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Contents 1 Rewrite 2 Asbestosis 3 This 4 Estrogen and lung disease 5 Move to chronic obstructive pulmonary disease? 6 Article Comments 7 Cured meats 8 URLs 9 Pharmacotherapy 10 Exacerbations 11 CAL as synonym for COPD 12 Guidelines 13 Blue Bloater, Pink Puffer 14 Bronchitis 15 No to screening 16 Cannabis Smoking and Other Causes 17 Additions without sources

Rewrite

I have rewritten the introduction and plan on rewriting the rest of the article over the next few weeks. I hope to clear up some of the confusion about what COPD actually is and to make the article a better read. I also plan to address the issues raised here on the talk pages.

Please leave feedback on the changes here near the top of the talk page Jtravers (talk) 14:24, 6 June 2008 (UTC)

This is what I have done so far. Assistance with this job is always much appreciated.

• Reduced the prominence of the term COAD in the introduction because it is in less common use in the scientific literature (2000 vs 28000 hits on Google scholar for example) and the major societies promoting respiratory health and awareness to the public use the term COPD.
• Rewritten the Symptoms and Signs section.
  • Removed mention of hemoptysis because I think it is very uncommon in COPD except if there is also a lung infection.
  • Removed mention of spirometry because I think this belongs in the diagnosis sectiion.Jtravers (talk) 16:00, 10 June 2008 (UTC)
• Rewritten the Etiology section and clarified the role of silica. I agree with Corvus.ag that asbestos does not cause COPD and have removed this section.Jtravers (talk) 21:27, 24 June 2008 (UTC)
• Rewritten the pathophysiology section and renamed it "disease process" as it encomapssed both pathology and pathophysiology. Pathophysiology links will now link to the relevant subsection of "disease process"Jtravers (talk) 14:55, 8 July 2008 (UTC)
• Rewritten Diganosis section.Jtravers (talk) 13:58, 22 July 2008 (UTC)

I have spent over 100 hours completely overhauling this article to be more comprehensive and be of use to a GP who needs a crash course in COPD with links to everything. It is also of use to laymen who want to know more about the risks of occupational exposure to a range of toxins. --Veganfanatic

I've spent a bit of time rewriting this article (mainly from scratch) here. I think this is a big improvement on the current article, but let me know (or edit it) if I've missed anything major. --Scot^t 19:30, 4 February 2007 (UTC)

Overall I like it, far cleaner. I touched up a couple of sentences in your sandbox so that they're more readable in my opinion. The parts I think are missing are pulmonary rehabilitation, which needs at least a mention, and the 0 to IV classifications of severity which I think clarifies the diagnosis a little better. Edit: Mentioning some of the other conditions which fall under the COPD umbrella would be a good idea also. I don't have the information around at the moment, so can't do it myself. MattVickers 04:45, 5 February 2007 (UTC)

Thanks for reading it. I've added in the table for diagnosis and a bit (enough?) on rehab. Was struggling to find something on the other conditions which is why it's not there, would appreciate it if you could add in anything I've missed. --Scot^t 20:03, 5 February 2007 (UTC)

I like the additions. I know I have the information regarding other conditions of COPD around, I just need to dig it up. I'll add it in as soon as I can, along with anything that might be appropriate for the rehab part (I have references for that too), without going into inappropriate detail. MattVickers 07:22, 7 February 2007 (UTC)

Excellent! Do you think it's suitable to move over to replace the main article without those additions? --Scot^t 08:00, 7 February 2007 (UTC)

Asbestosis

Asbestosis is a restrictive/interstitial/diffuse (not an obstructive) lung disease. It's characterized by a decrease in RV and FRC, which is diagnostic of a restrictive disease. An obstructive disease would have an increase in RV and FRC due to the increased compliance associated with this type of disease. As such, it would seem that asbestosis should not be part of this article.

