Talk:Chronic obstructive pulmonary disease/Archive 2

Targeted Lung Denervation therapy

Why is there no mention of this?

It is a research technique that is under study and not yet avaliable. Doc James (talk · contribs · email) 18:40, 9 August 2016 (UTC)

Added here [1] Doc James (talk · contribs · email) 18:54, 9 August 2016 (UTC)

People appear to be receiving the treatment successfully in the UK already: http://www.watfordobserver.co.uk/news/14664556.Woman_first_in_the_country_to_have_new_treatment_for_lung_disease/

We wait for high quality sources. We do not use popular press for medical content. Doc James (talk · contribs · email) 20:59, 10 August 2016 (UTC)

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References

Research

Submit an edit request

My edit request is in reference to the paragraph below:

...Treatment with stem cells is under study.[160] While there is tentative data that it is safe and with promising animal data there is little human data as of 2014.[161][162][163] Some of the human data that is available has found poor results.[164]

After reviewing the cited articles within the paragraph above, the sentence, "Some of the human data that is available has found poor results"--albeit true--seems particularly pointed and unindicative of the full state of research within the field. After reviewing the same source articles listed in the paragraph above (although a few are now greater than 3 years old) I believe this paragraph below is a more balanced and accurate summary of the state of stem cell therapy research and it's efficacy for the treatment of lung disease.

Suggested Edit:

"In recent years, treatment using stem cells has undergone a gradual shift from animal to human studies. [160] Although animal studies have shown promising results--proving efficacy in repopulating airway and alveolar epithelial cell lineages during homeostasis and repair--more clinical testing in humans is necessary in order to better understand the reparative mechanisms currently exhibited in rats. [161][162][163] Though treatment effectiveness in humans can vary, stem cell therapy and its ability to reduce systemic inflammation and reprogram developmental pathways to induce lung regeneration may be proven a risky but promising pathway.[164]"

I believe this is a fairer and more accurate depiction of stem cell therapy using the original sources of the initial paragraph, while the suggested changes have originated directly from its listed sources. --Ckennerly (talk) 17:41, 18 January 2017 (UTC)

I think it is fine how it is. Thanks for disclosing your COI. Best Doc James (talk · contribs · email) 20:01, 18 January 2017 (UTC)

Can you tell me if my suggested edit is fair? We spoke about a year ago on this very subject and the ultimate edit was, in fact, a more negative revision to the original post. If I can be frank, I've used the exact sources (taken directly from the articles' concluding remarks) and presented a revision that accurately portrays the tone and messaging of the article's intent; a treatment with a promising, albeit weary potential. I've followed the regulations and rules present within Wikipedia's guidelines to the letter and am not adding any messaging that is not directly present in the articles that were originally referenced. What can I do to influence a more balanced revision? --Ckennerly (talk) 19:31, 19 January 2017 (UTC)

Semi-protected edit request on 18 February 2017

Suggested Edit:

"In recent years, treatment using stem cells has undergone a gradual shift from animal to human studies. [160] Although animal studies have shown promising results--proving efficacy in repopulating airway and alveolar epithelial cell lineages during homeostasis and repair--more clinical testing in humans is necessary to better understand the reparative mechanisms currently exhibited in rats. [161][162][163] Though treatment effectiveness in humans can vary, stem cell therapy and its ability to reduce systemic inflammation and reprogram developmental pathways to induce lung regeneration may be proven a risky but promising pathway.[164]" Ckennerly (talk) 19:09, 23 February 2017 (UTC)

Not done: According to the page's protection level you should be able to edit the page yourself. If you seem to be unable to, please reopen the request with further details. Sir Joseph ^(talk) 20:48, 23 February 2017 (UTC)

Stem cells

• CKennerly, I reverted your addition. As a paid editor working for a company that promotes stem-cell therapy for lung disease, you have a financial COI here and should not edit the article directly; please see WP:NOPAY. The text about stem cells is conservative and reflects mainstream sources, for obvious reasons. If Wikipedia appears to promote it, there is a danger that readers with COPD will spend their money on inappropriate treatment, so we have to be cautious and make sure we carefully reflect mainstream opinion. SarahSV ^(talk) 21:17, 7 March 2017 (UTC)

