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Physiologic Approach to the Diagnosis of Asthma and COPD

Physiologic Approach to the Diagnosis of Asthma and COPD. Edward T Naureckas, MD University of Chicago. Physiologic Approach to the Diagnosis of Asthma and COPD. Disclosure of Conflict of Interest Information I have the following relationships that exist related to this presentation:

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Physiologic Approach to the Diagnosis of Asthma and COPD

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  1. Physiologic Approach to the Diagnosis of Asthma and COPD Edward T Naureckas, MD University of Chicago

  2. Physiologic Approach to the Diagnosis of Asthma and COPD Disclosure of Conflict of Interest Information • I have the following relationships that exist related to this presentation: University of Chicago Refractory Obstructive Lung Disease Center Chicago Asthma Consortium American Lung Association of Metropolitan Chicago American College of Chest Physicians Disclosure information stated above is current as of 3/15/07

  3. Set Theory (Venn Diagrams) A&B A B Neither A nor B

  4. Asthma Versus COPD Asthma COPD Neither Asthma nor COPD

  5. Asthma Versus COPD Emphysema Chronic Bronchitis Asthma Neither Asthma nor COPD

  6. “Lumpers” Vs. “Splitters” A

  7. Asthma Versus COPD • What is the same? • What is different?

  8. Asthma Versus COPD • What is the same? • Expiratory air flow obstruction • What is different?

  9. Expiratory Air Flow Obstruction • In other words • Hard to breath out

  10. Asthma Versus COPD • What is the same? • What is different? • Smokers vs. Nonsmokers? • Reversibility ? • Mechanisms of obstruction?

  11. Smokers and Non-Smokers Case 1 • 55 yo man with a history worsening of wheezing over the past five years and expiratory air flow obstruction on pulmonary function testing. • Childhood history of asthma got a bit better in adolescence states he “outgrew his asthma” • 60 pack year tobacco history • What does he have?

  12. Smokers and Nonsmokers Case 2 • 60 yo woman with progressive shortness of breath and expiratory air flow obstruction on spirometry with no improvement with bronchodilators • Never smoked- husband smoked • No family history of asthma nor any history of childhood asthma • What does she have?

  13. P1 P2

  14. P1 P2

  15. Air Flow Will Decrease With • Decreased Airway Diameter • Decreased Elastic Recoil

  16. Air Flow Will Decrease With • Decreased Airway Diameter • Decreased Elastic Recoil

  17. Air Flow Will Decrease With • Decreased Airway Diameter • Asthma • Chronic Bronchitis (COPD with small airways disease) • Decreased Elastic Recoil

  18. Jean Poiseulle 1799-1869

  19. P1 P2 (P1-P2)p r4 Flow = 8 h l • = Viscosity l = Tube Length r= radius of tube

  20. Forces on an Asthmatic Airway

  21. Forces on an Asthmatic Airway

  22. Airway in Chronic Bronchitis

  23. Air Flow Will Decrease With • Decreased Airway Diameter • Decreased Elastic Recoil

  24. Air Flow Will Decrease With • Decreased Airway Diameter • Decreased Elastic Recoil • Emphysema

  25. Julian Solway’s Demonstration of Dynamic Collapse

  26. What just happened?

  27. D = 3cm D = 2.1cm D = 3cm 140 cm/sec 280 cm/sec 140 cm/sec Pressure = Potential Energy Kinetic Energy

  28. Mouth Alveoli Terminal Bronchi Segmental Bronchi Trachea Cross-sectional Area

  29. . A V Plat Pel(v) Palv Ptm Ppl

  30. Asthma Versus COPD Loss of Recoil Emphysema Chronic Bronchitis Asthma Reversible Narrowing Small And Medium Airways Fixed Narrowing Small Airways Neither Asthma nor COPD

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