The inclusion of asbestosis with other obstructive lung diseases is also contradicted by the inclusion of asbestosis with restrictive lung disease (as opposed to obstructive lung diseases - ie COPDs) in the article on Lung Disease.

Normally I would wait a bit before deleting this part of the article, but my class is covering this topic right now, and I know at least 'several' people tend to get info from wikipedia, so I would hope that they would be getting the right information.

Other things...

under occupational pollutants, the assertation is made that cadmium and silica are risk factors for COPD. Is this implying that silicosis is a type of COPD? b/c is again is a restrictive lung disease. In general, I think that this subsection needs to be a bit more clear as to whether it is saying that industrial irritants like asbestos, silica, etc. can cause COPD (they can cause restrictive disease), or are simply a risk factor for developing COPD. I do not know whether exposure to these is a risk for other obstructive diseases like emphysema, so I can't make an accurate edit on this section, unless I have a better idea of what point these original statements were trying to make.

reference - http://www.emedicine.com/MED/topic2012.htm - see section 4 for some subtypes of RLDs

If for some reason it turns out I am completely wrong on this one, feel free to reinstate the deletion, and be annoyed at me :P (but please provide some reference)

--corvus.ag (talk) 22:23, 23 February 2008 (UTC)

This

This page could use some epidemilogy statistical information. StudentNurse (talk · contribs)

This page is in an abysmal state, you are right. But the topic is huge and needs a WP:MCOTW. JFW | T@lk 23:57, 28 January 2006 (UTC)

Is asthma a form of C.O.P.D.?

Is C.O.P.D. a form of asthma?

Not strictly speaking. COPD is the combination of at least 2 chronic conditions, ones which don't allow much relief. Although asthma is somewhat chronic, a patient with asthma who developed Emphysema would not be classified as having COPD. The most common combination is Chronic Bronchitis and Emphysema. MattVickers 10:12, 18 January 2007 (UTC)

Estrogen and lung disease

Removed the following misleading paragraph and reference that violates WP:NOR:

Among people over 70 who have never smoked, women make up 85 percent of those with COPD. This appears to be tied to decreases in estrogen as women age. Female mice that had their ovaries removed to deprive them of estrogen lost 45 percent of their working alveoli from their lungs. Upon receiving estrogen, the mice recovered full lung function. Two proteins that are activated by estrogen play distinct roles in breathing. One protein builds new alveoli, the other stimulates the alveoli to expel carbon dioxide. Loss of estrogen hampered both functions in the test mice. (Massaro & Massaro, 2004).

Massaro D, Massaro GD (2004). Estrogen regulates pulmonary alveolar formation, loss, and regeneration in mice. Am J Physiol Lung Cell Mol Physiol. Dec; 287(6):L1154-9. PMID 15298854

Study of 16 mice. Says "about 85% of aged never smokers with COPD are women" citing:

Birring SS, Brightling CE, Bradding P, Entwisle JJ, Vara DD, Grigg J, Wardlaw AJ, Pavord ID. (2002) Clinical, radiologic, and induced sputum features of chronic obstructive pulmonary disease in nonsmokers: a descriptive study. Am J Respir Crit Care Med. Oct 15; 166(8):1078-83. PMID 12379551

Of 441 adults with airflow obstruction seen over 2 years in an outpatient respiratory clinic in Leicester, England, 101 were nonsmokers, of whom 44 had no bronchodilator reversibility, of whom 25 had no explainable cause and no response to a corticosteroid trial, of whom 22 were not found to have another lung disease--their ages ranged from 40 to 82, with a mean age of 70, and 19 (86%) of the 22 were women.

This is misleading. More women than men under and over 70 have never smoked, but:

Behrendt CE (2005). Mild and moderate-to-severe COPD in nonsmokers: distinct demographic profiles. Chest. Sep; 128(3):1239-44. PMID 16162712

NHANES III survey of 16,238 adults age 18-80, of whom 13,995 underwent spirometry, of whom 7,526 (63% female) were nonsmokers, of whom 464 had COPD (403 mild COPD, 61 moderate COPD, 31 severe COPD).