Agree with SarahSV. Doc James (talk · contribs · email) 21:24, 7 March 2017 (UTC)

Hello User:SlimVirgin I understand the COI clause, and I apologize for the mix-up, my edit was a result of the direction given by User: Sir Joseph. As per my correspondence with User: Doc James I've followed the guidelines of wiki editing to the letter given my financial COI and have made no attempts to hide this information as I've included it (per wiki guidelines) on my user talk page. I also appreciate the straightforward and reasonable response. Although I agree wholeheartedly in your desire to keep statements on the efficacy of stem cell therapy for COPD conservative in nature, can I request that you give my edits a second look. I've cited the original text's references directly from their conclusion and abstract summaries. I say that to ensure that there has been no manipulation or "spin" on my part to give stem cell therapy any unsubstantiated appeal. Again, thank you for taking the time to provide a pragmatic and unbiased response. I only ask that you review the edit closely against the articles it references with the same objectivity.--Ckennerly (talk) 00:41, 8 March 2017 (UTC)

Ckennerly, thank you for disclosing your COI and your identity, and for agreeing to abide by WP:NOPAY. That's very much appreciated. The problem is that the company you work for is selling something, so it may not be possible for you to write about it neutrally. On their website, even when their blog posts are about other issues (e.g. pursed-lip breathing, diet), they always conclude with a plug for stem-cell therapy.

Rather than suggest an edit, can you say what's wrong with the current version, in your view? It says:

Treatment with stem cells is under study. While there is tentative data that it is safe and with promising animal data there is little human data as of 2014. Some of the human data that is available has found poor results.

SarahSV ^(talk) 01:21, 8 March 2017 (UTC)

I've just noticed that you based your final sentence—"Though treatment effectiveness in humans can vary, stem cell therapy and its ability to reduce systemic inflammation and reprogram developmental pathways to induce lung regeneration may be proven a risky but promising pathway"—on a 2002 source (PMID 12475805) that's already in the article supporting COPD in animals. Did you mean to do that, or was it a VisualEditor blip? SarahSV ^(talk) 02:42, 8 March 2017 (UTC)

Hello SarahSV, to answer your question, no, that closing sentence has been taken directly from reference 164 [The Prometheus Effect]. If there's a visual mix-up apparent, please allow this statement to clarify it. Regarding your initial question of what I think should be changed with the original text, I think it has a negative slant rather than an objective one on the subject of stem cell therapy. I'm not aware of how far back you can look, but the original text was short and objective. After attempting to edit the document myself, following an exchange with another editor, it was subsequently changed to reflect a more negative outcome i.e. "some of the human data that is available has found poor results." This strikes me as being particularly pointed, given that the source article referencing that line directly goes on to state the aforementioned "may be proven a risky but promising pathway." After reviewing the exact reference articles mentioned within the paragraph, I believe that the concluding remarks were fundamentally more hopeful than what is being currently communicated. In addressing this issue, I believe my suggested edit is both balanced as well as nuanced in regards to the potential benefits of stem cell therapy. Again, I'm not expositing or cherry-picking anything from the referenced articles that aren't present within the sources' abstract and conclusory summaries and tone. I'm open to merging the two paragraphs rather than outright replacing it but would you say that my argument is fair?--Ckennerly (talk) 19:09, 8 March 2017 (UTC)

Three versions

Previous text (26 Nov 2015) Treatment with stem cells is under study, and while generally safe and with promising animal data there is little human data as of 2014.
Current text (9 March 2017) Treatment with stem cells is under study. While there is tentative data that it is safe, and the animal data is promising, there is little human data as of 2014. Some of the human data has shown poor results.
Ckennerly proposal (7 March 2017) In recent years, treatment using stem cells has undergone a gradual shift from animal to human studies. Although animal studies have shown promising results--proving efficacy in repopulating airway and alveolar epithelial cell lineages during homeostasis and repair--more clinical testing in humans is necessary in order to better understand the reparative mechanisms currently exhibited in rats. Though treatment effectiveness in humans can vary, stem cell therapy and its ability to reduce systemic inflammation and reprogram developmental pathways to induce lung regeneration may be proven a risky but promising pathway.

