OBSTRUCTIVE

LUNG DISEASES
Purva Chavan
Shrishti Kansara
Sakshi Mav
Sana Ahmed
Preity Bhatia
Lata Kumavat
INTRODUCTION
Disease characterized by airways obstruction, Caused by
intraluminal mechanisms, airwaywall alteration And
airway And peribronchial tissue involvement.
Mechanism of obstruction
● Intraluminal mechanism
● Bronchial hypersecretion( Chronic bronchitis
● partial obstruction by foreign body, Pulmonary edema post
surgery.
● airway wall obstruction
● Bronchial muscle contraction,Glandular hypertrophy,
Inflammation and edema
● Peribronchial tissue involvement
● Pulmonary emphysema ( Palminary tissue destruction,
Resulting in loss of Elastic tissue which provide elastic recoil
● Compression by adenopathy or tumor
OBSTRUCTIVE LUNG DISEASES

● COPD
a) Emphysema
b) Chronic Bronchitis
● Bronchial asthma
● Bronchiectasis
● Cystic Fibrosis
COPD
COPD is characterized by chronic airflow limitation,
which is not completely reversible
The air flow limitation Is usually progressive And is
associated with abnormal Inflammatory response
of the lung to gas or dust.
It can be prevented and treated, With some
Significant Extrapulmonary consequences,which Can
contribute to disease severity in some patients
COPD RISK FACTOR
Certain
● Smoking
● Occupational exposure (dust, vapor smoke)
● Alfa-1-antitrypsine deficiency
Probable
● Outdoor and indoor pollution
● Social and economic factors
● Smoke exposure in childhood
● Airway hyperactivity
Possible
● Low birth weight baby, family history
● Respiratory disease in childhood
MEDICAL MANAGEMENT
PHARMACOLOGY
● Bronchodilators
Short-acting Beta 2 agonist( salbutamol)
Short acting anti colonergic( ipratropium) And long
acting(tiotropium)
● Sustained released theophylline
● Inhaled cortico steroids( Fluticazone, budesonide)
● Combination therapy(LABA+ICS)
● Mucolytic agents
Non pharmacological
● smoking cessation, 02, rehabilitation, surgery
 Emphysema
Emphysema is a type of
chronic obstructive
pulmonary disease (COPD).
With emphysema, lung
tissue loses elasticity, and
the air sacs and alveoli in
the lungs become larger.
Pathophysiology
Types of Emphysema
 BRONCHITIS
Bronchitis is inflammation or swelling
of the bronchial tubes (bronchi), the air
passages between the nose and the lungs.
More specifically, bronchitis is when the
lining of the bronchial tubes becomes
inflamed or infected.
Bronchitis is caused by viruses, bacteria,
and other particles that irritate the
bronchial tubes.
 TYPES OF BRONCHITIS
1.Acute bronchitis
Acute bronchitis is a shorter illness that commonly follows a
cold or viral infection, such as the flu Acute bronchitis
usually lasts a few days or weeks
2.Chronic bronchitis
Chronic bronchitis is characterized by a persistent, mucus-
producing cough on most days of the month, three months
of a year for two successive years in absence of a secondary
cause of the cough.
 Ashthma
It's a chronic inflammatory disorder of the airways,in
which many cells play a role,it is associated with
airway hyperresponsiveness that leads to recurrent
episodes of wheezing,breathlessness,chest
tightness,and coughing(especially at night and early
morning)
These episodes associated with widespread but
variable airflow obstruction within the lung that is
 Pathophysiology
Airway hyperractivity (AHR)-tendency for airways to narrow excessively to
triggers that have
no effect on normal individual, essential to diagnosis of ashthma.
Common allergens- house dust mites, pets, smoking, cockroaches,bugs,
cold,exercise,viral upper respiratory infection.
Allergic mechanisms are also implicated in occupational asthma.
In exercise induced asthma,hyperventilation results to water loss from
pericellular linning fluid of the respiratory mucosa,which triggers mediator
response
Heat loss from respiratory mucosa is important With increased severity of
disease, remodelling of airways may cause fibrosis,fixed
narrowing of airway and reduced response to bronchodilator
 Clinical features
Typically recurrent episodes of wheezing, chest tightness, breathlessness
and cough.
Asthma- mistaken for a cold or chest infection which is taking time to
resolve (e.g. longer than 10 days).
Classical precipitants include exercise, particularly in cold
weather, exposure to airborne allergens or pollutants, and viral upper
respiratory tract infections, wheezing.
An inspection for nasal polyps and eczema should be
performed. Rarely, a vasculitic rash may suggest Churg–Strauss syndrome
Patients with mild intermittent asthma are usually
asymptomatic between exacerbations.
 Medical management
Step 1: Occasional use of inhaled short-acting β2-adrenoreceptor agonist
bronchodilators
Step 2: Introduction of regular preventer therapy-regular antinflammatory
therapy-inhaled corticosteroid(ics),budesonide, beclometasone,
Step3- if a pt remains poorly controlled with ics add inhaled long acting b2
agonist and assess control of asthma
Step4- consider trial of increasing inhaled steroid upto 2000 microgram/day
and +of 4th drug leukotrines receptor antagonist,theophylline,b2 agonist,if
there is no improvement wid add on therapy stop it
Step 5- continous use of oral steroids -prednisolone therapy on daily basis
Pts on long term corticosteroid tablet develop other side effects( prevent
osteoporosis use bisphosponates.
Step down therapy- once asthma controlled ,dose of ics or oral should be
lowered to effective control of asthma is maintained
 Bronchiectasis
● It is characterized by permanent, abnormal dilation of
one or more large bronchi. The pathophysiogic change
results in dilation & destruction of elastic and muscular
structures supporting the bronchial wall.
● Results in reduced ability to clear mucus from lungs
● Symptoms- recurrent cough with purulent sputum that
may exceed 500ml/day, hemoptysis, clubbing of finger,
dyspnea, wheezing and chest pain
Types:
1) Saccular (cystic): This occurs in
proximal large bronchi. They show
marked dilation ending in karge sacs
2) cylindrical (fusiform): This involves
airway from 6th to 10th generation.
They look cylindrical or beaded and end
squarely and abruptly.
3) Varicose: They resemble varicose
vein.This is intermediate between
saccular and cylindrical changes.
 Management
● Nebulisation with 7% hypertonic saline in conjunction
with chest physiotherapy PD for minimum 5 -10
minutes
● Antibiotic for eradication of bacteria-oral ciprofloxacin
500mg, Tobramycin
● Exacerbation -amoxicillin, ampicillin, tetracycline,
fluoroquinolones
● Inflammation- Azithromycin 500mg , inhaled
corticosteroid
● Bronchodilaters-salmeterol, levalbuterol
 Cystic Fibrosis
It is a disease of exocrine
gland function that
involves multiple organ
systems but chiefly results
in chronic respiratory
infections, pancreatic
enzyme insufficiency, and
associated complications
Normal

Cystic
Fibrosis
Medications
● Antibiotics to treat and prevent lung infections
● Mucolytic drugs
● Bronchodilators
● Oral pancreatic enzymes to help the digestive tract to absorb
nutrients
Chest physical therapy
Surgical and other procedures
● Endoscopy and lavage to suction out mucous
● Bowel surgery incase a blockage develops in bowel or
Intussusception, where a section of bowel has folded in on itself,
also may require surgical repair.
● Lung transplant
THANK YOU!