临床医学蔡映云慢支肺气肿课件.pptVIP

Chapter three Chronic Obstructive Pulmonary Diseases (COPD) Chronic Bronchitis Obstructive Pulmonary Emphysema Definition of COPD Including chronic bronchitis and pulmonary emphysema Chronic airflow limitation progressing slowly Partial reversibility Abnormal inflammatory response of the lungs to noxious particles or gases Classification of COPD by Severity Stage 0 ( at risk) Chronic cough and sputum production Contact with harmful factors FEV1/FVC 70% Stage I( mild) FEV1/FVC 70% FEV1 ≥ 80 % predicted usually, but not always, chronic cough and sputum production Classification of COPD by Severity Stage II( moderate) IIA : FEV1/FVC 70% 50%≤ FEV1 80% predicted IIB: FEV1/FVC 70% 30%≤ FEV1 50% predicted With or without symptom Classification of COPD by Severity Stage III( Severe) FEV1/FVC 70% FEV1 ≤30 % predicted or with respiratory failure or cardiac failure 一.Chronic bronchitis (一) Definition Chronic nonspecific inflammation in mucosa and its peripheral tissues of trachia and bronchus （二）Etiology 1.Smoking Epidemical information Pathological examination Effects of giving up smoking Animal experiment （二）Etiology 2.Airway infection Virus Bacteria Mychoplasma （二）Etiology 3.physical and chemical factors Air pollution Occupational contamination Indoor and outdoor fumes 4.Climate Cold weather Variation of atmospheric temperature （二）Etiology 5.Atopy 6.Immunological and defensive disturbance 7.Imbalance between sympathetic and parasympathetic nerves systems 8.Deficiency of Vit C and A （三）Pathology Epithelial cells Mucosa and submucosa Goblet cells and mucous gland Smooth muscles Cartilage Fibrous tissues (四)Pathophysiological Changes 1.Early stage Abnormal small airway function CV CC V50 V25 2.Obstructive ventilatory defect FVCVC FEV1 FEV1/ FVC MEF MVV RV RV/TLC (五)Clinical manifestation 1.Symptoms Cough Sputum production Wheeze 2.Physical sign Dry or moist rales Prolonged exp