Results: Mild COPD is more prevalent among women nonsmokers under 60, but less prevalent among women nonsmokers over 70. Moderate-severe COPD is less prevalent among women nonsmokers of all ages.

Since there is no reliable source that says decreased estrogen causes COPD, including speculation about the possible clinical revelance of one study of 16 mice violates WP:NOR. 68.253.222.118 07:15, 21 October 2006 (UTC)

I agree that the COPD connection is spurious, but I reinserted the results of the Massaro mouse study into the estrogen article. Unless the study is not reproducible, we should report on it. AxelBoldt 15:41, 21 October 2006 (UTC)

Move to chronic obstructive pulmonary disease?

I don't think chronic obstructive pulmonary disease is "... almost exclusively known only by its acronym". Therefore, per WP:NAME#Prefer_spelled-out_phrases_to_acronyms and WP:NCA, I think the article ought to be named chronic obstructive pulmonary disease.

• Support as per above. Nephron  T|C 07:17, 18 January 2007 (UTC)

Article Comments

Hi,

I a live with COPD and I just want to correct yuo on one thing. The GOLD standard you refer to has changed and no longer has a stage 0 classification. See the GOLD site for reference.—Preceding unsigned comment added by 213.202.148.1 (talk • contribs)

Cured meats

Someone clearly read the BBC news item that cured meats vastly increase the COPD risk. This is based on PMID 17255565. While interesting, this should not be in the intro until confirmed in larger cohorts; it distracts from the simple message that most COPD is due to smoking. JFW | T@lk 11:45, 17 April 2007 (UTC)

URLs

Could whoever added all those references change them from PubMed URLs to real nice academic citations? The most effective way is with Dave Iberri's template filler. JFW | T@lk 18:50, 20 April 2007 (UTC)

I rewrote this article a while back (see above) and since then have sort of lost track of the large edits that have taken place. Perhaps I'm wrong, but it looks to my like a lot of the added information is not really related to COPD (at least, not by any definition I've ever found). If others agree, maybe it should be trimmed as well as fixing the refs? --Scot^t 20:19, 20 April 2007 (UTC)

Trim, trim, trim, and don't stop until sentences like this "Occupationally exposed workers to hazardous materials frequently develop lung disease(s)." have been erased! Mmoneypenny 08:53, 28 April 2007 (UTC)

I've made a start, not sure whether I've been a bit over-trimming. Will move onto the treatment section later, I think it just needs a restructure as most of it is pretty good. --Scot^t 16:17, 28 April 2007 (UTC)

Off-topic material should be removed. If you are not sure, just copy it to the talkpage and we will offer our comments. We should rely as much as possible on published guidelines (e.g. the GOLDCOPD 2006 guidelines, British Thoracic Society etc). All the rest is extra. JFW | T@lk 11:59, 1 May 2007 (UTC)

Pharmacotherapy

"Cromones are mast cell stabilizers that are thought to act on a chloride channel found on mast cells that help reduce the production of histamine and other inflammatory factors. Chromones are also thought to act on IgE-regulated calcium channels on mast cells. Cromoglicate and Nedocromil, which has a longer half-life, are two chromones available.[12]"

Sorry folks, Cromones have NO place in COPD therapy. They are strictly used for allergic conjunctivitis (opthalmic), asthma, and brochospasm prophylaxis (ie asthma attack). This section should be removed.

The person that posted that there is no Stage 0 is correct. There is no longer an "at risk" classification, and I altered the Very Severe to what the current classifications say. I did not delete the at-risk section yet.

We should also add flu shots and pneumovax to the treatment algorithm.

