Download - Sindromes obstructivos
![Page 1: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/1.jpg)
Enfoque Diagnóstico del Síndrome Obstructivo Bronquial en el Adulto
JORGE CORNEJO PORTELLAMédico Neumólogo
UNIVERSIDAD NACIONAL DE TRUJILLO
![Page 2: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/2.jpg)
¿En qué radica la importancia?
![Page 3: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/3.jpg)
Chest 2007;131:60–67
![Page 4: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/4.jpg)
Subdiagnóstico (89%) Mal Diagnóstico (64%)
Chest 2007;131:60–67
Total (Prior Diag.) 237
![Page 5: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/5.jpg)
Chest 2007;131:60–67
![Page 6: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/6.jpg)
OBJETIVOS DE LA SECION
Explicar los mecanismos fisiológicos y fisiopatológicos de la obstrucción al flujo aéreo.
Diferenciar los principales trastornos funcionales y su relación con algunas enfermedades.
![Page 7: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/7.jpg)
Fisiología
![Page 8: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/8.jpg)
Flujo aéreo a través de tubos:FLUJO LAMINAR
Poiseuille:
![Page 9: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/9.jpg)
Flujo aéreo a través de tubos:FLUJO TURBULENTO
![Page 10: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/10.jpg)
Reynolds number (Re), a dimensionless number that depends on the average velocity (v), the density of the gas (ρ), the viscosity of the gas (η), and the diameter of the tube (D)
Flujo aéreo a través de tubos:FLUJO DE TRANSICION
![Page 11: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/11.jpg)
Fig. Flow of gas molecules into an acinus during tidal breathing. Penetration into the alveolar ducts is by bulk flow. The alveoli and the zone of nearly stationary gas at the periphery of airways are ventilated by diffusion
![Page 12: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/12.jpg)
¿Cómo se define Resistencia?
![Page 13: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/13.jpg)
FIGURE: Bag-and-tube analogy of the respiratory system, whereΔPTM= change in transmural pressure (inside − outside) of bag; ΔV = change in volume; C = compliance. V = flow; R = resistance; and ΔPtube = pressure difference from one end of the tube to the other
Donde:V= Flujo aéreo (L/s)PA = presión alveolar(cmH2O)Pao = presión de la vía aérea abierta (cmH2O)Raw = resistencia de la vía aérea (cmH2O/L/s)
![Page 14: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/14.jpg)
Obstrucción al flujo aéreo
Retroceso
Elástico
Resistencia Por
Fricción
Fuerza Muscular
![Page 15: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/15.jpg)
Obstrucción al flujo aéreo
Resistencia de la Vía Aérea
Tono de la Vía Aérea
Volumen Pulmonar Tipo de flujo
![Page 16: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/16.jpg)
![Page 17: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/17.jpg)
COMPRESION DINAMICA: Colapso de la Vía aérea relacionado al Flujo
![Page 18: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/18.jpg)
![Page 19: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/19.jpg)
TENDENCIA AL COLAPSO
VEF-1
Reproducible
Propiedades Elásticas
Resistencia de la Vía
Aérea
![Page 20: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/20.jpg)
![Page 21: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/21.jpg)
![Page 22: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/22.jpg)
Y ¿qué mecanismo lo causaría?
![Page 23: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/23.jpg)
MECANISMOS
Fig. 4-1. Mecanismos responsables de la obstrucción de las vías aéreas
![Page 24: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/24.jpg)
Y ¿qué signos se encuentran?
![Page 25: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/25.jpg)
![Page 26: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/26.jpg)
Acoustic Characteristics
ATS nomenclature
Common Synonyms
Continuous sounds (> 250 msec, high-pitched; dominant frequency of 400 Hz or more, a hissing sound)
WheezeSibilant
rhonchus
Continuous sounds (> 250 msec, low-pitched; dominant frequency about =200 Hz, a snoring sound)
RhonchusSonorous rhonchus
![Page 27: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/27.jpg)
![Page 28: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/28.jpg)
![Page 29: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/29.jpg)
![Page 30: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/30.jpg)
![Page 31: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/31.jpg)
¿Ante qué enfermedad nos enfrentamos?
![Page 32: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/32.jpg)
ASMA
Limitación del flujo aéreoReversible+ Reversible +/-
Inflamación de las vías aéreas
Linfocitos-T CD4+Eosinófilos
Inflamación de las vías aéreasLinfocitos-T CD8+
Macrófago/Neutrófilo
EPOCComienzo Temprano
HRBRespuesta a esteroides
Comienzo tardíoAsociado a tabaquismo
Sin respuesta a esteroides
![Page 33: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/33.jpg)
![Page 34: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/34.jpg)
![Page 35: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/35.jpg)
![Page 36: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/36.jpg)
![Page 37: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/37.jpg)
Figure: Airway remodeling in asthma is depicted through representations of the airway wall in health (left) and in asthma (right). In asthma there is goblet cell hyperplasia/hypertrophy, subepithelial fibrosis, increased 18
![Page 38: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/38.jpg)
ATS. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. AJRCCM 1995.
![Page 39: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/39.jpg)
Proportional classifications of COPD phenotypes. Thorax. 2008 September; 63(9): 761–767.
20%
19%
55%
26%
30%
32%
![Page 40: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/40.jpg)
ASMAEPOC
![Page 41: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/41.jpg)
¿Qué examen funcional deberíamos emplear?
![Page 42: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/42.jpg)
Equipo
Aceptable
Interpretación
Reproducible
![Page 43: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/43.jpg)
¿Y pueden coexistir las dos enfermedades?
![Page 44: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/44.jpg)
Obstrucción Crónica al Flujo Aéreo
ASMA EPOC
![Page 45: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/45.jpg)
Hipótesis DutchChronic Non-Specific Lung Disease
(CNSLD)
En 1961, Orie et al. plantearon la hipótesis que las enfermedades crónicas obstructivas de la vía aérea como el asma, BC y enfisema representan diferentes fenotipos de un proceso común pato-genético– Fletcher et al. luego empleó el término de “Dutch hypothesis”.
Una predisposición hereditaria desarrollar alergia e Hiperreactividad de la vía aérea (HRA) fue planteado como un importante factor de susceptibilidad para esta enfermedad
![Page 46: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/46.jpg)
Interacciones probables entre Asma y EPOC
Genetic Susceptibility Asthma
Environmental Factors COPD
Airway InflammationAirway Hyperresponsiveness
Allergy, Infection, Smoking, Air Pollution
E.R. Bleecker. Chest 2004;126:93S-95S
![Page 47: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/47.jpg)
Síndrome de superposición entre Asma y EPOC: Estudio
PLATINO
Chest 2007;131:60–67
![Page 48: Sindromes obstructivos](https://reader034.vdocuments.site/reader034/viewer/2022051414/55c913b2bb61eb3f258b460e/html5/thumbnails/48.jpg)