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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From a conceptual standpoint, the tests of pulmonary function can be divided into those that assess the ventilatory function of the lungs and those concerned with gas exchange. Tests of ventilatory function reflect alterations of the elastic resistance and flow resistance of the respiratory apparatus. The elastic properties of the lungs are assessed by determining the position and shape of the curve representing the relationship between the pressure across the lungs and absolute lung volume. When there is reduced distensibility of either the lungs or the chest wall, the volume-pressure curve is shifted down and to the right. The slope of the curve is reduced in the patient with pulmonary fibrosis, while it is normal in the patient with obesity. In asthma (or chronic bronchitis) and emphysema, the volume-pressure curve is shifted up and to the left. In emphysema, the slope of the curve is increased, while it is normal in patients with asthma or bronchitis. In practice, lung volume is used as an index of alterations of the volume-pressure characteristics of the lungs and/or chest wall. The vital capacity is often used as a surrogate for the TLC but it is lower than expected in both restrictive and obstructive disorders. The FEV1.0 reflects the degree of expiratory flow limitation. In a restrictive disorder, lung volume and the FEV1.0 are reduced, but the FEV1.0/FVC ratio is normal. In airflow limitation, lung volume, the FEV1.0, and the FEV1.0/FVC ratio are lower than expected. In airflow limitation, the reversibility with inhaled bronchodilator should be determined. Tests of airway responsiveness are indicated when evaluating patients with unexplained chronic cough, chest tightness, or wheezing, particularly if other lung function tests are normal. The adequacy of gas exchange is assessed by determining the arterial blood gas tensions--PaO2 and PaCO2--and the alveoloarterial pO2 gradient--P(A-a)O2. A lower-than-expected PaO2 can result from several different physiologic disturbances. When alveolar hypoventilation is the sole disturbance, the oxygen in the alveoli and in the blood perfusing them virtually comes into equilibrium, so that the P(A-a)O2 is normal. An elevated P(A-a)O2 is caused by either mismatching of ventilation and perfusion, true venous admixture, a diffusion abnormality, or a combination of these disturbances. Because dyspnea on exertion is a cardinal symptom of respiratory disease, exercise tolerance should be assessed. A reduced exercise tolerance may result from ventilatory limitation, impaired gas exchange, cardiac impairment, impaired delivery of the oxygen to the working muscles, or an inability to use the energy.
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PMID:Evaluation of respiratory function in health and disease. 160 91

1. Laennec's lung disease lasted for at least 20 years. Its stigmata included chronic cough, sputum production and intermittent wheeze. 2. Laennec had long term stigmata commonly associated with chronic bronchiectasis, sinusitis, physical frailty, and short stature (5ft 2in). 3. Chronic diarrhoea of at least 20 years duration is not strongly associated with tuberculosis. 4. During Laennec's last illness his physicians equivocated as to whether he had respiratory disease at all. Bronchial breathing at the apex, if indeed present, could have been caused by compensatory emphysema secondary to middle lobe bronchiectasis rather than to active tuberculosis. 5. Laennec did not have haemoptysis in his final illness. 6. Laennec's last illness, a wasting illness characterised by intermittent fevers, cardiac murmur, and persistent tachycardia followed a dental manipulation. The painful "abdominal abscess" noted by Laennec's colleagues may actually have been splenomegaly. These features suggest endocarditis. The cardiac murmurs associated with pulmonary hypertension secondary to bronchiectasis are not usually audible at a remote distance from the patient. Endocarditis was a disease largely unknown to physicians of the early 19th century before Osler clarified its pathology in the 1880s.
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PMID:Rene Laennec: his brilliant life and tragic early death. 266 72

Emphysema and a variety of lesions directly involving the conducting airways constitute the morphologic basis of air-flow obstruction in chronic obstructive pulmonary disease (COPD). Traditionally, inflammation and hypertrophy of the mucus-secreting elements within the central airways (chronic bronchitis), manifest clinically by chronic cough and recurrent bouts of purulent sputum expectoration due to infection, were held to be important in the development of COPD. While chronic cough and purulent bronchitis contribute to the morbidity associated with established COPD, epidemiologic studies suggest that neither is an independent factor in its causation. Furthermore, structure-function studies indicate that lesions in the distal bronchial tree (peripheral airways disease) are functionally more important than central airways disease in the genesis of air-flow obstruction. The severity of peripheral airways increases with advancing age, but it is only weakly related to the history of cigarette use. Other causes of peripheral airways disease have not been clearly elucidated, but a role for viruses, and certain other infectious agents, has been suggested by experimental animal studies.
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PMID:The role of chronic bronchitis in the pathogenesis of chronic obstructive pulmonary disease. 328 79

