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Chronic non-specific lung diseases

Chronic non-specific lung diseases (COPD) is a group of lung diseases of various etiologies, pathogenesis and morphology, characterized by the development of chronic cough with sputum production and paroxysmal or persistent breathing difficulties that are not associated with specific infectious diseases, primarily pulmonary tuberculosis.

The chronic bronchitis, bronchial asthma, bronchiectatic disease, chronic obstructive pulmonary emphysema, chronic abscess, and chronic pneumonia are referred to the group of chronic lung infections. A number of authors include interstitial pulmonary diseases in the group of COPD. With all COPD, hypertension of the pulmonary circulation and pulmonary heart develop. Depending on the morphological and functional features of the damage to the air-conducting and respiratory departments of the lungs, obstructive and restrictive chronic respiratory infections are distinguished.

a. At the heart of obstructive pulmonary diseases is a violation of the drainage function of the bronchi with partial or complete obstruction, resulting in increased resistance to air passage.

b. Restrictive lung diseases are characterized by a decrease in the volume of the pulmonary parenchyma with a decrease in the vital capacity of the lungs. The basis of restrictive pulmonary diseases is the development of inflammation and fibrosis in the interstitium of the respiratory departments, which is accompanied by progressive respiratory failure.

• In the late stages of most pulmonary diseases, a combination of obstructive and restrictive components is noted.

Mechanisms of the development of COPD.

1. Bronchitogenic, which is based on a violation of the drainage function of the bronchi and bronchial obstruction.

• Diseases united by this mechanism - chronic obstructive pulmonary diseases - are represented by chronic bronchitis, bronchiectasis, chronic obstructive pulmonary emphysema, bronchial asthma.

2. The pneumoniogenic mechanism is associated with acute pneumonia and its complications (acute abscess, carnification) and leads to the development of a chronic abscess and chronic pneumonia.

3. The pneumonitogenic mechanism determines the development of chronic interstitial diseases, represented by various forms of fibrosing alveolitis, or pneumonitis.

• As a result, all three mechanisms of the development of COPD lead to pneumosclerosis, secondary pulmonary hypertension, right ventricular hypertrophy (pulmonary heart) and cardiopulmonary failure.

• In addition, secondary AA amyloidosis is a frequent complication of bronchiectatic disease (less commonly a chronic abscess): kidney damage leads to the development of nephrotic syndrome and, in the end, chronic renal failure.

Chronical bronchitis

Chronic bronchitis is a disease characterized by excessive production of mucus by the bronchial glands, which leads to the appearance of a productive cough lasting at least 3 months (annually) for at least 2 years.

• Smoking = the most important etiological factor in chronic bronchitis.

• Mucosal hyperplasia = one of the main morphological criteria for chronic bronchitis.

Classification of chronic bronchitis.

1. In terms of prevalence.

a. Local (often in II, IV, VIII, IX, X segments of the lungs).

b. Diffuse bronchitis.

2. Depending on the presence of bronchial obstruction.

a. Obstructive.

b. Non obstructive.

3. By the nature of catarrhal inflammation.

a. Simple catarrhal.

b. Mucopurulent.

Bronchiectasis

Bronchiectatic disease is characterized by a combination of a characteristic morphological substrate of pronounced bronchiectasis and a certain extrapulmonary symptom complex due to respiratory hypoxia and the development of hypertension in the pulmonary circulation. In patients, the fingers take the form of drumsticks, nails - the form of watch glasses, characterized by "warm" cyanosis, hypertrophy of the right ventricle and the development of the pulmonary heart.

• Bronchiectasis - persistent pathological expansion of one or more bronchi containing cartilaginous plates and mucous glands, with the destruction of the elastic and muscle layers of the bronchial wall.

• By origin, bronchiectasis can be congenital and acquired. Acquired bronchiectasis, developed against the background of chronic bronchitis, can be considered a morphological substrate of bronchiectasis.

• Often the development of bronchiectasis and bronchiectasis is pathogenetically associated with complicated measles and severe influenza.

Morphological characteristics.

