management and treatment of patients with broncho-obstructive syndrome

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handouts bos managementand treatment of the patients with broncho-obstructive syndrome. management of the patients with acute and chronic respiratory failure chronic obstructive pulmonary disease (copd) clinically significant, irreversible, generalized airways obstruction associated with varying degrees of chronic bronchitis, abnormalities in small airways, and emphysema. the designation was introduced because chronic bronchitis, small airways abnormalities, and emphysema often coexist and it may be difficult in an individual case to decide which is the major factor producing the airways obstruction. when it is clear that the patient's entire disease can be explained by emphysematous changes in the lung, the diagnosis "chronic obstructive emphysema" is preferred to the more general designation copd. similarly, the diagnosis "chronic obstructive bronchitis" should be used when the obstructive abnormality is a direct result of an inflammatory process in the airways. to avoid the semantic confusion often encountered in discussions of these disorders, the following definitions are provided. …

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fig. 34-1. some degree of emphysematous change is extremely common in the general population, but not all patients with emphysema have sufficient airways obstructive problems to be considered as having copd. similarly, many cigarette smokers have evidence of chronic bronchitis, but only a minority have clinically significant airways obstruction, usually associated with marked changes in the small airways of the lung. as noted in fig. 34-1, most patients with clinically significant irreversible airways obstruction (copd) have some combination of chronic bronchitis and emphysema. it is uncertain, however, whether this overlap results from a common causal factor or whether emphysema and chronic bronchitis predispose to one another. picture 1 smoking and copd etiology the development of chronic bronchitis, emphysema, and chronic airways obstruction appears to be determined by a balance between individual susceptibility and exposure to provocative agents. the basic lesion of emphysema apparently results from the effect of proteolytic enzymes …

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hanisms. in the absence of severe deficiency of ai-globulin in the serum, however, the factors which make some cigarette smokers more susceptible to development of emphysema than others remain uncertain. it is also uncertain why persons with similar degrees of emphysema may have considerably varying degrees of severity of airways obstruction. with sufficient exposure to bronchial irritants, particularly cigarette smoke, most persons develop some degree of chronic bronchitis. the lesion essential to development of severe airways obstruction is apparently located in the small airways and may be basically different from the ordinary large airways abnormality which leads to hypersecretion of mucus in most smokers. the reason why small airways abnormalities develop in some patients with chronic bronchitis is uncertain, but viral or bacterial pulmonary infections in childhood, an unidentified immunologic mechanism, a mildly impaired ability to inactivate proteolytic enzymes (as in heterozygotic antitrypsin deficiency), or unidentified genetic characteristics could be …

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s are large and pale and often fail to collapse when the thorax is opened. microscopic examination reveals "departitioning" of the lung due to loss of alveolar walls. large bullae may be present in advanced disease. changes may be most marked in the center of the secondary lobule (centrilobular emphysema) or more diffusely scattered throughout the lobule (panacinar emphysema). in all forms, the normal architecture is destroyed; rupture of septa results in air sacs of various sizes. the number of capillaries in the remaining alveolar walls is reduced, and the pulmonary arterial vessels may show sclerotic changes. these abnormalities lead not only to a reduction in the area of alveolar membrane available for gas exchange, but also to the perfusion of non-ventilated areas and to the ventilation of nonperfused parts of the lung; i.e., ventilation/perfusion abnormalities. they also lead to poor support of the airways of the lung, accounting for …

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presenting complaint. patients may date the onset of dyspnea to an acute respiratory illness, but the acute infection may only unmask a preexisting subclinical chronic respiratory disorder. cough, wheezing, recurrent respiratory infections, or, occasionally, weakness, weight loss, or lack of libido may also be initial manifestations. rarely, initial complaints are related to congestive heart failure secondary to cor pulmonale, patients with such complaints apparently ignoring their cough and dyspnea prior to the onset of dependent edema and severe cyanosis. cough and sputum production are extremely variable. the patient may admit only to "clearing his chest" on awakening in the morning or after smoking the first cigarette of the day. other patients may have severe disabling cough. sputum varies from a few ml of clear viscid mucus to large bronchiectasis-like quantities of purulent material. wheezing also varies in character and intensity. asthma-like episodes may occur with acute infections. a mild chronic …

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handouts bos managementand treatment of the patients with broncho-obstructive syndrome. management of the patients with acute and chronic respiratory failure chronic obstructive pulmonary disease (copd) clinically significant, irreversible, generalized airways obstruction associated with varying degrees of chronic bronchitis, abnormalities in small airways, and emphysema. the designation was introduced because chronic bronchitis, small airways abnormalities, and emphysema often coexist and it may be difficult in an individual case to decide which is the major factor producing the airways obstruction. when it is clear that the patient's entire disease can be explained by emphysematous changes in the lung, the diagnosis "chronic obstructive emphysema" is preferred to the more general designa...

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