1. Prof. dr. Bacani
By
Kazemi Mohammad
Sadegh
Dmd2ee
2013
RESPIRATORY
DISEASE

2. Major Determinants of
Disease
• Diseases of one lung compartment tend to
affect the others
• The lungs are open to the environment,
exposing them to infectious agents,
allergens, irritants, & carcinogens
• Most lung disease is caused by inhalation
of material; the most common exception is
autoimmune lung disease

3. • Lost pulmonary membrane is not
recoverable
• Smoking is a major cause of lung
disease
• The heart & lungs are a functional unit;
lung disease usually affects the heart; &
heart disease usually affects the lungs

4. Chronic Obstructive Pulmonary
Diseases (COPD)
• Chronic bronchitis
• Emphysema
• Bronchiectasis
• Asthma

5. Chronic Bronchitis
• Chronic bronchitis is defined clinically. It is
present in any patient who has persistent
cough with sputum production for at least 3
months in at least 2 consecutive years, in the
absence of any other identifiable cause.
(1) Progress to chronic obstructive airway
disease
(2) Lead to cor-pulmonale and heart failure
(3) Cause atypical metaplasia and dysplasia of
the respiratory epithelium

6. Pathogenesis
• Tobacco smoke
– 90% of patients are smokers.
• Grain, cotton, and silica dust
• Air pollution
• Infection
– Bacterial and viral infections are important
intriggering acute exacerbation of the disease.
• Others

7. Chronic bronchitis. The lumen of the bronchus is above. Note the marked
thickening of the mucous
gland layer (approximately twice normal) and squamous metaplasia of lung
epithelium. (From the teaching collection of the Department of Pathology,
University of Texas, Southwestern Medical School,
Dallas, Texas.)

8. Clinical Course
• Prominent cough
• Production of sputum
• Hypercapnia, hypoxemia, and cyanosis
• Pulmonary hypertension and cardiac failure
• Recurrent infections and respiratory failure

9. Emphysema
• Definition
– Emphysema is a condition of the lung
characterized by abnormal permanent
enlargement of the airspaces distal to the
terminal bronchiole, accompanied by
destruction of their walls and without
obvious fibrosis.

10. Pathogenesis
• The genesis of emphysema is not
completely understood.
• A consequence of two critical imbalances
– The protease-antiprotease imbalance
– Oxidant-antioxidant imbalance

11. Pathogenesis of emphysema. The protease-antiprotease
imbalance and
oxidant-antioxidant imbalance are additive in their effects and
contribute to tissue damage. α1-antitrypsin (α1-AT) deficiency
can be either congenital or "functional" as a result of oxidative
inactivation.

12. Types of Emphysema
• According to its anatomic distribution within
the lobule
• Four major types
– Centriacinar
– Panacinar
– Paraseptal
– Irregular
• Only the first two cause clinically significant
airflow obstruction.

13. A, Centriacinar emphysema. Central areas show
marked emphysematous damage (E), surrounded by
relatively spared alveolar spaces.
B, Panacinar emphysema involving the entire
pulmonary architecture.

14. Microscopically at high magnification, the loss of
alveolar walls with emphysema is demonstrated.
Remaining airspaces are dilated.

15. Clinical Course
• Dyspnea is usually the first symptom
• Steadily progressive
• Cough and wheezing
• Weight loss
• Pulmonary function tests
– The ratio of FEV1 to FVC is reduced

16. Complications
• Cor pulmonale
• Pneumothorax
• Respiratory failure

17. Anatomic distribution of pure chronic bronchitis and pure emphysema. In
chronic bronchitis the small-airway disease (chronic bronchiolitis) results in
airflow obstruction, while the large-airway disease is primarily responsible for
the mucus hypersecretion.

18. Bronchiectasis
• The permanent dilation of bronchi and
bronchioles caused by destruction of the
muscle and elastic supporting tissue.

19. Pathogenesis
• Obstruction
• Chronic persistent infection
– Damage to bronchial walls, leading to
weakening and dilation.
– Obstructive secretions, inflammation
throughout the wall

20. Morphology
• Affects the lower lobes bilaterally
• The airways dilated
• Histologically
– Intense acute and chronic inflammatory
exudate within the walls of the bronchi and
bronchioles
– The desquamation of lining epithelium
cause extensive areas of ulceration
– Fibrosis of the bronchial and bronchiolar
walls and peribronchiolar fibrosis

21. This is the microscopic appearance of bronchiectasis.
Bronchiectasis is not a specific disease, but a
consequence of another disease process that destroys
airways.