Break

Ckennerly, above are the three versions we're discussing. Please check the references in your version, as the final one was a 2002 paper, so I swapped it for the one you intended to add. You appear to have used the VisualEditor to make the edits, and that has caused problems with the references (it's in experimental mode; using "edit source" may be easier). This is the diff of your edit; as you can see, it slotted some numbers in, and those attached the wrong references.

Anyway, your main objection is to the final sentence of the current version: "Some of the human data has shown poor results," sourced to PMID 23256721. Do you have access to that source, and if so are you willing to forward it to me? SarahSV ^(talk) 19:03, 9 March 2017 (UTC)

Hey SarahSV regarding the original source references they are: [161][162][163][164]

"In recent years, treatment using stem cells has undergone a gradual shift from animal to human studies. [160] Although animal studies have shown promising results--proving efficacy in repopulating airway and alveolar epithelial cell lineages during homeostasis and repair--more clinical testing in humans is necessary to better understand the reparative mechanisms currently exhibited in rats. [161][162][163] Though treatment effectiveness in humans can vary, stem cell therapy and its ability to reduce systemic inflammation and reprogram developmental pathways to induce lung regeneration may be proven a risky but promising pathway.[164]

The closing line is from the reference [164] and can be found at: http://www.eurekaselect.com/106217/article

[160] Chong, Jimmy; Leung, Bonnie; Poole, Phillippa (2013-11-04). "Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease". The Cochrane Database of Systematic Reviews (11): CD002309. doi:10.1002/14651858.CD002309.pub4. ISSN 1469-493X. PMID 24190161.

[161] Inamdar, AC; Inamdar, AA (October 2013). "Mesenchymal stem cell therapy in lung disorders: pathogenesis of lung diseases and mechanism of action of mesenchymal stem cell.". Experimental lung research. 39 (8): 315–27. doi:10.3109/01902148.2013.816803. PMID 23992090.

[162] Conese, M; Piro, D; Carbone, A; Castellani, S; Di Gioia, S (2014). "Hematopoietic and mesenchymal stem cells for the treatment of chronic respiratory diseases: role of plasticity and heterogeneity.". TheScientificWorldJournal. 2014: 859817. doi:10.1155/2014/859817. PMC 3916026Freely accessible. PMID 24563632.

[163] McQualter, JL; Anthony, D; Bozinovski, S; Prêle, CM; Laurent, GJ (November 2014). "Harnessing the potential of lung stem cells for regenerative medicine.". The international journal of biochemistry & cell biology. 56: 82–91. doi:10.1016/j.biocel.2014.10.012. PMID 25450456.

[164] Tzouvelekis, A; Ntolios, P; Bouros, D (2013). "Stem cell treatment for chronic lung diseases.". Respiration; international review of thoracic diseases. 85 (3): 179–92. doi:10.1159/000346525. PMID 23364286.

Does this make sense? --Ckennerly (talk) 20:52, 9 March 2017 (UTC)

The references you've added here don't correspond at all to what you added to the article. I'll fix them in the example above. As for ref 164, this—<http://www.eurekaselect.com/106217/article>—is just the abstract. We would need access to the whole article. SarahSV ^(talk) 00:32, 10 March 2017 (UTC)

I've asked for that article at RX, and FourViolas pointed to Lipsi et al. (2014), in case it's helpful. PMID 25548520 SarahSV ^(talk) 22:29, 10 March 2017 (UTC)

SarahSV Hey Sarah is it possible to send the original source articles directly to your email. I think the referencing index is causing some confusion. In these articles' pdfs I can highlight the sections I've used directly. Could you email me your email directly?--97.76.132.170 (talk) 21:18, 11 March 2017 (UTC)

Done. SarahSV ^(talk) 21:28, 11 March 2017 (UTC)

Cameron, I have that article now from WP:RX, so there's no need to send it. But thank you for offering. SarahSV ^(talk) 23:53, 11 March 2017 (UTC)

Cameron, I've had a chance to look at Tzouvelekis, Laurent and Bouros (2013), the ref for your proposed final sentence:

Though treatment effectiveness in humans can vary, stem cell therapy and its ability to reduce systemic inflammation and reprogram developmental pathways to induce lung regeneration may be proven a risky but promising pathway.

