Chronic Obstructive Pulmonary Disease Essay

5004 words - 20 pages

Chronic Obstructive Pulmonary Disease

1.2.1

Definitions and Terminology
---------------------------

There are no universally accepted terminology or definition for the
group of conditions characterised by airways obstruction that is
completely reversible (Snider, 1996). There are several problems that
have to be considered. The first results from the use of the term
‘chronic obstructive pulmonary disease’ (COPD), which is considered
inaccurate since this is not truly a disease but a group of diseases.
The second relates to the British preference for the terms ‘chronic
bronchitis’ and ‘emphysema’, which although describing two conditions
with an apparently more precise clinical or pathological definition,
lack any reference to airways obstruction in their definitions. The
third problem, which is the most difficult to resolve, is the concern
over differentiating this condition from asthma, which the terms
‘chronic bronchitis’ and ‘emphysema’ seem to do whereas this is not
the case for COPD. In all the recent consensus statements from
scientific societies, COPD is the term used and considered as a
separate condition from asthma (American Thoracic Society, 1995;
Siafakas, 1995; British Thoracic Society, 1997). This latter problem
is compounded by the fact that persistent airways obstruction in older
chronic asthmatics is often difficult or even impossible to
differentiate from that in COPD, although a history of heavy cigarette
smoking, evidence of emphysema by imaging techniques, decreasing
diffusing capacity for carbon monoxide and chronic hypoxaemia favour a
diagnosis of COPD (Siafakas, 1995).

Chronic bronchitis is defined as the presence of a chronic productive
cough on most days for 3 months, in each of two consecutive years, in
a patient in whom other causes of chronic cough have been excluded
(Medical Research Council, 1965). Emphysema is defined as abnormal,
permanent enlargement of the distal airspaces, distal to the terminal
bronchioles, accompanied by destruction of their walls and without
obvious fibrosis (Snider et al, 1985). Thus chronic bronchitis is
defined in clinical terms, whereas emphysema is defined
pathologically.

A group of synonyms have arisen, which in the UK include chronic
obstructive bronchitis or chronic obstructive bronchitis with airways
obstruction; in the USA, COPD, chronic obstructive airways disease
(COAD) and chronic obstructive lung disease are favoured. However,
the term ‘chronic bronchitis and emphysema’ has often been used
loosely to define a patient with chronic cough and associated airflow
obstruction, although airflow obstruction does not appear in the
definition. The most widely used term is COPD, which has been
accepted by the British Thoracic Society (BTS) guidelines on the
management of...

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