inflammation in BA (AD)The development of AD is based on chronic inflammation in the airways.Mast cellsEosinophilsT-lymphocytesNeutrophilsMacrophages
- 10. Bronchial hyperreactivityBHR - the possibility of developing
- 11. Provoking factors of the bronchospasmAllergen triggers (have
- 12. IgE-depended allergic reaction
- 13. Provoking factors of the bronchospasmNonspecific triggers (non-allergenic)
- 14. SymptomsWheezing ralesFeeling of chest congestionDyspneaUnproductive cough (may
- 15. Chokingappears with non-stopping severe attack of asthma,
- 16. About asthma symptoms (it may help in
- 17. Patient examinationImportant !signs of bronchial obstruction appear
- 18. History of lifeChildhood (early beginning)Occupational hazards (risk
- 19. TestsConfirmation of variability of bronchial obstructionPeak expiratory
- 20. Peakflowmeter
- 21. Слайд 21
- 22. Criteria of bronchial obstruction variabilityPositive test with
- 23. Положительный тест с бронхолитиком
- 24. Can a patient with asthma have normal spirometry and peak flow results?
- 25. Allergic testsSkin scarification tests (prick tests) with allergen panelBlood level of specific IgE
- 26. OthersEosinophilia is detected in a small number
- 27. TreatmentLong-term (in many patients lifelong) basic anti-inflammatory
- 28. Chronic bronchitisCB - “smoker's cough” when other
- 29. Smokers usually do not seek medical help
- 30. CB =Chronic productive cough +Long-term exposure to
- 31. Smoking
- 32. EmphysemaPathomorphological conceptDestruction of the lung parenchyma with
- 33. EL pathogenesisSmokingActivation of alveolar macrophagesProteases> Antiproteases (α1-antitrypsin)Destruction
- 34. COPDChronic obstructive pulmonary disease is a disease
- 35. C(O)B ELCOPD / ХОБЛ
- 36. Pathogenesis - Long-term smoking (smoking experience 20
- 37. With the development of bronchial obstruction (narrowing
- 38. Air traps (dynamic hyperinflation)With bronchial obstruction, it
- 39. "Air traps" lead to an increase in
- 40. COPD hystory
- 41. Symptoms: complaintsShortness of breath on exertion,
- 42. CoughMost patients with COPD have a productive
- 43. ExaminationCentral cyanosis in severe COPD due to
- 44. Слайд 44
- 45. Chest examinationBarrel chest in emphysematous COPDIn severe
- 46. Слайд 46
- 47. Слайд 47
- 48. Palpation and percussionWith emphysema and pulmonary hyperinflation,
- 49. Spirometry
- 50. Слайд 50
- 51. Chest X-raySigns of hyperinflation (flattened diaphragm, increased transparency of the lungs, disappearance of the vascular pattern)
- 52. COPD diagnosis =Long-term exposure to smoking
- 53. Treatment principlesQUITING SMOKING is the only
- 54. Слайд 54
- 55. Слайд 55
- 56. Скачать презентанцию
Definition of BOBO - condition develops due to the presence of obstacles to the outgoing air flow in the respiratory tract.BO syndrome is a complex of symptoms of obstructive respiratory failure.
Слайды и текст этой презентации
Слайд 2Definition of BO
BO - condition develops due to the presence
BO syndrome is a complex of symptoms of obstructive respiratory failure.
Слайд 3Types of BO
By prevalence:
1. Local:
tumor
foreign body
diseases with intrathoracic LAP
2. Diffuse:
Chronic
obstructive bronchitis
Emphysema of the lungs
Bronchial asthma
Слайд 6
2. Irreversible:
fibrosis of the wall
pathological expiratory collapse of bronchioles (due
to the lost of alveolar support and destruction)
hyperplasia of the
epithelium of the bronchial mucosahypertrophy of bronchial submucosal glands
Слайд 7BA is a disease characterized by chronic inflammation of the
airways and recurrent bronchospasm, which leads to respiratory symptoms (wheezing,
shortness of breath, chest congestion, and cough)
Слайд 9Inflammation in BA (AD)
The development of AD is based on
chronic inflammation in the airways.
