Question

A 67-year-old man presents to your office with worsening cough, sputum production, and shortness of
breath. He is a smoker for the past 50 years. He is known to have Chronic Obstructive Pulmonary
Diseases (COPD). He was in his usual state of health until one week ago until he got a common cold and
since then he has a hacking cough and increased sputum production. this is all information I have

1. What are the two major clinical disorders/diseases are classified as Chronic Obstructive
Pulmonary -Diseases? How do they differ?

2. Which one of the two syndromes above is more predominant in this patient? What is the
predisposing factors for the syndrome from the scenario?

3. Asthma is considered one of the obstructive disease of pulmonary diseases, explain the
pathological mechanism that is responsible for asthma that causes the asthma attack.

can you solve it not on paper to be easy for me

Answer 1

1. What are the two major clinical disorders/diseases are classified as Chronic Obstructive
Pulmonary -Diseases? How do they differ?

answer 1:

Chronic obstructive pulmonary disease is a group of diseases or disorders which are caused due to the obstruction of airway by chronic inflammation,The two major clinical disorders/diseases that are classified as Chronic Obstructive Pulmonary -Diseases include Chronic Bronchitis and emphysema

The differences between Chronic Bronchitis and emphysema is tabulated below

Differentiating features	Chronic Bronchitis	Emphysema
disease characterisation/clinical manifestation Predominant	Chronic Bronchitis is characterized by chronic inflammation of the airways with increased mucus production leading to airway obstruction and decreased oxygenation. The common clinical manifestation of these patients is described as  blue bloaters(cyanosis,.bloated facial look)	Emphysema is defined as chronic progressive destructive disease of the lungs where there is gradual destruction of the connective tissue adjoining the alveoli leading to poor gas exchange and progressive dyspnea The clinical manifestation here is commonly referred to as Pink puffers.[compensatory polycythemia,puffed look]
etiology	Main causative factor is chronic smoking .The risk factors are exposure to irritants, pollutants, upper respiratory tract infections and weak immunity which cause repeated episodes of acute bronchitis followed by chronicity.	The main causative factor is smoking and the associated risk factors for the development of emphysema are hereditary factors ,male gender predisposition,air pollution, associated asthma and congenital alpha antitrypsin 1 deficiency(genetic enzyme deficiency)
Predominant symptom complex	The chief symptoms of this condition are chronic cough with sputum which can be white,clear, yellow or greenish, breathlessness,chronic fatigue and chest pain	The chief complaints in emphysema is that of gradually increasing progressive breathlessness with difficulty in expiration and visible enlargement of the the [barrel]chest wall.There is scanty sputum production.
main pathology	The main pathology in Chronic Bronchitis is chronic inflammation of the bronchi which causes increased mucus production of sputum and cough and is responsible for the symptoms	The main pathology in emphysema is destructive lung disease where in the connective tissue surrounding the alveoli is destroyed thereby causing alveolar wall damage and poor oxygenation,
treatment	The treatment of chronic bronchitis includes anti inflammatory drugs, bronchodilators antitussive drugs and antibiotics for management of superadded acute bacterial infection	The treatment is by using anti inflammatory drugs like corticosteroids to decrease the destructive process in the lungs along with bronchodilators and oxygen therapy. Surgical lung transplant is the definite procedure for treatment for this disease
chest radiography	Hazy lung fields[infection,inflammation] with prominent vessel markings and enlarged heart due to Cor pulmonale in late stages	Hyperlucent lung fields with hyperinflated lungs and small heart

2. Which one of the two syndromes above is more predominant in this patient? What is the
predisposing factors for the syndrome from the scenario?

answer 2:

The more predominant condition of two syndromes in the above patient is Chronic Bronchitis as he has cough which is productive in nature and has lot of sputum which is the characteristic feature of chronic bronchitis.The main pathology in Chronic Bronchitis is a chronic inflammation of the bronchi which causes increased mucus production and cough and is responsible for the patient's symptoms.

The predisposing factors for the syndrome from the scenario is:

1.Chronic smoking: Smoking is the main predisposing factor for chronic bronchitis and is the cause of the symptomatology in the above patient. He is a smoker for the past 50 years.

Inhalation of the cigarette smoke and the toxic particles in it causes the inflammatory immune response from the cells lining the airways and increases the mucus production. causing cough and breathlessness,

2.Exacerbating factor:common cold
The patient  has hacking cough, increased sputum production.,shortness of breath since the common cold which is the immediate aggravating factor for his symptoms of chronic bronchitis.

3. Asthma is considered one of the obstructive disease of pulmonary diseases, explain the
pathological mechanism that is responsible for asthma that causes the asthma attack.

answer 3:

Asthma is chronic inflammatory disease of the airways caused by allergen-antibody reaction and is considered one of the obstructive disease of pulmonary diseases

The occurrence of an allergic reaction between an intrinsic/extrinsic allergan and IgE antibody in the airways is the main event in the pathophysiology of the asthma

The pathophysiology is outlined in the flowchart and explained in detail below the flowchart

flowchart for pathophysiology of asthma

intrinsic /extrinsic allergan trigger----> allergan -antibody reaction----> stimulation of basophils, mast cells and eosinophils----> release of inflammatory mediators like histamines, leukotrienes, cytokines prostaglandins etc----> increase in the capillary permeability,fluid leakage and airway edema----> stimulation of the bronchus and bronchoconstriction(Ach mediated) ---->decrease in the airway passage lumen leading to airway obstruction----> decreased oxygenation and air flow in the obstructed airways ---->symptomatology of asthma [ breathlessness, wheeze and feeling of constriction in the chest]

explanation:

Pathophysiology of asthma

In predisposed individuals, the exposure of the individual to an external allergan like pollen,dander, dust mites, dirt,cold air,smoke or intrinsic factor like exercise can cause an allergen antibody reaction in the airways and lungs. The chief antibodies mediating the allergen antibody reaction are IgE antibodies. The IgE antibody gets primarily attached to  the mast cells, eosinophils and basophils.On exposure to an allergan, binding of the allergen takes place to the IgE antibody. There is crosslinking of the antibody receptor complexes on the surface of these cells due to allergan binding..The crosslinking leads to the activation of the eosinophils ,basophils and the mast cells and causes the release of inflammatory cytokines along with histamine from these cells.The .inflammatory cytokines t rigger an inflammatory cascade of reactions in the airways leading to airway edema and bronchoconstriction. This causes inflammation of the airway passages and airway obstruction. The airway obstruction is responsible for the symptomatology in acute asthma.

This explains the pathophysiology of asthma.