Chronic obstructive pulmonary disease classification: Difference between revisions

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Revision as of 16:08, 13 November 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [3], Mehrian Jafarizade, M.D [4]

Overview

COPD may be classified into two types based on pathology, chronic bronchitis type, and emphysema type. Emphysema may be classified further in to four sub-types such as panacinary, centroacinary, congenital lobar and paraseptal.

Classification

COPD may be classified into two types based on pathology, chronic bronchitis type, and emphysema type.

Chronic Bronchitis

There is no classification system established for chronic bronchitis.

Emphysema

Emphysema can be classified by location into four categories:^[1]

1- Panacinary (panlobular):

The entire respiratory acinus, from respiratory bronchiole to alveoli, is expanded. Occurs more commonly in the lower lobes (especially basal segments) and in the anterior margins of the lungs.^[2]

2- Centroacinary (panacinar and centriacinar):

The respiratory bronchiole (proximal and central part of the acinus) is expanded. The distal acinus or alveoli are unchanged. Occurs more commonly in the upper lobes.^[2]^[3]

3- Congenital lobar emphysema (CLE):

CLE results in over-expansion of a pulmonary lobe, and resultant compression of the remaining lobes of the ipsi-lateral lung (and possibly also the contralateral lung). There is bronchial narrowing because of weakened or absent bronchial cartilage.^[4] There may be congenital extrinsic compression, commonly by an abnormally large pulmonary artery. This causes malformation of bronchial cartilage, making them soft and collapsible.^[4] CLE is a potentially reversible (yet possibly life-threatening) cause of respiratory distress in the neonate.^[4]

4- Paraseptal emphysema:

Para-septal emphysema is a type of emphysema which involves the alveolar ducts and sacs at the lung periphery. The emphysematous areas are sub-pleural in location and often surrounded by inter-lobular septa (hence the name). It may be an incidental finding in young adults, and may be associated with spontaneous pneumothorax. It may also be seen in older patients with centri-lobular emphysema. Both centri-lobular and para-septal emphysema may progress to bullous emphysema. A bulla is defined as being at least 1 cm in diameter, and with a wall less than 1 mm thick. Bullae are thought to arise by air trapping in emphysematous spaces, causing local expansion.^[5]

References

↑ Kumar V, Abbas AK (2009). Robbins Pathologic Basis of Disease. p. 684.
↑ ^2.0 ^2.1 "Emphysema". Retrieved 2008-11-20.
↑ Anderson AE, Foraker AG (1973). "Centrilobular emphysema and panlobular emphysema: two different diseases". Thorax. 28 (5): 547–50. doi:10.1136/thx.28.5.547. PMC 470076. PMID 4784376. Unknown parameter |month= ignored (help)
↑ ^4.0 ^4.1 ^4.2 eMedicine Specialties > Radiology > Pediatrics --> Congenital Lobar Emphysema Author: Beverly P Wood, MD, MS, PhD, University of Southern California. Updated: December 1, 2008
↑ Webb WR, Higgins CB. Thoracic Imaging. Lippincott, Williams & Wilkins 2005.

Template:WikiDoc Sources

[1] Kumar V, Abbas AK (2009). Robbins Pathologic Basis of Disease. p. 684.

[urlEmphysema-2] 2.0 ^2.1 "Emphysema". Retrieved 2008-11-20.

[pmid4784376-3] Anderson AE, Foraker AG (1973). "Centrilobular emphysema and panlobular emphysema: two different diseases". Thorax. 28 (5): 547–50. doi:10.1136/thx.28.5.547. PMC 470076. PMID 4784376. Unknown parameter |month= ignored (help)

[Wood-4] 4.0 ^4.1 ^4.2 eMedicine Specialties > Radiology > Pediatrics --> Congenital Lobar Emphysema Author: Beverly P Wood, MD, MS, PhD, University of Southern California. Updated: December 1, 2008

[5] Webb WR, Higgins CB. Thoracic Imaging. Lippincott, Williams & Wilkins 2005.