One hundred men and 100 women between the ages of 70 and 89 years were examined clinically and with pulmonary function tests to determine the prevalence and type of chronic obstructive bronchopulmonary disease in very old people. Rhonchi were present in 45% of the old men and 24% of the old women. Obstruction to air flow (FEV(1) < 60% of FVC) was demonstrated in 23% of the men and 6% of the women. Chronic bronchitis was present in 32% and 12% of the old men and women, respectively. Only five individuals, all men, showed emphysema as defined by significant obstruction to air flow with a low diffusing capacity. In old people there was a relationship between smoking, chronic cough and obstruction to air flow.
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PMID:The prevalence and type of chronic obstructive bronchopulmonary disease in very old people. 495 76

The role of genetic or familial factors in the development of bronchopulmonary dysplasia (BPD) has not been evaluated. Detailed histories concerning asthma, allergy, and other lung diseases were obtained on first and second degree relatives of 17 infants with BPD, and 21 infants who had hyaline membrane disease but who did not develop BPD (HMD group). All infants in the BPD and HMD groups had hyaline membrane disease requiring assisted ventilation and greater than 50% inspired oxygen in the first five days of life. The diagnosis of HMD and BPD were made on radiographic and clinical criteria. Of the 17 infants with BPD, 13 had first or second degree relatives with physician-diagnosed asthma, compared to seven of 21 in the HMD group (P less than .01). In addition, a significantly greater number of relatives of BPD infants (P less than .005) had been hospitalized for their asthma as compared to HMD relatives. There were no differences between the groups for allergic rhinitis, eczema, bronchitis, emphysema, chronic cough, smoking, or wheezing with respiratory illnesses. These results suggest the possibility that airways with a genetic predisposition for reactivity may become highly reactive following neonatal lung disorders and their treatment. These irritable airways may then contribute to the development, or progression, or both of BPD.
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PMID:Family history of asthma in infants with bronchopulmonary dysplasia. 737 38

Advances in the understanding of human respiratory disease can come from careful clinical studies of the diseases as they occur in man, but such studies are naturally limited in terms of experimental manipulation. In the last 2 decades, an increasingly complex plethora of experimental respiratory disease models has been developed and utilized by investigators, but relatively less attention has been paid to the naturally occurring pulmonary diseases of animals as potential models. This paper is aimed at presenting selected examples of spontaneous pulmonary disease in animals that may serve as exploitable models for human chronic bronchitis, bronchiectasis, emphysema, interstitial lung disease, hypersensitivity pneumonitis, hyaline membrane disease, and bronchial asthma. Chronic bronchitis in dogs is characterized by chronic cough, excessive mucus production, and chronic inflammatory changes in bronchial walls. The disease affects mainly smaller-breed dogs of middle age or older. Equine chronic bronchitis tends to be a small airway disease with marked goblet cell proliferation and excessive mucus production, which may be accompanied by alveolar emphysema. Many animals develop bronchiectasis or bronchiolitis obliterans secondary to chronic suppurative bronchopneumonia, but chronic respiratory disease (CRD) of rats may be the most useful model of bronchiectasis. Models for emphysema must include actual alveolar destruction and ideally should be accompanied by appropriate pathophysiologic decrements. Many animals occasionally develop emphysema, but the disease has not been well documented, except possibly in horses. The interstitial lung diseases of man represent a complicated and poorly understood group of entities and near-entities. The same is true for animals, although interstitial lung disease in animals is much less common than bronchopneumonia. Cattle seem prone to develop interstitial lesions. Proliferative interstitial pneumonia of cattle includes many morphologic similarities to the spectrum of human interstitial pneumonitides. Fibrosing alveolitis of cattle is a morphologic end point that may have its origins in different forms of interstitial injury. Hypersensitivity pneumonitis has been best detailed in cattle and in horses and is clinically, etiologically, immunologically, and morphologically similar to the disease in man. Hyaline membrane disease has been poorly documented in animals, with the possible exception of the neonatal respiratory distress syndromes of foals and piglets. Bronchial asthma is similarly not well established as a spontaneous disease in animals, although experimental models exist. Eosinophilic bronchiolitis of cattle may represent a useful asthma model but has been poorly detailed. In order to make them useful as models, more attention should be paid to detailing the clinical, morphologic, and etiologic aspects of these naturally occurring animal pulmonary diseases.
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PMID:Criteria for development of animal models of diseases of the respiratory system: the comparative approach in respiratory disease model development. 745 67

