内科学 慢支、肺气肿课件.pptVIP

Chapter five Chronic Obstructive Pulmonary Diseases COPD Definition of COPD Mainly including chronic bronchitis and pulmonary emphysema Chronic airflow limitation Progressing slowly Partial reversibility Abnormal inflammatory response of the lungs to noxious particles or gases Clinical significance The fourth leading cause of death and 16million persons are affected in the united states. The incidence of COPD in Chinese people aged 40 years and above is 8.3% It is estimated that COPD will rise from the sixth to the third most common cause of death worldwide by 2020 Chronic bronchitis Chronic nonspecific inflammation in mucosa and its peripheral tissues of trachia and bronchus Obstructive pulmonary emphysema Abnormal permanent enlargement of air spaces distal to the terminal bronchiole with destruction of their walls and without obvious fibrosis Etiology 1. Smoking most important Epidemical information Pathological examination Effects of giving up smoking Animal experiment Etiology Etiology 2. Airway Responsiveness Increased airway responsiveness is clearly a significant predictor of subsequent decline in pulmonary function Etiology 3. Respiratory Infections The important cause of exacerbation The association of respiratory infection to the development and progression of COPD remains to be proven Etiology 4. Occupational Exposures Occupational dusts and fumes Less important than the effect of cigarette smoking Etiology 5. Indoor and outdoor Air Pollution Etiology 6. Passive smoking exposure? Exposure of children to maternal smoking results in significantly reduced lung growth In utero tobacco smoke exposure also contributes to significant reductions in postnatal pulmonary function Etiology 7. Genetic factors α1 antitrypsin deficiency 1 ~ 2% of COPD patients inherit severe α1 AT deficiency Other genetic risk factors Etiology 8. Other factors Climate Cold weather Variation of atmospheric temperature Immunological and defensive disturba