Talk:Chronic obstructive pulmonary disease

End to the confusion

Doc James (talk · contribs) In the link to the Ferri's ebook you gave on this page, it states the following:

"Traditionally COPD was described as encompassing emphysema, characterised by loss of lung elasticity and destruction of lung parenchyma with enlargement of air spaces, and chronic bronchitis, characterised by obstruction of small airways and productive cough - 3 months for more than 2 successive years. These terms are no longer included in the definition of COPD, although they are still used clinically.” (page 299)

This is an updated newer version that reflects the GOLD position, and is a very clearly written paragraph. All the confusion has arisen from the mismatch of older and newer information on the page. If this newer reading is instead incorporated into the lead thus changing the version that refers to 'older terms' all else could follow through, including the reinstatement of the clinical use of chronic bronchitis and emphysema. I really do hope that you can appreciate the difference this would make.--Iztwoz (talk) 19:11, 5 June 2019 (UTC)

Yes and this means that COPD used to be broken into two types, emphysema and chronic bronchitis (thus they are older terms for types of COPD). Though people still often use these terms when they mean COPD.

Chronic bronchitis is still a clinical description (ie it is still used as a symptom). Though it should no longer be used for COPD even though it is.

Doc James (talk · contribs · email) 20:13, 5 June 2019 (UTC)

You appear to refuse to accept what the World Health Organization has written which is:

"Chronic Obstructive Pulmonary Disease (COPD) is not one single disease but an umbrella term used to describe chronic lung diseases that cause limitations in lung airflow. The more familiar terms 'chronic bronchitis' and 'emphysema' are no longer used, but are now included within the COPD diagnosis."

https://www.who.int/respiratory/copd/en/

The more recent description which you refuse to acknowledge is given on

https://www.who.int/en/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd) --Iztwoz (talk) 15:15, 15 June 2019 (UTC)

I am not sure why? WHO is an excellent source. Yes it is confusing. The same term can be used in different ways. One does not need to try to force consistently into the language. This same problem exists in a number of medical topics. Doc James (talk · contribs · email) 20:23, 5 June 2019 (UTC)

My only issue is with the use of "older terms" and their meaning to you....these terms are the same topics of chronic bronchitis and emphysema both of which are primary topics - yet they have been submerged on the COPD page. As brought up before the refs do not use the language of "older terms" - familiar terms is not the same reading. GOLD does not include them in the definition of COPD which is what most of this page stands by - yet there's the strange redirection of chronic bronchitis and emphysema here which are not included in the definition. i don't know why the newer definition of Ferri's that i posted is not welcomed by you - it is very clear, very up to date and does not confuse issues by speaking of older terms.--Iztwoz (talk) 17:46, 7 June 2019 (UTC)

Yes Ferri says "Traditionally (that means historically or before) COPD was described as encompassing emphysema... and chronic bronchitis... These terms are no longer included in the definition of COPD."

So agrees with WHO, GOLD, the CDC, and our article.

We have redirected these old terms to the new term which is COPD.

So again why do you refuse to accept the WHO as a valid source? It is clear that "emphysema" and "chronic bronchitis" are older terms that were used for types of COPD but such use is no longer recommended. Doc James (talk · contribs · email) 00:26, 10 June 2019 (UTC)

Traditionally does not mean historically - traditional means long-standing and current - for example 'it is traditional to have turkey at Christmas or Thanksgiving' and he wasn't writing about the traditional use of the terms - he writes that -traditionally COPD was described using the terms - now COPD is not so described (and the terms remain the same).--Iztwoz (talk) 15:10, 15 June 2019 (UTC)

Together with the WHO "The more familiar terms 'chronic bronchitis' and 'emphysema' are no longer used, but are now included within the COPD diagnosis." the meaning is clear. Doc James (talk · contribs · email) 03:26, 16 June 2019 (UTC)

Questions for you

I am unclear what you are pushing for:

1) Do you agree that chronic bronchitis and emphysema were once terms for types of COPD? Doc James (talk · contribs · email) 03:22, 16 June 2019 (UTC)

