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  Chronic Bronchitis : Inflammation and swelling of the lining of the airways, leading to narrowing and obstruction generally resulting in daily cough. Chronic Bronchitis - Muco-ciliary escalator  In heavy smoker ➝ Tar ↓ Ciliary damage ↓ Failure of muco - ciliary escalator ↓ Stasis of secretion ↓ infection ↓ Pus ↓ Occlusion of respiratory bronchiole Leading to underventilation of alveoli ↓ Very severe hypoxia ⟶ Central Cyanosis (↓↓ PO2) Increased pCO2 ➝ Narcosis , sleeping period increase , weight gain - 'BLUE BLOATERS' Clinical Feature : Wheel chair bound patients Type 2 Respiratory failure Respiratory acidosis Bronchorrhea central cyanosis On Examination : Increased Respiratory Rate Accessory muscles overactivity , subcostal recession Pursed lips, Central Cyanosis(blue bloater) Halitosis Clubbing absent Both inspiratory and expiratory Ronchi Hemoptysis is absent Work up : Spirometry Chest X ray - increased Broncho vascular markings(dirty lungs) IOC - HRCT ABG - Type 2 Respira

 Emphysema is a type of  COPD  (chronic obstructive pulmonary disease). Emphysema is defined as enlargement of the air spaces distal to the terminal bronchioles, with destruction of their walls of the alveoli. Blebs in respiratory airways  Type 1 respiratory failure respiratory alkalosis Air trapping on exhalation and amount of air going out is lesser ↓ So FEV1 less than normal  ↓ On giving Salbutamol, no change in FEV1 So it is a Non Reversible Air flow obstruction On examination : Breathlessness Exercise intolerance Tachypnoea Accessory muscle working excessively Barrel shaped chest ( anterioposterior diameter > Transverse diameter) Liver palpable (due to hyperinflation of lungs) work up : Spirometry HRCT (investigation of choice) - Blebs ABG - Type 1 Respiratory failure (Respiratory Alkalosis) DLco - Diffusion capacity of lung for carbon monoxide - decreased chest x-ray - Flattening of diaphragm - Tubular heart - Lungs appear more black than normal - Vascular markings present Tre

Main diagnostic criteria for bronchial asthma is reversibility of airflow obstruction which is demonstrated by spirometry.                               SPIROMETER : Patient is made to perform forceful inspiration and expiration and flow volume curves are obtained Baseline curve for inspiration part remain same but expiration part patient is not able to push out the air as asthma is disease of expiratory. so, marked concavity in expiration part is present Now salbutamol is given and test is repeated in 10 - 15 min, concavity will reduce significantly (see above) FEV1 decreased ⟶⟶ after S.A.B.A (short acting beta2 agonist) ➝➝ FEV1 normal Methacholine provocation test : It is of historical importance. not done now as may lead to imminent respiratory failure. Eucapnic hyperventilation test : Person is made to breathe in cold air. asthmatics has bronchial hyper reactivity to cold air and FEV1 will fall DIAGNOSTIC CRITERIA : Reversibility (Absolute criteria): asthma is reversible airflow ob

Acute infection of pulmonary parenchyma Causative Organism : Streptococcus pneumoniae (pneumococci) - most common Haemophilus influenzae - 2nd most common Mycoplasma pneumonia Chlamydia pneumonia Rare : Legionella Staphylococcus aureus Gram negative organism ( klebsiella , pseudomonas) virus (adenovirus , meta pneumo virus) In India : - 20% cases of CAP - Tuberculosis - 40% cases of CAP - Not established PATHOLOGY : Initially there is a inhalational of bacteria into the lungs results in phase of Edema  ↓  proteinaceous exudates developed in the alveoli (so there can be a crepitation, crackles of  bronchial breathing in the patient and subsequently patients enter into the following phases) Red hepatization - RBC + Neutrophils (3-4 days) Grey hepatization - RBC lysis + Neutrophils (it signifies successful)(5 -7 days) Resolution - here Macrophages predominantly present because these cells restore the normal tissue Typical / lobar pneumonia : Lobar consolidation causative organism ; - Pneu