蔡映云－慢支肺气肿

nullChapter threeChapter threeChronic Obstructive Pulmonary Diseases (COPD) Chronic Bronchitis Obstructive Pulmonary Emphysema Definition of COPDDefinition of COPDIncluding chronic bronchitis and pulmonary emphysema Chronic airflow limitation progressing slowly Partial reversibility Abnormal inflammatory response of the lungs to noxious particles or gasesClassification of COPD by SeverityClassification of COPD by SeverityStage 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 productionClassification of COPD by SeverityClassification of COPD by SeverityStage 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 SeverityClassification of COPD by SeverityStage III( Severe) FEV1/FVC < 70% FEV1 ≤30 % predicted or with respiratory failure or cardiac failure一.Chronic bronchitis一.Chronic bronchitis(一) Definition Chronic nonspecific inflammation in mucosa and its peripheral tissues of trachia and bronchus（二）Etiology（二）Etiology1.Smoking Epidemical information Pathological examination Effects of giving up smoking Animal experiment （二）Etiology（二）Etiology2.Airway infection Virus Bacteria Mychoplasma（二）Etiology（二）Etiology3.physical and chemical factors Air pollution Occupational contamination Indoor and outdoor fumes 4.Climate Cold weather Variation of atmospheric temperature（二）Etiology（二）Etiology5.Atopy 6.Immunological and defensive disturbance 7.Imbalance between sympathetic and parasympathetic nerves systems 8.Deficiency of Vit C and A（三）Pathology（三）PathologyEpithelial cells Mucosa and submucosa Goblet cells and mucous gland Smooth muscles Cartilage Fibrous tissues(四)Pathophysiological Changes(四)Pathophysiological Changes1.Early stage Abnormal small airway function CV CC V50 V25 2.Obstructive ventilatory defect FVC