22. Clinical Course
• Severe, persistent cough with expectoration
of mucopurulent
– Fetid, sputum.
– The sputum may contain flecks of blood
• Hypoxemia, hypercapnia, pulmonary
hypertension, and (rarely) cor pulmonale.

23. Complications
• Lung abscess
• Pyemia--metastatic abscesses
• Pulmonary fibrosis
• Cor pulmonale

24. Asthma

27. Pathophysiology
Asthma trigger
- Inflammation & edema of the mucous
membranes.
- Accumulation of tenacious secretions
from mucous glands.
- Spasm of the smooth muscle of the
bronchi & bronchioles decreases
the caliber of the bronchioles.

28. • Coughing
• Wheezing, a whistling
sound
• Shortness of breath
• Chest tightness
• Sneezing & runny
nose
• Itchy and inflamed
eyes

29. Asthma
Therapeutic Drug therapy:
management B- adrenergic,
Theophyllin, &
corticosteroids
- Allergic control preparations + chest
to prevent physiotherapy (only
attacks. in between attacks).

30. Clinical Anatomic Major Etiology Signs/
Term Site Pathologic Symptoms
Changes
Chronic Bronchus Mucous gland Tobacco Cough,
bronchitis hyperplasia, smoke, air sputum
hypersecretion pollutants production
Bronchiectasis Bronchus Airway dilation Persistent or Cough,
and scarring severe purulent
infections sputum, fever
Emphysema Acinus Airspace Tobacco Dyspnea
enlargement; smoke
wall
destruction
Asthma Bronchus Smooth Immunologic Episodic
muscle or undefined wheezing,
hyperplasia, causes cough,
excess mucus, dyspnea
inflammation

31. Lower Respiratory Tract Infections:
Bronchiolitis (RSV Infection)
• 2-12 month
• Caused by syncytial virus
• Transmitted by oral droplet
• Predisposing factors (asthma, smoking)
• Causes necrosis and inflammation of small bronchi and
bronchioles
• Signs and dyspnea
– Wheezing
– Rapid, shallow respirations
– Cough
– Rales
– Chest retractions
– Fever
• Treatment and symptomatic
– Supportive

32. Pulmonary Infections
• Pneumonia can result
whenever these defense
mechanisms are impaired
or whenever the
resistance of the host in
general is lowered.
• Most deadly infectious disease in the U.S.
• 6th leading cause of death

33. Pneumonia
• Etiological classification
– Bacterial pneumonia
– Viral pneumonia
– Fungal pneumonia
• Anatomical classification
– Lobar pneumonia
– Lobular pneumonia
– Interstitial pneumonia

34. Pulmonary Infections or
Pneumonia
• Pneumonia can be very broadly defined
as any infection in the lung. It may
present as acute, fulminant clinical
disease or as chronic disease with a
more protracted course.

35. Pathogenesis
• Streptococcus Pneumoniae
– The most common cause of acute pneumonia.
– Examination of Gram-stained sputum is an important step
in the diagnosis of acute pneumonia.
– Pneumococcal pneumonias respond readily to penicillin
treatment, but there are increasing numbers of
penicillinresistant
strains of pneumococci.
• Haemophilus Influenzae
– A major cause of life-threatening acute lower respiratory
tract
infections and meningitis in young children.
• Moraxella Catarrhalis

36. Lung cancer
•Lung cancer is currently the most
frequently diagnosed major cancer in the
world and the most common cause of
cancer mortality worldwide.
• Cancer of the lung occurs most often
between ages 40 and 70 years, with a
peak incidence in the fifties or sixties.
• The 5-year rate for all stages combined is
only 15%.

