Obstructive_versus_Restrictive_Pulmonary_Disorders -...

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Obstructive versus Restrictive Pulmonary Disorders Obstructive lung disease is characterized by an increased resistance to airflow. Chronic obstructive pulmonary disease (COPD) includes: Emphysema, Chronic Bronchitis, Asthma, Bronchiectasis and Small Airway disease. Restrictive lung disease is characterized by a decreased expansion of the lung tissue, and a reduced total lung capacity. TABLE 15-3 -- Disorders Associated with Airflow Obstruction: The Spectrum of Chronic Obstructive Pulmonary Disease Clinical Term Anatomic Site Major Pathologic Changes Etiology Signs/Symptoms Chronic bronchitis Bronchus Mucous gland hyperplasia, hypersecretion Tobacco smoke, air pollutants Cough, sputum production Bronchiectasis Bronchus Airway dilation and scarring Persistent or severe infections Cough, purulent sputum, fever Asthma Bronchus Smooth muscle hyperplasia, excess mucus, inflammation Immunological or undefined causes Episodic wheezing, cough, dyspnea Emphysema Acinus Airspace enlargement; wall destruction Tobacco smoke Dyspnea Small-airway disease, bronchiolitis Bronchiole Inflammatory scarring/obliteration Tobacco smoke, air pollutants, miscellaneous Cough, dyspnea Kumar et al. Robbins and Cotran Pathologic Basis of Disease, 8 th edition. 2010. The diagnosis of emphysema is made on pathologic criteria. The air spaces distal to the terminal bronchiole are irreversibly enlarged. There is destruction of the alveolar walls, and no fibrosis. The two main types of emphysema are: 1) centriacinar which is found in 95% of emphysema and associated with cigarette smoking; and 2) panacinar which is associated with alpha-1 antitrypsin deficiency. The principal mechanisms involved in the pathogenesis of emphysema are: 1) an imbalance of greater protease enzyme than anti-protease enzyme activity; and 2) an excess of pro-oxidant versus anti-oxidant substances. In response to cigarette smoke, neutrophils and macrophages are stimulated to secrete elastases that destroy the alveolar walls and septa that support the respiratory bronchioles. Thus, respiratory bronchioles collapse during
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This note was uploaded on 02/17/2012 for the course MPAS PA 602 taught by Professor Dr.laird during the Fall '10 term at Chatham University.

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Obstructive_versus_Restrictive_Pulmonary_Disorders -...

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