Leukotriene antagonists also have no place in COPD therapy. This needs to be removed. The algorithm goes: SABA => LAAC => LABA => Theo => ICS (if freq hospitalizations) => O2 tx 15 hrs per day. I realize now that acronyms may not make sense: Short acting beta agonist (albuterol), Long acting anti cholinergic (tiotropium...NOT ipratropium-which is short acting), Long acting Beta Agonist, Theophylline, Inhaled Corticosteroid, Oxygen therapy. [[TheAngriestPharmacist] 04:53, 3 May 2007 (UTC)

By all means feel free to fix the treatment bits up. I've started to remove a lot of the irrelevant information, just haven't had time to finished it yet. --Scot^t 07:32, 3 May 2007 (UTC)

Exacerbations

Should there be a section on exacerbations? They are staged by cardinal symptoms (increase sputum volume, increased sputum purulence, and shortness of breath). 1 sx is mild, 2 is moderate, 3 is severe. They are usually caused by infections of Haemophilus influenzae, haemophilus parainfluenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Moderate and severe are treated with 7-10 days of antibiotic therapy (augmentin usually). [[TheAngriestPharmacist] 05:09, 3 May 2007 (UTC)

There should be a VERY comprehensive section on exacerbations and how best to recognise them early and also how to avoid them. Especially for those who are most at risk of an exacerbation causing any serious further lung damage. --Phil Wardle (talk) 11:53, 17 July 2008 (UTC)

CAL as synonym for COPD

I haven't heard of CAL being used as a synonym for COPD. I've changed it back to COPD. Andrew73 16:18, 8 July 2007 (UTC)

-Dear Andrew, my apologies, CAL (Chronic Airway Limitation) is one of those frustrating new acronyms that are used which has replaced COPD. They all mean the same thing and this may seem trivial, but it is actually quite important. These days most UK, Australian and increasingly many more U.S. hospitals are using this as the 'default' title in place of COPD (or others) haha... Sorry to be fussy but I think it is very important to use up to date terms so that the article is easy to find and so that it uses the "correct" title. Whatever that means haha... best wishes, Tom H. (see http://www.abacci.com/wikipedia/topic.aspx?cur_title=Chronic_obstructive_pulmonary_disease, and http://www.ncahs.nsw.gov.au/chronic-disease/index.php?pageid=576&siteid=182, http://www.erj.ersjournals.com/cgi/content/abstract/10/1/114) Tom H. 03:11, 10 July 2007 (UTC)

This may reflect an American bias, but I think COPD is by far, much more widely used than CAL, and this should be reflected in the article. I've yet to hear of someone referring to COPD as CAL. Andrew73 11:34, 10 July 2007 (UTC

Hm yeah this is fair enough, but I think it is still perfectly legit to add it to the synonym list at the top - how about that for now at least? Tom H. 27th Aug

COPD is generally more widely used amoungst Respiratory units and lung function units in Australia. CAL is used and it is used by Respiratory Physicians, but the Pathologists prefer COPD. Most undergraduate pathology and physiology courses use the term COPD with only a very few referring to CAL as an alternate name. Stephen. 13:13 25 July 2007

I am actually hearing CAL used in many hospitals in Sydney, including St George, Liverpool, Sutherland, Prince of Wales and St Vincents. Most patient notes written by recent graduates in health sciences inc. phys. med. are using this term at the moment. Maybe it's just a brief trend but it's what I'm reading at the moment :) Ciao for now, Tom H. 27th Aug

Dear all -- can we please put CAL in as the synonym. This is a bit silly really. Many many textbooks use this. One particular stock standard (Talley and O'Connor's Clinical Examination, A Systematic Guide to Physical Diagnosis) for medical education uses it frequently. Tom H. 6th Nov, 07

Put it in as a synonym but don't let CAL predominate/rename article. My gran died of COPD, which is a disease that's been gaining increased public awareness for decades. I don't know how many non-doctors have ever heard of CAL, and wikip doesn't use the 'most accurate name, esp for a title, it used the most commonly used name.Merkinsmum 23:44, 9 November 2007 (UTC)