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@@ Line 4: / Line 4: @@
 ==Overview==
-Chronic obstructive pulmonary disease is the co-occurrence of [[chronic bronchitis]] and [[emphysema]], a pair of commonly co-existing diseases of the lungs in which the [[airways]] become narrowed.<ref>{{cite web |title=What is COPD? |date=June 01, 2010 |work=National Heart Lung and Blood Institute |publisher=U.S. National Institutes of Health |url=http://www.nhlbi.nih.gov/health/health-topics/topics/copd/}}</ref> This leads to a limitation of the flow of air to and from the lungs, causing [[shortness of breath]] (dyspnea). In clinical practice, COPD is defined by its characteristically low airflow on [[lung function test]]s.<ref name="Nathell">{{cite doi|10.1186/1465-9921-8-89}} [http://respiratory-research.com/content/8/1/89]</ref> In contrast to [[asthma]], this limitation is poorly reversible and usually gets progressively worse over time. In England, an estimated 842,100 of 50&nbsp;million people have a diagnosis of COPD.<ref name="BJGPref">{{cite journal |author=Simpson CR, Hippisley-Cox J, Sheikh A| title= Trends in the epidemiology of chronic obstructive pulmonary disease in England: a national study of 51 804 patients | journal=Brit J Gen Pract |volume=60 |issue=576 |pages=483–488| year=2010 |pmid=20594429 |pmc=2894402| doi= 10.3399/bjgp10X514729}}</ref>
+COPD may be classified into two types based on pathology, chronic bronchitis type, and emphysema type. Emphysema may be classified further in to four sub-types such as panacinary, centroacinary, congenital lobar and paraseptal.
 ==Classification==
+COPD may be classified into two types based on pathology, chronic bronchitis type, and emphysema type.
 ===Chronic Bronchitis===
-{{Main|chronic bronchitis}}
+There is no classification system established for chronic bronchitis.
-Lung damage and inflammation in the large airways results in chronic bronchitis. Chronic bronchitis is defined in clinical terms as a cough with [[sputum]] production on most days for 3&nbsp;months of a year, for 2 consecutive years.<ref name="ohcm">{{cite book |author=Longmore, J. M.; Murray Longmore; Wilkinson, Ian; Supraj R. Rajagopalan |title=Oxford handbook of clinical medicine |publisher=Oxford University Press |location=Oxford [Oxfordshire] |year=2004 |pages=188–9 |isbn=0-19-852558-3 }}</ref> In the airways of the lung, the hallmark of chronic bronchitis is an increased number ([[hyperplasia]]) and increased size ([[hypertrophy]]) of the [[goblet cells]] and [[mucous glands]] of the airway. As a result, there is more mucus than usual in the airways, contributing to narrowing of the airways and causing a cough with sputum. [[Microscope|Microscopically]] there is [[Infiltration (medical)|infiltration]] of the airway walls with [[Inflammation|inflammatory]] cells. Inflammation is followed by scarring and remodeling that thickens the walls and also results in narrowing of the airways. As chronic bronchitis progresses, there is [[squamous metaplasia]] (an abnormal change in the tissue lining the inside of the airway) and [[fibrosis]] (further thickening and scarring of the airway wall). The consequence of these changes is a limitation of airflow.<ref name="kc">{{cite book |author=Kumar P, Clark M |title=Clinical Medicine |publisher=Elsevier Saunders |year=2005 |isbn=0702027634 |pages=900–1 |edition=6th }}</ref>
-Patients with advanced COPD that have primarily chronic bronchitis rather than emphysema were commonly referred to as "Blue Bloaters" because of the bluish color of the skin and lips ([[cyanosis]]) seen in them.<ref>{{cite book |author=Chung C, Delaney J, Hodgins R |chapter=Respirology |editor=Somogyi, Ron; Colman, Rebecca |title=The Toronto notes 2008: a comprehensive medical reference and review for the Medical Council of Canada Qualifying Exam — Part 1 and the United States Medical Licensing Exam — Step 2 |publisher=Toronto Notes for Medical Students |location=Toronto |year=2008 |page=R9 |isbn=0-9685928-8-0 }}</ref> The [[Hypoxia (medical)|hypoxia]] and [[Water retention (medicine)|fluid retention]] leads to them being called "Blue Bloaters".
 ===Emphysema===
-Lung damage and inflammation of the air sacs ([[alveoli]]) results in emphysema. [[Emphysema]] is defined as enlargement of the air spaces [[distal]] to the [[terminal bronchioles]], with destruction of their walls.<ref name="ohcm" /> The destruction of air space walls reduces the [[surface area]] available for the exchange of oxygen and [[carbon dioxide]] during breathing. It also reduces the elasticity of the lung itself, which results in a loss of support for the airways that are embedded in the lung. These airways are more likely to collapse causing further limitation to airflow.
 Emphysema can be classified by location into four categories:<ref>{{cite book |author=Kumar V, Abbas AK |title=Robbins Pathologic Basis of Disease |year=2009 |page=684 }}</ref>
 ==== '''1- Panacinary (panlobular):''' ====