I agree that COPD is a newer umbrella term that the more familiar names of chronic bronchitis and emphysema related to.--Iztwoz (talk) 14:55, 15 June 2019 (UTC)

2) Do you agree that these terms are no longer recognized as types of COPD? Doc James (talk · contribs · email) 03:22, 16 June 2019 (UTC)

Yes and that the the familiar terms now exist as their own entity, with their own identity. As mentioned elsewhere the 'terms' are still referring to the diseases however defined. BUT many sources describe them as types of COPD.--Iztwoz (talk) 14:55, 15 June 2019 (UTC)

I'm sure I made this point before - there is no reason to have used the phrase "older terms for COPD" and made these items bold after redirecting them - they had their primary topic places; and even using the same words (not in the refs given) without bolding and making redirects would have 'worked' and not generated all this confusion. Confusion for the general reader that is.--Iztwoz (talk) 14:55, 15 June 2019 (UTC)

3) Do you agree that chronic bronchitis remains a symptom defined condition? Doc James (talk · contribs · email) 03:22, 16 June 2019 (UTC)

I agree that chronic bronchitis is a symptom defined condition that is described as a disease - it is a long-term condition of the disease Bronchitis. Most references including MeSH and ICD11 describe it as a disease (even GOLD) describes it as a disease entity.--Iztwoz (talk) 14:55, 15 June 2019 (UTC)

4) Do you agree that emphysema remains a pathological change? Doc James (talk · contribs · email) 00:44, 10 June 2019 (UTC)

Emphysema as far as I know has always been described as such but it still does not negate its description as a disease - a disease being anything structurally or pathologically different from the norm. A look through ncbi databases will show its constant and current reference as a disease. Even if you cannot bring yourself to acknowledge others' use of the term disease - emphysema still needs its own page. As noted before, when I last looked there were over 16 million hits for emphysema and far less than a million for pneumatosis. Since this is the usually known search for pulmonary emphysema how can it not have its own page?--Iztwoz (talk) 14:55, 15 June 2019 (UTC)

Primary source?

In MEDRS - a section headed Medical and scientific organisations states that info from the National Academy of Sciences is acceptable - so how is the journal of the NAS the PNAS not acceptable and said to be a primary source? What am I missing here? --Iztwoz (talk) 19:31, 7 July 2019 (UTC)

An overarching principle of MEDRS is that single primary studies are not adequate sources for encyclopedia articles. This study (doi:doi/10.1073/pnas.1715564115), while interesting from an academic perspective, is a primary source and its precise relevance in the broader context of the body of knowledge about COPD is not established unless this has been established by a secondary source.

I note that this article has been cited by secondary sources (for instance doi:10.1183/13993003.01570-2018 and also doi:10.1242/dev.163485) and these are secondary sources that might be appropriate for citation.

I would caution against citing ongoing studies, even if they have over 10,000 participants[1] because the outcome cannot be anticipated and its impact is unknowable. JFW | T@lk 20:56, 7 July 2019 (UTC)

Thanks for your response.--Iztwoz (talk) 21:31, 7 July 2019 (UTC)

JFW A big thank you for the links they will be very helpful to me.--Iztwoz (talk) 08:58, 8 July 2019 (UTC)

Potential new subheading for Management section

I'm new to Wikipedia so please forgive any neophyte errors. The Management section does not currently have a section discussing Airway clearance techniques (ACTs) for COPD. I wanted to suggest an addition of a subheading along the lines of: "Airway clearance techniques (ACTs) aim to address cough and sputum production by removing sputum from the lungs. ACTs such as 'conventional' therapy (e.g. postural drainage, percussion, vibration), autogenic drainage, hand-held positive expiratory pressure (PEP) devices, and mechanical devices applied to the chest wall attempt to clear mucus from the lungs. In people with acute COPD, ACTs may reduce the need for increased ventilatory assistance and the duration of ventilatory assistance, and length of hospital stay. In people with stable COPD, ACTs may lead to short-term improvements in health-related quality of life and a reduced long-term need for hospitalisations related to respiratory issues." Citation: Osadnik, C. R., McDonald, C. F., Jones, A. P., & Holland, A. E. (2012). Airway clearance techniques for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (3). https://www.ncbi.nlm.nih.gov/pubmed/22419331?dopt=Abstract Would welcome any thoughts or comments. Thank you! --Audrey.r.tan (talk) 12:17, 6 September 2019 (UTC)