Mast cells
Eosinophils
T-lymphocytes
Neutrophils
Macrophages
Слайд 10Bronchial hyperreactivity
BHR - the possibility of developing bronchospasm under the
action of a stimulus that does not cause bronchospasm in
a healthy personInflammation in the airways in AD leads to BHR
Слайд 11Provoking factors of the bronchospasm
Allergen triggers (have a protein structure)
- cause sensitization (the appearance of specific IgE) and provoke
bronchospasm through an IgE-dependent allergic reactionAeroallergens:
household (house dust mite, cockroaches)
pollen (ragweed ...)
epidermal (animal allergens)
fungal allergens (mold)
Слайд 13Provoking factors of the bronchospasm
Nonspecific triggers (non-allergenic) - provoke bronchospasm
in the presence of bronchial hyperreactivity
Exercise stress
Cold air
Tobacco smoke
Laughter, emotions
Smells
(perfumes, household chemicals, exhaust gases, gasoline, varnish-and-paint products ...)
Слайд 14Symptoms
Wheezing rales
Feeling of chest congestion
Dyspnea
Unproductive cough (may be the dominant
symptom !)
Choking… is a symptom of severe asthma exacerbation
Слайд 15Choking
appears with non-stopping severe attack of asthma, which is regarded
as a severe exacerbation of asthma and requires urgent hospitalization
and emergency care
Слайд 16About asthma symptoms (it may help in diagnosis)
Provocation (exercise, exposure
to an allergen, cold air, laughter, irritants)
Paroxysmal
Reversibility (spontaneous or after
inhalation of a bronchodilator)Variability
Symptoms often worsen at night or early in the morning
Viral respiratory infections often cause exacerbations of asthma
Слайд 17Patient examination
Important !
signs of bronchial obstruction appear only at the
time of an attack of bronchospasm:
- inability to speak in
sentences with a severe attack- orthopnoe, sitting position with an inclination forward with an emphasis on the hands
- wheezing, breathing with difficulty prolonged exhalation
- participation in the respiration of additional muscles
with a severe attack - diffuse cyanosis
- achypnoe
- on auscultation - wheezes
Слайд 18History of life
Childhood (early beginning)
Occupational hazards (risk of occupational BA)
Living
conditions (mold, house dust mites, pets ...)
Smoking
Heredity (many patients have
familial AD cases, but not all)Allergic history
Other diseases associated with AD - allergic rhinitis, atopic dermatitis (not in all patients)
Слайд 19Tests
Confirmation of variability of bronchial obstruction
Peak expiratory flow (PEF) monitoring
- peak flowmetry
Spirometry + test with bronchodilator
Слайд 22Criteria of bronchial obstruction variability
Positive test with bronchodilator (assessed 15
min after 400 mcg salbutamol)
FEV1 increase> 12% or 200 ml
from the initialIncreased PEF variability measured twice a day
mean PEF variability> 10%
Слайд 25Allergic tests
Skin scarification tests (prick tests) with allergen panel
Blood level
of specific IgE
Слайд 26Others
Eosinophilia is detected in a small number of patients with
AD
In the analysis of sputum, eosinophils can be detected in
some patients 
Слайд 27Treatment
Long-term (in many patients lifelong) basic anti-inflammatory therapy with inhaled
glucocorticoids (ICS)
Use of short-acting bronchodilators (SAB) (salbutamol) as needed
With proper
treatment with ICS, asthma symptoms stop, the need for SAB is minimal, there are no restrictions on physical activity and there are no exacerbations of asthma (controlled asthma)
Слайд 28Chronic bronchitis
CB - “smoker's cough” when other causes of cough
are excluded (such as asthma, bronchiectasis, tuberculosis, cancer, pulmonary fibrosis,
sarcoidosis, ACE inhibitors)The pathological basis of CB is the hyperproduction of sputum in the bronchi in response to prolonged irritation by inhaled particles and gases (more often tobacco smoke)
The only symptom of CB is a chronic cough with little sputum.
Long-term exposure to tobacco smoking or occupational exposure to inorganic dust will be mandatory for the development of CB.
Слайд 29Smokers usually do not seek medical help at the stage
of CB, since the cough in this case is not
severe and painful.Smokers should be actively asked about coughing
The only treatment is to quit smoking
Слайд 30CB =
Chronic productive cough
+
Long-term exposure to tobacco smoking
+
Other
causes of chronic cough have been ruled out
Слайд 31Smoking
CB
Inflamation and fibrosis Destruction of alveolar wall
in distal bronchi
Irreversible BO
COPD
50%
Слайд 32Emphysema
Pathomorphological concept
Destruction of the lung parenchyma with destruction of alveolar
septa due to exposure to tobacco smoke
Now pulmonary emphysema is
a component of the diagnosis of COPD.
