RESPIRATORY SYSTEM: BRONCHIAL ASTHMA AND BRONCHIECTASIS

1. BRONCHIAL ASTHMA
BRONCHIECTASIS
Dr Vijay Shankar S

2. Overview
• Bronchial asthma,
• types
• Pathogenesis and pathology
• Bronchiectasis
• Etiopathogenesis
• Pathology

3. Bronchial asthma

4. • Defn:
• Asthma is a chronic inflammatory disorder of the
airways that is characterized by increased
responsiveness of tracheobronchial tree to a
variety of stimuli
• Manifested physiologically by
• Widespread narrowing of airways which may be
releived spontaneously or as a result of therapy.

5. • Manifested clinically by
• Paroxysms of dyspnea , cough and
wheezing

7. http://www.globalasthmareport.org/burden/causes.php

10. • A very common disease
• immense social impact
• All ages
• 50% before age of 10
• 2:1::M:F in childhood
• 1:1::M:F in adults

11. • World Asthma Day
• is an annual event organized by
the Global Initiative for Asthma (GINA) to
• improve asthma awareness and care
around the world.
• World Asthma Day takes place on the first
Tuesday of May.
• The theme of World Asthma Day 2014
is“You Can Control Your Asthma./ "It's
Time to Control Asthma,".”
• 2015: 5th
May: The theme will continue

12. Etiopathogenesis & Types
• Types 1) Extrinsic asthma,( atopic or
allergic) -
MC
2) Intrinsic asthma ( Non atopic)
In either types, the triggers of bronchospasm:
-respiratory infections
-irritants
-cold air, stress & excercise

13. • Seasonal
• Drug induced
• Exercise induced
• Occupational

14. Pathogenesis
• Genetic predisposition to type 1
hypersensitivity!

15. Atopic asthma

16. Pathogenesis of non atopic
asthma
• Viral infection: lowers the threshold of
subepithelial vagal receptors to irritants
• Drugs like aspirin- inhibits COXpathway
without affecting lipoxygenase pathway
• Occupational asthma- various
mechanisms

17. Gross

18. Hyperinflated lungs of status asthmaticus

19. Curschmann spirals
result either from mucus plugging in subepithelial mucous gland
ducts which later become extruded or from plugs in bronchioles

20. Charcot-Leyden crystals
crystalloid made up of an eosinophil lysophospholipase binding
protein called galectin-10

21. Airway Remodelling

23. Clinical features
• Episodes of acute exacerbations
interspered with symptom free periods.
• Dyspnoea
• Cough
• & wheezing.

27. Bronchiectasis

28. Bronchiectasis
• Defn
– ABNORMAL & PERMANENT dilation of
bronchi and bronchioles
– caused by destruction of the muscle and
elastic tissue,
– resulting from or associated with chronic
necrotizing infections

29. • Now Uncommon!
• Cough, fever & expectoration of foul
smelling, purulent sputum

30. Etiopathogenesis
OBSTRUCTION & INFECTION

31. OBSTRUCTION
Impairment of mucociliary clearance
Pooling of secretions distal to obstruction
inflammation
Destruction of bronchial wall, smooth muscle and
elastic tissue
Weakening of the wall
Dilatation
INFECTION

32. 1. Hereditary & congenital factors.
2. Obstruction,
3. Infections
4. Secondary complication

33. Gross
• Characteristically affects distal bronchi &
bronchioles beyond the segmental
bronchi.
• Involve diffuse or segmentally
• B/L lower lobes more common.
• Pleura is usually fibrotic & thickened with
adesion to chest wall.

34. REID subclassification
• Brochographic appearance
– Cylindrical;
– Fusiform
– Saccular
– varicose

40. HONEY COMB
APPEARANCE

41. Microscopy
• Bronchial epithelium may be normal,
ulcerated or show squamous metaplasia.
• Wall show infiltration by acute & chronic
inflammatory cells

43. Clinical features
• Severe persistent cough
• Expectoration of foul smelling sputum
• Dyspnea and orthopnea in severe cases
• Occasional life threatening hemoptysis
• Systemic febrile reaction

44. Complications
• Lung abscess
• Pulmonary fibrosis
• Chronic cor pulmonale- RHF
• Reactive systemic amyloidosis

45. Summary!

46. Thank you