Sure a brief sentence or two sounds reasonable. Fits under "exercise"Doc James (talk · contribs · email) 05:29, 19 September 2019 (UTC)

RfC: Redirects of "chronic bronchitis" and "emphysema"

Should the terms "chronic bronchitis" and "emphysema" redirect here or elsewhere? Doc James (talk · contribs · email) 22:32, 23 September 2019 (UTC)

1) Support redirecting both terms to COPD with a hatnote for secondary uses

1. Support links here. "Chronic bronchitis" and "emphysema" are most commonly used to mean COPD. They were previously commonly used for types of COPD specifically. The World Health Organizations page on COPD says "The more familiar terms 'chronic bronchitis' and 'emphysema' are no longer used, but are now included within the COPD diagnosis." and "The more familiar terms “chronic bronchitis” and “emphysema” have often been used as labels for the condition." Ie COPD The CDC says COPD "includes emphysema and chronic bronchitis" GOLD comments that these terms were frequently used in COPD definitions.[2] These terms each also have a secondary and less common meaning. Chronic bronchitis is used to mean a chronic productive cough and emphysema is used to mean specifically pathological changes to tissue but these are less common meanings and thus should be linked to as a hatnote IMO. Doc James (talk · contribs · email) 22:32, 23 September 2019 (UTC)
2. Support. Redirects should go here. There is a diagnostic entity of "chronic bronchitis" without COPD but this is uncommon and most people are referring to COPD when they say chronic bronchitis. JFW | T@lk 08:24, 27 September 2019 (UTC)
3. support per JFW and Doc James rationale--Ozzie10aaaa (talk) 09:37, 27 September 2019 (UTC)

2) Support reverting previous redirects to own pages with Main article hatnotes on page

1. Support. GOLD states that both chronic bronchitis and emphysema are not included in the definition of COPD - so why do they redirect here. If they are not included they must be treated separately. GOLD states clearly that chronic bronchitis should be treated as a separate entity. There is far more information on chronic bronchitis on the Bronchitis page than there is on the COPD page. Chronic bronchitis and emphysema were the original phenotypes of COPD and  are still used as such, though others have been proposed - GOLD has discussed an exacerbator phenotype’’ which is also discussed elsewhere. A more common third phenotype is sometimes included as Asthma-COPD overlap. Chronic bronchitis and emphysema are components of COPD. They are distinct conditions which warrant their own pages. COPD is the umbrella term for these phenotypes. The fact that a large proportion of people with chronic bronchitis  do not have COPD must indicate the need for its own page. The same holds for emphysema. There are several types of emphysema,  and many instances where the use of the term emphysema is unequivocally used, as for example in references to lung volume reduction surgery; nobody would ever refer to LVRS in the terms of pneumatosis, the condition of emphysema is clearly used.  GOLD makes many references to emphysema in this regard (Interventional therapy chapter).  Imaging gives results for emphysema not for COPD or pneumatosis. Again there is more information on the obfuscated page of Pneumatosis, which really does need to revert to its previous page name of Emphysema. Who in any medical field speaks in terms of pneumatosis when referring to (pulmonary) emphysema? Emphysema always relates to the lung condition. Would also note that the previous page was merged to COPD without any notice for discussion.--Iztwoz (talk) 11:29, 24 September 2019 (UTC)

Discussion

User:Iztwoz Were you going to make a proposal that people can support? Doc James (talk · contribs · email) 02:41, 25 September 2019 (UTC)

Done - I think --Iztwoz (talk) 06:28, 25 September 2019 (UTC)

Okay have started the RfC. Doc James (talk · contribs · email) 04:45, 27 September 2019 (UTC)