37. • Cigarette smoking
– Passive smoking
increases the risk of
developing lung cancer to
approximately twice
that of nonsmokers.
• Industrial Hazards
• Air Pollution
• Molecular Genetics

38. • Squamous cell
carcinoma (25% to
40%)
• Adenocarcinoma
(25% to 40%)
• Small cell carcinoma
(20% to 25%)
• Large cell carcinoma
(10% to 15%)

39. • Insidious onset
• Normally metastized
before diagnosis
• 4 possible categories
of signs of lung cancer
–Direct effects of
tumor
–Systemic effects of
cancer
–Paraneoplastic
syndromes
–Metastizes at other
sites

40. • Chest X-rays
• Bronchoscopy
• Pulmonary function tests

41. • Surgery on localized
lesions
• Chemotherapy and
radiation
• Poor prognosis unless
tumor in early stages
of development

42. What is tuberculosis (TB)?
Tuberculosis (TB) is a disease caused by
bacteria called Mycobacterium tuberculosis.
The TB bacteria can affect any part of the
body, but usually affects the lungs.
If not treated properly, a person who has TB
infection can develop TB disease.
If a person develops TB disease and does
not get appropriate medical treatment he/she
can die.

43. • Mycobacterium tuberculosis
• Chronic granulomatous inflammation with
caseous necros

44. What are the symptoms of TB?
Symptoms of TB disease include:
feelings of sickness or weakness,
weight loss, fever, and night sweats.
When TB disease affects the lungs,
additional symptoms may include: a bad
cough that lasts longer than 2 weeks,
shortness of breath, pain in the chest and
coughing up blood.

45. Remember…
TB infection occurs when a person has
breathed in the TB germ, but the person is not
sick.
TB disease can develop in a person with
TB infection if they do not get medical
treatment.
A person with TB disease is sick and may
have several symptoms of the disease.
If left untreated, persons with TB disease
can die from TB.

46. How is TB treated?
TB disease can usually be cured
by taking several medicines for 6-12 months.
It is very important that people who have TB
disease take the medication exactly as
prescribed.
If you stop taking the medication too soon,
you can become sick again.
Also, if you do not take the medication
correctly, the germs may become resistant to
those medications and become more difficult to
treat.

47. An inflammation of the larynx.
It causes hoarse voice or the
complete loss of the voice
because of irritation to the
vocal folds.

48. Colds or flu. This is the
most common cause
What are the symptoms?
The main symptom of laryngitis
is hoarseness. Your voice may
sound raspy, be deeper than
normal, or break now and then.
You may lose your voice
completely. Other symptoms
may include a dry or sore
throat, coughing, and trouble
swallowing.

49. How is it treated?
With most cases of laryngitis, home treatment is
all that you need. Try to rest your voice, add
moisture to the air in your home with a
humidifier or vaporizer, and drink plenty of
fluids. Don't smoke, and stay away from other
people’s smoke.
Chronic laryngitis may need more treatment. If
you keep getting laryngitis because of a problem
with the way you talk or sing, you may need
speech training. This can help you change
habits that can cause laryngitis. It can also help
your larynx heal.
You may need surgery if your vocal cords have
been damaged, such as by sores or polyps.

50. Bronchitis
•Bronchitis is an inflammation of the main air
passages to the lungs
•Most prevalent in winter
•Generally part of an acute URI
•It may develop after a common cold or
other viral infection of the nasopharynx,
throat, or bronchi
•Often with secondary bacterial infection

52. 1.Malaise
2.Chilliness
3.Slight fever
4.Back and muscle pain
5.Sore throat
6.Onset of a distressing
cough usually signals
onset of bronchitis
7.Cough starts off dry and
later produces mucous.

54. Tonsillitis
What is tonsillitis?
• Tonsillitis is a viral or bacterial infection in
the throat that causes inflammation of the
tonsils. Tonsils are small glands (lymphoid
tissue) in the pharyngeal cavity.
• In the first six months of life tonsils
provide a useful defense against
infections. Tonsillitis is one of the most
common ailments in pre-school children,
but it can also occur at any age.

55. Tonsillitis
• Palatine
tonsils
(Visible during
oral
examination)

56. Tonsillitis is caused by a variety of
contagious viral and bacterial
infections. It is spread by close
contact with other individuals and
occurs more during winter
periods. The most common
bacterium causing tonsillitis is
streptococcus.

57. Tonsillitis caused by bacteria
Antibiotics are prescribed for
tonsillitis caused by strep
bacteria. A strep infection will
usually go away on its own,
but antibiotic treatment is
needed because untreated
strep throat can cause
serious complications

58. Surgery
Surgical removal of the
tonsils (tonsillectomy) is
still a common procedure,
particularly for children