Spirometry was performed by 5,201 elderly participants of the Cardiovascular Health Study during their baseline examination and a subset of the ATS/DLD-78 respiratory questionnaire was administered by trained interviewers. In never smokers (46 percent of the cohort), the overall prevalence of chronic cough was 9 percent, chronic phlegm was 13 percent, attacks of wheezing with dyspnea were 8 percent, and grade 3 dyspnea on exertion was 10 percent. The prevalence of lung disease in current smokers (12 percent of the cohort) was 8/7 percent (men/women) with chronic bronchitis and 14/5 percent with emphysema. Overall, 6 percent reported asthma (a physician-confirmed history) and 12 percent reported hay fever. Using a logistic regression model, attacks of wheezing with dyspnea were strongly associated with a lower FEV1, coronary heart disease, heart failure, and a large waist size (in participants without a diagnosis of asthma, chronic bronchitis, or emphysema). Undiagnosed airways obstruction was twice as likely in women and those with lower income, and was associated with current and former smoking, pack-years of smoking, and chronic cough. Dyspnea on exertion (DOE) was three times or more likely if a participant reported heart failure, coronary heart disease, or emphysema; and much more likely if their FEV1 or FVC was substantially reduced. Dyspnea on exertion was also positively associated with older age, chronic bronchitis or asthma, a larger waist or hip size, pack-years of smoking, and less education. We conclude that DOE and attacks of wheezing with dyspnea are commonly associated with cardiovascular disease and a low FEV1 in those over 65 years and that airways obstruction frequently remains undiagnosed in the elderly.
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PMID:Prevalence and correlates of respiratory symptoms and disease in the elderly. Cardiovascular Health Study. 808 66

Four women with a chronic respiratory illness characterized by chronic cough, dyspnea, mild to severe physiologic abnormalities, relatively normal chest radiographs, and lack of response to bronchodilators or prednisone were identified and prospectively evaluated. Constrictive bronchiolitis, defined as concentric narrowing of the bronchiolar lumen, mural scarring, smooth muscle hyperplasia, and mucus stasis, was the major histologic finding on open lung biopsy in all cases. Each presented with an illness clinically distinct from asthma, connective tissue disorders, occupational or environmental lung disease, bronchiectasis, diffuse panbronchiolitis, cystic fibrosis, and emphysema. None of the patients smoked cigarettes. None had clinical evidence of a recent viral lower respiratory tract infection. The physical examinations were normal except for rales heard on chest examination in two patients. Chest radiographs showed increased bronchovascular markings in three patients. Lung function was normal in one patient, two of the patients had a reduced diffusing capacity associated with moderate hypoxemia and an obstructive ventilatory defect, and one patient exhibited a mixture of restrictive and obstructive defects. None have experienced significant progression of their disease over 1 to 5 yr of follow-up. However, complete return to normal function did not occur. We hypothesize that patients with the constellation of findings described represent a distinct and definable clinicopathologic entity and further clarifies the spectrum of "small airways disease." Establishing the diagnosis appears important for prognostic and possibly therapeutic reasons.
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PMID:Cryptogenic constrictive bronchiolitis. A clinicopathologic study. 821 31

Peripheral airways of lung biopsies from patients with HP commonly show several morphologic changes, including inflammation, fibrosis, or both. In most cases, damage of the airways is parallel to damage of surrounding parenchyma and the functional result is lung restriction, perhaps with alterations in the so-called "small airway tests." Chronic cough and phlegm also are more common in subjects exposed to organic antigens. Overt airflow obstruction is present in a number of patients with HP, and they usually have other risk factors, such as asthma, cigarette smoking, or dust inhalation. There are limited studies of patients who have HP and CAO but not concomitant risk factors for CAO, making it difficult to reach any firm conclusion about their association. In most cases, the lesion that could explain severe airflow obstruction seems to be located in bronchioles but, based on several clinical reports, there is the possibility that HP occasionally ends in emphysema.
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PMID:Airflow obstruction and airway lesions in hypersensitivity pneumonitis. 831 74

Respiratory diseases can cause considerable disability in the elderly because of their limited respiratory reserve as a result of ageing. We have investigated the prevalence of respiratory symptoms and diseases in elderly Chinese in Hong Kong and compared these data with those in elderly Caucasian populations. Two thousand and thirty two (999 male and 1,033 female) subjects, selected by age-stratified random sampling from a register of Hong Kong residents aged 70 yrs and over were interviewed to complete a respiratory questionnaire. Total serum immunoglobulin E (IgE) was measured in 195 subjects. At least one respiratory symptom was reported by 56% of subjects. The most frequently reported symptoms were morning phlegm (26%), chronic cough with phlegm (10%) and wheeze in the past 12 months (8%). Of the self-reported diseases, the commonest was chronic bronchitis (7%), followed by asthma (5%), pulmonary tuberculosis (3%) and emphysema (2%). Of the 218 subjects with obstructive airway diseases, 128 (59%) had sought medical advice in the past 12 months. The most important determinants for respiratory symptoms and diseases were smoking and social class. Total serum IgE was significantly higher in current smokers than nonsmokers and also in those with chronic cough and phlegm than those without these complaints. Our study shows that respiratory ailments in Hong Kong elderly are as common as those reported in Sweden and the USA but less than those in England.
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PMID:Respiratory symptoms in elderly Chinese living in Hong Kong. 866


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