Obstructive Lung Diseases

Disease

Bronchial

Asthma

Atopic (Allergic, Extrinsic) Asthma

Nonatopi c (Intrinsic) Asthma

Mechanism

Hyperreactive airways react to various stimuli and produce episodic bronchoconstriction

Inhaled allergens produce a type I hypersensitivity response with increased eosinophils seen in sputum and peripheral blood

Bronchoconstriction is triggered by infections, cold, and air pollutants, typically in middle-aged adults

Патогенез бронхиальной астмы

Obstructive Lung Diseases

Disease	Mechanism

Chronic Bronchi tis

Chronic irritation of airways (smoking, air pollution) complicated by repeated infections leads to a persistent cough with sputum production for at least 3 months in at least 2 consecutive years. There is hypersecretion of mucus from hypertrophied submucosal glands with goblet cell hyperplasia

хронический бронхит

Obstructive Lung Diseases

Disease

Mechanism

Emphysema

Centrilobular (Centriacinar)

Panlobular (Panacinar)

Paraseptal (Irregular)

Destruction of the normal pulmonary acinar structure leads to dilation of distal airspaces

Predominantly the respiratory bronchioles of the proximal acinar structure are affected, sparing distal alveoli. Mostly seen in smokers. Upper lung fields are predominantly involved. Most common in smokers

All portions of the acinus are involved. Lower lung fields are predominantly involved. Can occur in association with alpah-1-antitrypsin deficiency

Focal scarring, often subpleural, results in dilation of airspaces

эмфизема лёгких

Obstructive Lung Diseases

Disease	Mechanism

Bronchiectasis

Localized

Diffuse

Chronic infection leads to destruction and dilation of bronchi

Focal obstruction from a neoplasm, enlarged lymph nodes, or an inhaled foreign body leads to stasis distal to the obstruction and consequent infection

A congenital condition such as cystic fibrosis, immotile cilia, or Kartagener's syndrome affects all airways and diminishes their normal functioning with mucus obstruction

This is another form of obstructive lung disease known as bronchiectasis. Bronchiectasis occurs when there is obstruction or infection with inflammation and destruction of bronchi so that there is permanent dilation.

Иммуннологические механизмы повреждений лёгких

		Restrictive Lung Diseases
	Disease		Mechanism
	Pneumoconioses		Inhaled inorganic dusts trigger an interstitial
			inflammatory reaction with fibrosis
			Inhaled silica dust produces a fibrogenic
	Silicosis		response in a nodular pattern ("silicotic
			nodules")
			Inhaled asbestos fibers become encrusted with
			calcium and iron ("ferruginous bodies"). Pleural
			plaques (often diaphgragmatic) and interstitial
	Asbestosis		fibrosis occur. The risk of bronchogenic
			carcinoma is increased, particularly in smokers.
			Mesotheliomas can occur but are rare
			The amount of carbonaeous dust inhaled to
	Coal Worker's		produce CWP is far in excess of the simple
			anthracosis that nearly everyone has. "Coal
	Pneumoconiosis
			macules" induce fibrosis
			In this rare condition the inhaled dusts contain
	Berylliosis		beryllium that produces a granulomatous
			response with "sarcoid-like" granulomas