Guidelines

There are already NICE guidelines (National Institute for Health and Clinical Excellence. Clinical guideline 12: COPD. London, 2004.), and the American College of Physicians has published their lot: http://www.annals.org/cgi/content/abstract/147/9/633 JFW | T@lk 22:19, 1 November 2007 (UTC)

Blue Bloater, Pink Puffer

Blue Bloater, Pink Puffer, no mention of these terms at all in the article. Both commonly used in textbooks when explaining COPD
Justcop (talk) 02:14, 29 March 2008 (UTC)

I find them massively confusing and not really helpful in distinguishing improvement. JFW | T@lk 08:04, 5 May 2008 (UTC)

Agreed. WAY out of date and really something that my mother's generation used when dealing with end-stage patients as nurses/doctors. Not funny and clinically pretty useless (especially once the cyanosis is obvious).--Phil Wardle (talk) 11:56, 17 July 2008 (UTC)

Bronchitis

Why does this page say "Acute bronchitis usually resolves in 2-10 years" when Acute bronchitis gives the far more accurate prognosis of "several days or weeks"? See http://www.medicinenet.com/bronchitis/article.htm and http://familydoctor.org/online/famdocen/home/common/infections/common/mulitsource/677.html. I am, in fact, so flabbergasted that I'm not even sure what to do to fix it! Orinoco-w (talk) 17:24, 20 April 2008 (UTC)

By clicking "edit this page". JFW | T@lk 08:04, 5 May 2008 (UTC)

No to screening

US Preventive Services Taskforce discourages use of spirometry to screen - NNS is in the 100s. JFW | T@lk 08:04, 5 May 2008 (UTC)

NNT for screening intevention can be much greater than NNT for therapeutic intervention. I believe the NNT for abdominal aortic aneurysm in susceptible populations is around 350. I'll have to look at the USPS guidelines though. Nbauman (talk) 18:53, 17 July 2008 (UTC)

Cannabis Smoking and Other Causes

Way too little mention of other, increasingly common causes of COPD in this article. Mainly (in addition to tobacco smoking) cannabis smoking, as well as other less well known home/industrial precursors. For a poorly understood and recognised disease (by the average layperson) this and related articles should be classified as TOP PRIORITY for raising to exceptional article quality. This disease not only kills nearly as many people as malaria, but it is very poorly understood by the average Joe Smoker and Jane Pothead, it kills slowly and with the sufferers full awareness. It is a major cause of poor quality of life and chronic depression in those afflicted (and by Jesus I should know...I've got it bad enough myself, as have many in the music industry). We have a duty here folks to make this issue (COPD in general) stand out. --Phil Wardle (talk) 12:08, 17 July 2008 (UTC)

The British Lung Association published a study, which I read, on COPD, and they concluded that there was no evidence that cannabis contributed to COPD. I also heard this discussed at a conference in New York City, and none of the experts there knew any evidence that cannabis caused COPD. Unless someone can find a reliable source, we can't make that claim. Nbauman (talk) 18:50, 17 July 2008 (UTC)

There is now some evidence that smoking cannabis is linked to COPD. I have added a citation from a reasonably reliable source. Jtravers (talk) 01:44, 18 July 2008 (UTC)

That article doesn't say anything about COPD. It doesn't support your claims. It merely says:

CONCLUSIONS: Smoking cannabis was associated with a dose-related impairment of large airways function resulting in airflow obstruction and hyperinflation. In contrast, cannabis smoking was seldom associated with macroscopic emphysema.

"Airflow obstruction" is not COPD. For you to draw that conclusion would violate WP:OR.

How does that support your claim that cannabis is linked to COPD? Nbauman (talk) 14:59, 18 July 2008 (UTC)

BTW, when you read the Taylor abstract PMID 12144608 on Pubmed, didn't you see this in the "Related articles"?

http://www.ncbi.nlm.nih.gov/pubmed/9001303

Heavy habitual marijuana smoking does not cause an accelerated decline in FEV1 with age.

