Clinical management of chronic obstructive pulmonary disease by Thomas Similowski, William Whitelaw, Jean-Philippe Derenne

By Thomas Similowski, William Whitelaw, Jean-Philippe Derenne

This reference provides a accomplished assessment of the newest ideas used to evaluate, deal with, and deal with sufferers in each one section of persistent obstructive pulmonary ailment (COPD)-offering the most recent diagnostic modalities to spot and distinguish parts of COPD in past, extra reversible stages.

Contains views from the area well-being association at the epidemiology and keep an eye on of COPD in Africa, South the USA, and japanese Europe!

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Sample text

Gas washout techniques have been used to detect early evidence of altered ventilation distribution. The best known and most widely studied of these is the nitrogen washout technique or single breath nitrogen test (22). Following the inhalation of 100% oxygen to total lung capacity in a single inspiration from residual volume, the nitrogen concentration in the exhaled gas is continuously analyzed. During exhalation, the nitrogen concentration rises rapidly and reaches a quasiplateau during which the nitrogen concentration rises slowly (phase III or alveolar plateau).

PI*Z persons who are nonsmokers may live into their eighth or ninth decade; however, they usually develop some airflow obstruction as they age. In addition to cigarette smoking, asthma, recurrent respiratory infections, and unidentified familial factors were identified as possible risk factors for chronic airflow limitation. There may well be other, as yet undiscovered genetic factors that play a role in the phenotypic manifestations of AAT lung disease. Radiographically, AAT-deficient patients characteristically have more definite evidence of emphysema than patients with usual COPD.

It would be therefore, reasonable to redefine emphysema in etiological rather than pathological terms. However, it is also well known that only about 15 to 20% of smokers develop emphysema. Thus, it seems virtually certain that host factors, likely of genetic origin and as yet unidentified [except for alpha1antitrypsin deficiency (AAT)], also play a major etiological role. It is therefore too soon to redefine emphysema. Contribution of Physiological Studies Although studies of lung function began with the invention of the spirometer by Bourgery in Paris and Hutchinson in London in the 19th century, knowledge of the extent of loss of lung recoil pressure began with Christie in 1934 and developed at an accelerating pace, especially after World War II.

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