Слайд 33EL pathogenesis
Smoking
Activation of alveolar macrophages
Proteases> Antiproteases (α1-antitrypsin)
Destruction of the alveolar
walls
Decreased elastic traction of the lungs
Decreased alveolar support of bronchioles
Early
expiratory collapse of bronchioles(irreversible bronchial obstruction)
Слайд 34COPD
Chronic obstructive pulmonary disease is a disease with progressive irreversible
bronchial obstruction that develops due to chronic inflammation caused by
the prolonged action of inhaled pathogenic particlesSymptoms include breathing difficulty, cough, mucus (sputum) production and wheezing.
Слайд 36Pathogenesis
- Long-term smoking (smoking experience 20 packs / years
or more, women may have less smoking experience)
- Occupational exposure
to inorganic dust (miners)- Genetic predisposition that determines an excessive inflammatory response to inhaled particles
COPD develops in 20-30% of smokers
Слайд 37With the development of bronchial obstruction (narrowing of the distal
AW), the volumetric velocity of the expiratory air flow is
limited, which is the main feature of COPD.A patient with COPD cannot quickly exhale large volumes of air due to an increase in the resistance of the AW, at first this feature manifests during physical activity
Слайд 38Air traps (dynamic hyperinflation)
With bronchial obstruction, it is impossible to
quickly breathe out a required volume of air
During physical exertion,
with increased breathing, the expiration time decreases, which does not allow to fully exhale the required volume of air (air trap), and the next inhalation begins after the incomplete removal of air from the alveoli
Слайд 39"Air traps" lead to an increase in the residual volume
and a decrease in VC, disrupt the mechanics of the
respiratory musclesHyperinflation develops already in the early stages of the disease and serves as the main mechanism for the onset of shortness of breath during exertion in COPD
When the load stops and the respiratory rate decreases, hyperinflation (air traps) are resolved
Air traps (dynamic hyperinflation)
Слайд 41Symptoms: complaints
Shortness of breath on exertion,
in the terminal
stage - at minimal exertion and at rest
Patients can avoid
shortness of breath for a long time by limiting physical activity (slow pace of walking, avoid climbing stairs)Often, patients first visit a doctor because of shortness of breath, which limits their daily activities (at stages III-IV of COPD)
Слайд 42Cough
Most patients with COPD have a productive cough with little
sputum.
During periods of exacerbation, the cough increases, the sputum becomes
purulentCOPD cough is rarely a reason to see a doctor
Слайд 43Examination
Central cyanosis in severe COPD due to arterial hypoxemia.
Flushing of
the neck and upper chest is common
In some COPD patients,
exhalation through the pursed lips, which increases the pressure in the airway during exhalation and decreases respiratory collapse of the bronchioles.Some patients have a symptom of finger clubbing ("drumsticks“)
Слайд 45Chest examination
Barrel chest in emphysematous COPD
In severe patients with COPD,
the involvement of additional respiratory muscles is observed. The inclusion
of the scalenae and sternocleidomastoideus muscles in the act of respiration is an indicator of further deterioration of respiratory mechanic disorders .
Слайд 48Palpation and percussion
With emphysema and pulmonary hyperinflation, a boxed (hyperresonant)
percussion sound is determined.
Auscultation
Emphysema silence the main breathing sound and
even heart soundsAdventitious breathing sounds:
Monophonic (rhonchi) and polyphonic high pitched wheezes may be heard
Слайд 51Chest X-ray
Signs of hyperinflation (flattened diaphragm, increased transparency of the
lungs, disappearance of the vascular pattern)
Слайд 52COPD diagnosis =
Long-term exposure to smoking
+
Detection of irreversible BO on spirometry (Tiffno index <0.7)
+
Other causes of irreversible BO are excluded
Слайд 53 Treatment principles
QUITING SMOKING is the only treatment that can
slow the progression of COPD
Bronchodilators on demand (for shortness of
breath, before exercise) and on an ongoing basisWith the development of severe RF, long-term home oxygen therapy
