Chronic obstructive pulmonary disease classification: Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
__NOTOC__ | |||
{{Chronic obstructive pulmonary disease}} | {{Chronic obstructive pulmonary disease}} | ||
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AOEIC}} {{CZ}} | {{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AOEIC}} {{CZ}} | ||
==Overview== | ==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 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> | |||
==Classification== | ==Classification== | ||
===Chronic | ===Chronic Bronchitis=== | ||
{{Main|chronic bronchitis}} | {{Main|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 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> | 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 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> | ||
| Line 28: | Line 29: | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Primary care]] | |||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Revision as of 21:08, 26 February 2013
|
Chronic obstructive pulmonary disease Microchapters |
|
Differentiating Chronic obstructive pulmonary disease from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Chronic obstructive pulmonary disease classification On the Web |
|
American Roentgen Ray Society Images of Chronic obstructive pulmonary disease classification |
|
Chronic obstructive pulmonary disease classification in the news |
|
Blogs on Chronic obstructive pulmonary disease classification |
|
Directions to Hospitals Treating Chronic obstructive pulmonary disease |
|
Risk calculators and risk factors for Chronic obstructive pulmonary disease classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Philip Marcus, M.D., M.P.H. [3]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [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.[1] 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 tests.[2] In contrast to asthma, this limitation is poorly reversible and usually gets progressively worse over time. In England, an estimated 842,100 of 50 million people have a diagnosis of COPD.[3]
Classification
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 months of a year, for 2 consecutive years.[4] 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. Microscopically there is infiltration of the airway walls with 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.[5]
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.[6] The hypoxia and 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.[4] 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.
There are 4 types of emphysema:
- Centriacinar / centrilobular: proximal to central parts of acini (air spaces closer to bronchioles) are affected
- Panacinar / panlobular: enlargement of all air spaces (from bronchioles to terminal blind alveoli). This type is associated with alpha-1-antitrypsin deficiency
- Distal acinar / paraseptal: proximal acinus normal, distal acinus affected
- Irregular: various parts of acinus involved. Associated with fibrosis.[7]
References
- ↑ "What is COPD?". National Heart Lung and Blood Institute. U.S. National Institutes of Health. June 01, 2010. Check date values in:
|date=(help) - ↑ Template:Cite doi [1]
- ↑ Simpson CR, Hippisley-Cox J, Sheikh A (2010). "Trends in the epidemiology of chronic obstructive pulmonary disease in England: a national study of 51 804 patients". Brit J Gen Pract. 60 (576): 483–488. doi:10.3399/bjgp10X514729. PMC 2894402. PMID 20594429.
- ↑ 4.0 4.1 Longmore, J. M.; Murray Longmore; Wilkinson, Ian; Supraj R. Rajagopalan (2004). Oxford handbook of clinical medicine. Oxford [Oxfordshire]: Oxford University Press. pp. 188–9. ISBN 0-19-852558-3.
- ↑ Kumar P, Clark M (2005). Clinical Medicine (6th ed.). Elsevier Saunders. pp. 900–1. ISBN 0702027634.
- ↑ Chung C, Delaney J, Hodgins R (2008). "Respirology". In Somogyi, Ron; Colman, Rebecca. 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. Toronto: Toronto Notes for Medical Students. p. R9. ISBN 0-9685928-8-0.
- ↑ Kumar V, Abbas AK (2009). Robbins Pathologic Basis of Disease. p. 684.