Tashkin DP, Simmons MS, Sherrill DL, Coulson AH.

Am J Respir Crit Care Med. 1997 Jan;155(1):141-8.

Although men showed a significant effect of tobacco on FEV1 decline (p < 0.05), in neither men nor women was marijuana smoking associated with greater declines in FEV1 than was nonsmoking, nor was an additive effect of marijuana and tobacco noted, or a significant relationship found between the number of marijuana cigarettes smoked per day and the rate of decline in FEV1. We conclude that regular tobacco, but not marijuana, smoking is associated with greater annual rates of decline in lung function than is nonsmoking. These findings do not support an association between regular marijuana smoking and chronic COPD but do not exclude the possibility of other adverse respiratory effects.

PMID 9001303

It's not good science (and it violates WP:NPOV) to pick only the peer-reviewed studies that agree with your position. Nbauman (talk) 15:16, 18 July 2008 (UTC)

Thank you, a NPOV is especially important here as cannabis always seems to be a controversial topic. As cannabis smoke is very similar to tobacco smoke in composition, it seems very plausible that smoking enough cannabis could cause COPD. Both studies discussed above used pulmonary function testing as a surrogate measure of COPD and came to different conclusions. Without arguing about the relative merits of the studies, perhaps some neutral statement like "...altough the scientific evidence for this is conflicting." is best. Jtravers (talk) 14:36, 21 July 2008 (UTC)

Regarding cannabis smoking (and unfiltered vaporization of cannabis). Cannabis smoke often contains irritants and pollutants that are extra to the cannabis itself. Prime among these are mould spores which CAN cause exacerbations and flare ups of bronchitis (I know; again, because I have had them...try vomiting up a pint of jet black sputum filled with mould....I did that some years ago and ended up in hospital...bad weed grown in a wet late season...result? Accelerated loss of lung function). In regards to COPD of the smaller airways and emphysemia damage to the alveoli, I have not found any papers that confirm this personally. However I have read a papers that cites cannabis as more likely to produce large bullae (basically large empty air sacs)in the lungs which obviously impair lung function and make any fine airway COPD that much worse. http://www.ctsnet.org/sections/clinicalresources/clinicalcases/article-1.html In addition a suspected autoimmune component of COPD in some sufferers (especially those with concomitant asthma) suggests that the highly irritant nature of cannabis smoke for some could be a cause of fine airway inflammation. --Phil Wardle (talk) 03:35, 19 July 2008 (UTC)

That is your personal interpretation and opinion, which you can't include in Wikipedia because it violates WP:OR among other rules. Unless you can find a [[WP:RS] source that specifically says that cannabis causes COPD, it will be deleted. There are many sources, like the one I cited above, that say that cannabis was not associated with COPD. Nbauman (talk)

Which is why I mentioned my inability to find a reliable paper on the subject. At present I can only state that for someone who already has COPD, smoking cannabis is perhaps not in their best interests and in my personal case has made my condition worse (a fact that I would not us for the actual article of course). I'm as much against personal POV as the next contributor. :-) --Phil Wardle (talk) 04:12, 20 July 2008 (UTC)

Additions without sources

You're adding a lot of material that doesn't have sources. Please read WP:RS. All unsourced material must be removed. (There's a lot of unsourced material in the entry right now that should also be sourced or removed.)

Please also read WP:MEDMOS. Wikipedia doesn't give medical advice to patients. WP doesn't tell people when to see a doctor, or how to care for their disease. Nbauman (talk) 05:11, 19 July 2008 (UTC)

OK, then I suggest we revert to before I made any contributions...though I would hope that someone else could clean up the mess that is the bronchitis section. :-) Sorry to cause any problems here, or goof on Wiki guidelines (I admit it gets a bit personal when you have the disease yourself.....and it's a real bastard of a disease). --Phil Wardle (talk) 05:03, 20 July 2008 (UTC)

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