According to the macroscopic picture, bronchiectasis can be saccular (at the level of the proximal bronchi, including 4th order bronchi) and cylindrical (at the level of bronchi of the 10th order).

A microscopic examination in the wall of bronchiectasis results in chronic suppurative inflammation with destruction and atrophy of structural elements and sclerosis.
In the adjacent lung tissue - fields of fibrosis, foci of obstructive emphysema.

Complications

• Pulmonary bleeding.

• Lung abscesses (bronchiectatic abscesses).

• Empyema of pleura.

• Chronic cardiopulmonary failure.

• Secondary amyloidosis (AA amyloidosis).

Chronic obstructive pulmonary emphysema

Emphysema is a syndrome characterized by persistent expansion of air spaces distal to terminal bronchioles. There are various types of emphysema: perifocal, vicar, senile, idiopathic, interstitial, chronic obstructive.

Chronic obstructive pulmonary emphysema is a disease caused by the formation of chronic airway obstruction due to chronic bronchitis and bronchiolitis.

Pathogenesis.

• The disease is associated with the destruction of the elastic and collagenous frameworks of the lung due to the action of leukocyte proteases (elastase, collagenase) during inflammation.

• The genetically determined deficiency of the serum protease inhibitor ai-antitrypsin is a crucial pathogenetic link. The role of absolute or relative acquired deficiency of serum at-antitrypsin (for liver diseases) or terminal bronchioles locally synthesized by Clara cells (for chronic bronchiolitis) cannot be ruled out.

Morphological characteristics

• In chronic obstructive emphysema, the lumens of the respiratory bronchi and alveoli are widened, the walls of the alveoli are thinned and straightened, the disappearance of elastic fibers is noted in them; the capillary network is reduced, which leads to the development of the capillary-alveolar block and impaired gas exchange (pulmonary insufficiency).

• As a result of sclerotic changes in the pulmonary capillaries and increased pressure in the pulmonary artery system, the pulmonary heart develops.

Chronic abscess

• It develops from acute and is often localized in the II, VI, IX, X segments of the right lung.

• It is a source of bronchogenic spread of purulent inflammation in the lung.

Macroscopic picture: an abscess is a cavity filled with pus and surrounded by a dense capsule.

Microscopic picture: the outer layers of the capsule are represented by connective tissue, the inner ones by granulation tissue and pus (pyogenic membrane).

Chronic pneumonia

• It is characterized by a combination of many pathological processes in the lungs: areas of carnification and fibrosis alternate with cavities of chronic abscesses; in peribronchial and perivascular tissue, chronic inflammation and fibrosis develop, which leads to the appearance of emphysema, which is supported by chronic bronchitis; sclerotic changes are noted in the vessels.

• Each exacerbation is accompanied by the appearance of fresh foci of inflammation with an increase in the lesion area and an increase in sclerotic changes, which leads to pneumofibrosis and deformation of the pulmonary artery.

Chronic interstitial lung disease

• Accompanied by diffuse interstitial fibrosis with the development of cell lungs in the final, which are characterized by cystic transformation of terminal and respiratory bronchioles.

• The airborne barrier block, secondary pulmonary hypertension, and pulmonary heart very quickly arise.

The basic principles for the classification of interstitial diseases are the etiology and nature of productive pneumonia.

According to the etiology, interstitial lung diseases are divided into diseases with established and undefined etiology. The latter prevail.

a. To chronic interstitial diseases with established etiology include pneumoconiosis caused by organic and inorganic dust, exogenous allergic alveolitis. Of the etiological factors of alveolitis, bacteria, fungi, and dust containing antigens of animal and plant origin are of great importance. It is widely distributed among people employed in agriculture (“farmer’s lungs”, “flour mills”, etc.), as well as among workers in the textile, pharmaceutical industries, etc.

b. Interstitial diseases with an unknown etiology include idiopathic fibrosing alveolitis (the acute forms of which are called Hamman-Rich disease), secondary fibrosing alveolitis in rheumatic diseases and HBV infections, sarcoidosis, fibrosing alveolitis in Goodspacer syndrome, idiopathic pulmonary hemosiderosis, idiopathic hemosiderosis, and etc.
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Chronic non-specific lung diseases

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