Chronic obstructive pulmonary disease (COPD)
Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 30 August 2011, last major update August 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.
● Permanent dilation of bronchi and bronchioles caused by destruction of mucosal and elastic tissues, caused by or associated with chronic necrotizing infection of bronchi and bronchioles
● Obstruction (due to tumor, foreign body, inspissated mucus) causes resorption of air distal to obstruction, atelectasis and accumulation of intraluminal secretions
● Non-obstructive bronchiectasis is due to pneumonia and atelectasis, which increases negative, intrapleural pressure, which exerts an external force on bronchial walls, causing them to dilate; usually left sided affecting lower lobes
● Diagnosis is based on presence of infection (stasis occurs in dilated bronchi) and obstruction
● Patients have significant morbidity
● 9% prevalence in Korean study; associated with TB (Tohoku J Exp Med 2010;222:237)
● Symptoms: cough, fever and copious amounts of foul-smelling, purulent sputum
● Causes: bronchial obstruction (localized bronchiectasis), congenital bronchiectasis, cystic fibrosis, intralobar sequestration of lung, immunodeficiency, immotile cilia/Kartegener's syndrome, Young’s syndrome, necrotizing pneumonia (staphylococcus, tuberculosis)
● Cystic fibrosis: obstruction due to mucus plugs, infection due to decreased ciliary clearance of bacteria
● Kartegeners syndrome: autosomal recessive condition with variable penetrance; due to absent or irregular dynein arms of cilia, which causes defective bacterial clearance (bronchiectasis, sinusitis), defective cell motility during embryogenesis (situs inversus), and immotile sperm (infertility)
● Young’s syndrome: infertility caused by azoospermia, but without ultrastructural ciliary abnormalities
● Sputum culture prior to initiating treatment with antibiotics (Prim Care Respir J 2011;20:135)
● Markedly distended peripheral bronchi, usually in lower lobes, can trace to pleural surface; bronchial walls are irregularly thickened
● Chronic inflammation, ulceration of bronchial wall, ossification of bronchial cartilage, thickened pleura
● Variable inflammation and fibrosis of alveoli
Dilated bronchus with necrotizing inflammation and destruction
End of Lung-nontumor > Chronic obstructive pulmonary disease (COPD) > Bronchiectasis
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