I- Overview :
- Very frequented, willingly ignored, unknown potential evolution.
- 20% progress to IR and the rest dyspnea.
- Every year 1200 DC COPD.
- In France : 3 million, 1/3 presents trbles obstructive lung.
- 6th rank of chronic conditions just after the & rsquo; asthma.
- public health issue.
II- Definition :
clinical definition (anamnestique)
Chronic bronchitis “BC” is a very common condition characterized by an hypersecretion of mucus sufficient to cause a cough bringing back serum-mucous and / or mucopurulent sputum occurring at any time of the day, for at least 3 consecutive months and for at least 2 successive years.
It s & rsquo; also acts d & rsquo; an obstructive ventilatory defect characterized by little or no reversible report.
III- etiological factors :
A- Extrinsic factors :
- active or passive smoking (90 % cases).
- Professional pollution (inhalation of dust, vapors.), industrial, atmospheric, household.
- The weather and climate.
B- Intrinsic factors :
- especially viral infections (viroses explain BC in the & rsquo; child).
- Allergy and bronchial hyperresponsiveness.
- L & rsquo; obesity.
- genetic predisposition (premature).
- Some immune deficiencies (especially secretory IGA and al antitrypsin.)
C- other factors :
- Adverse socioeconomic conditions.
- L & rsquo; age and sex (men more 50 years.)
IV- Anapath :
Histological Changes in BC can be :
- hypertrophy of sero-mucous glands along the & rsquo; tracheo-bronchial tree .
- changing the proportions of the different cells of the & rsquo; epithelium with overproduction of mucus responsible for the & rsquo; airway obstruction .
- airway inflammation with tendency to the & rsquo; atrophy and fibrosis of it
- infection of the mucus n & rsquo; is not mandatory (purulence n & rsquo; not accompanied tjrs l & rsquo; infection).
V- Clinical Diagnostics :
It s & rsquo; is usually d & rsquo; a man 40 – 50 years who consults for a productive chronic cough + dyspnea (can be a woman or a child).
* At & rsquo; interrogation is emphasized :
- Search d & rsquo; raised etiological factors and signs of & rsquo; severe hypoxia (cyanose, hippocratisme digital).
- the characteristics of the cough, l’expectoration.
- dyspnea and characteristics.
* Clinical examination Search :
- sick obese, bréviligne, cyanosé, thorax distendu, with the presence of signs of Hoover (↓ paradoxical the basal diameter thoracic), and sign Combell (↓ distension cartilage with respect to the sternum)
- Groans sounding. Sometimes associated with wheezing.
- Sometimes signs of impact on the heart right (right gallop, signes d’IT, signes d’HTAP, edema of the lower limbs).
WE- Diagnostic Paracliniques :
A- Standard chest radiograph :
It is normal at the beginning, but at an advanced stage, one can find:
1- thoracic distension signs:
- Horizontalization odds
- Increase in & rsquo; intercostal space
- Flattening of the diaphragmatic
2- Signs of parenchymal destruction : A lucency associated with depletion of peripheral vascularization => Installation of emphysema
3- Bronchitic signs : An area-type image.
4- Inflammatory signs: An image reticular micronodular.
5- Rights heart signs: With a cardiomegaly (Htap, dilatation, IVD,…)
B- TDM :
- Make an early and accurate lesion inventory
- Dgc of Kc
- It n & rsquo; is not systematic
- Extended the & rsquo; inflammation and confirmation
- Appearance and abundance of secretions (hemoptysis)
- Bx to d & rsquo; establish a histological dgc (dysmitose : Prior Kc lesion)
- Detecting COPD
- Eliminate any local cause (foreign body)
D- Pulmonary function testing :
But : dgc, prognosis and therapeutic
- classic spirometry : flow rates and gas volumes
- Curve flow / volume : l & rsquo; study of respiratory flow rates (dynamic) Fct in volumes (static)
- Measurement of lung compliances (static and dynamic)
- Measurement of the transfer capacity of CO (DLCO^)
- measurement of arterial blood gases at rest and the & rsquo; stress
E- Biology report.
VII- Evolution :
Variable d & rsquo; s one subject & rsquo; other, depends on the genotype
Evolved by stages, from simple bronchitis chronic bronchitis with disorders & rsquo; hematosis and sometimes to death (does not take into account the time factor)
A- Bluetongue Stadium Chronic bronchitis or single (beginning) : purely clinical, Absence & rsquo; functional respiratory abnormalities, Tiffeneau N, WHOSE / CV >70% (normal)
B- Chronic Bronchitis Stage with Obstructive Ventilation Disorders :
- Dyspnea effort
- Thrust cyanosis.
- Rails sounding with wheezing.
- Signs of thoracic distension and / or parenchymal destruction.
EFR : Sd obstructive little or no reversible
- WHOSE base, low CV, Tiffneau bas <70, high VR, CPT normal, CRFÎTT, lung elasticity preserved but increased resistance.
Depending on COPD can be classified in FEV :
Stade 1 : mild COPD for FEV> 80
Stade 2 : COPD moderate to between FEV 50 and 80%.
Stade 3 : Moderately severe COPD for FEV between 30 and 50%.
Stade 4 : severe COPD for FEV < 30%.
C- Chronic bronchitis Stadium with Disorder & rsquo; hematosis respiratory failure : It must absolutely be corrected. If not, it will cause :
- Ler in time : d & rsquo; hypoxia reflecting the & rsquo; shunting
- in 2nd time : d’hypercapnie (severe if greater than or equal to 60mmHg) sign of seriousness
- polycythemia, Southeast Htap, IVD and d & rsquo; oliguria.
The obstructive syndrome is exacerbated with increased CPT.
VIII- Treatment :
A- Preventive treatment :
- Screening for patients at risk.
- Location and treatment of infections.
- Investigating Causes
B- Medical treatment :
1- Stade catarrhal :
- Chest physiotherapy.
- Antibiotic therapy if infection.
2- Stade obstructif :
- Chest physiotherapy.
- Antibiotic therapy if infection.
- Weight loss if obesity.
- Never d & rsquo; antitussives.
3- Stade d & rsquo; respiratory failure :
- assisted ventilation or oxygen therapy.
- Bled if polycythemia.
- anti-inflammatory (AIS = steroids) : stade III
- Diuretics and anticoagulants.
IX- Differential diagnosis :
- obliterating bronchitis.
- bronchiectasis : DDB.
- cardiac problem : IVG, ICG => dyspnea.
- cystic fibrosis.
Dr Mokrane Course – Faculty of Constantine