Respiratory diseases with bronchial obstruction

Definition of BO

BO - condition develops due to the presence of

Types of BO

By prevalence:
1. Local:
tumor
foreign body
diseases with intrathoracic LAP
2. Diffuse:
Chronic obstructive

Types of BO

By duration:
1.Reversible (BA);
2. Irreversible (COB, EL).
life time

Mechanisms

1. Reversible:
spasm of SMC
wall edema
impaired mucus secretion

2. Irreversible:
fibrosis of the wall
pathological expiratory collapse of bronchioles (due to

BA is a disease characterized by chronic inflammation of the airways

Pathomorphology

mast cell

Inflammation in BA (AD)

The development of AD is based on chronic

Bronchial hyperreactivity

BHR - the possibility of developing bronchospasm under the action

Provoking factors of the bronchospasm

Allergen triggers (have a protein structure) -

IgE-depended allergic reaction

Provoking factors of the bronchospasm

Nonspecific triggers (non-allergenic) - provoke bronchospasm in

Symptoms

Wheezing rales
Feeling of chest congestion
Dyspnea
Unproductive cough (may be the dominant symptom

Choking
appears with non-stopping severe attack of asthma, which is regarded as

About asthma symptoms (it may help in diagnosis)

Provocation (exercise, exposure to

Patient examination

Important !
signs of bronchial obstruction appear only at the time

History of life

Childhood (early beginning)
Occupational hazards (risk of occupational BA)
Living conditions

Tests

Confirmation of variability of bronchial obstruction
Peak expiratory flow (PEF) monitoring -

Peakflowmeter

Criteria of bronchial obstruction variability

Positive test with bronchodilator (assessed 15 min

Положительный тест с бронхолитиком

Can a patient with asthma have normal spirometry and peak flow

Allergic tests

Skin scarification tests (prick tests) with allergen panel
Blood level of

Others

Eosinophilia is detected in a small number of patients with AD
In

Treatment

Long-term (in many patients lifelong) basic anti-inflammatory therapy with inhaled glucocorticoids

Chronic bronchitis

CB - “smoker's cough” when other causes of cough are

Smokers usually do not seek medical help at the stage of

CB =

Chronic productive cough
+
Long-term exposure to tobacco smoking
+
Other causes

Smoking
CB
Inflamation and fibrosis Destruction of alveolar wall
in distal bronchi
Irreversible

Emphysema

Pathomorphological concept
Destruction of the lung parenchyma with destruction of alveolar septa

EL pathogenesis

Smoking
Activation of alveolar macrophages
Proteases> Antiproteases (α1-antitrypsin)
Destruction of the alveolar walls
Decreased

COPD

Chronic obstructive pulmonary disease is a disease with progressive irreversible bronchial

COPD / ХОБЛ

Pathogenesis

- Long-term smoking (smoking experience 20 packs / years or

With the development of bronchial obstruction (narrowing of the distal AW),

Air traps (dynamic hyperinflation)

With bronchial obstruction, it is impossible to quickly

"Air traps" lead to an increase in the residual volume and

COPD hystory

Symptoms: complaints

Shortness of breath on exertion,
in the terminal stage

Cough
Most patients with COPD have a productive cough with little sputum.
During

Examination

Central cyanosis in severe COPD due to arterial hypoxemia.
Flushing of the

Chest examination

Barrel chest in emphysematous COPD
In severe patients with COPD, the

Palpation and percussion
With emphysema and pulmonary hyperinflation, a boxed (hyperresonant) percussion

Spirometry

Chest X-ray

Signs of hyperinflation (flattened diaphragm, increased transparency of the lungs,

COPD diagnosis =

Long-term exposure to smoking
+
Detection of irreversible BO on

Treatment principles

QUITING SMOKING is the only treatment that can slow