That doesn't seem to be a fair summary of the paper's conclusion. The authors conclude (paragraph break added):

So far there is still an open question regarding applicability of stem cell therapy in COPD patients: “Is it a scientific reality or just an alternative scenario of Promytheus myth?" ... [The constant process of maintenance and regeneration of the human lung] leads to a complete renewal of all lung cells and protein pool every 100 days meaning that by the age of 75 years an otherwise healthy subject will have renewed approximately 300 lungs. Although the aforementioned number is arbitrary and is based mainly on animal data it is still considerably high and underlines the tremendous regenerative capacity of human lung that is severely hampered by age, smoking and chronic lung disorders such as COPD. Repairing and regenerating lung structure and function represents the great hype for the treatment of COPD. ...

Understanding the molecular mechanisms regulating mobilization and activation of resident progenitor cells is of critical importance to identify novel therapeutic targets. Reducing systemic inflammation and reprogramming developmental pathways to induce lung regeneration may be proven a risky but promising pathway (Fig. 1). Nevertheless, we should always keep in mind the potential side-effects of these stem cell based therapies since many of the current neoplastic diseases arise from stem cells. Therefore, it is crucial when you inform the patients regarding stem cell therapeutic applications to separate the hope from the hype. There is plenty of room for technical improvements, further development, and more widespread acceptance and accessibility. For these cell-based therapies to become truly evolutionary there is only one approach: large, multicentric, randomized safety and efficacy clinical trials.

Regarding its use to support the current sentence: "Some of the human data has shown poor results", the relevant passage is:

The first study was recently published by Ribeiro-Paes J et al. [54] who reported a marginal statistically significant improvement in functional parameters as well as in exercise capacity in patients with severe COPD after an intravenous administration of autologous bone marrow derived MSCs. However, this study was severely underpowered with only 3 eligible for analysis patients posing major limitations to the data presented. Regarding the second phase II clinical trial, sponsored by Osiris Pharmaceuticals, recruitment has been completed and a total of 62 patients, with diagnosis of moderate (n=23) or severe (n=39) COPD patients, based on the recent GOLD functional criteria [1], have been enrolled and are being followed for a period of two years in the placebo-controlled study. Despite the great hype that was generated, first anecdotal results are rather disappointing highlighting the need for careful study design before rigid conclusions can be drawn. Official findings and publication are greatly anticipated.

That was 2013. Has the Osiris Pharmaceuticals study been published? SarahSV ^(talk) 03:19, 14 March 2017 (UTC)

Hey SarahSV Sarah, I understand what you're saying within the larger context of that excerpt, but only if the line--

"Though treatment effectiveness in humans can vary, stem cell therapy and its ability to reduce systemic inflammation and reprogram developmental pathways to induce lung regeneration may be proven a risky but promising pathway"

--Is taken as a standalone sentence. However, I think the proposed edit more-or-less covers the general consensus that stem cell therapy for the treatment of lung disease still requires large and continuous studies to understand the efficacy it has exhibited in rat models. I believe the sentences above it accurately portray the field as one that has potential but is still a while away from being a definitive alternative. Do you think there's a middle ground in finding this sense of balance within my suggested edit and the current version?Ckennerly (talk) 03:22, 14 March 2017 (UTC)

Cameron, I don't know. I'd have to read a lot more, and perhaps email some specialists to get a sense of how to summarize it. The problem is that you stress "more clinical testing in humans is necessary" but don't mention "results so far have been disappointing". Do you know whether the Osiris Pharmaceuticals study has been published? SarahSV ^(talk) 03:30, 14 March 2017 (UTC)

SarahSV No actually. Only a press release. The information I have been able to find has varied between addressing cardiovascular disease and orthopaedic injuries. If the issue is a lack of sources reflecting a more positive light on human-based stem cell application for lung disease, I can send over an article or two. The size of the study is relatively small (less than 50) but small sample sizes have been pretty common as indepedent research within the field currently stands. Ckennerly (talk) 03:41, 14 March 2017 (UTC)

Is there anything about it online? I can't find any mention of a recent one (just one in 2009). It's not on their website either. SarahSV ^(talk) 03:44, 14 March 2017 (UTC)

PMID 28119741 gives an overview of current research. SarahSV ^(talk) 06:16, 14 March 2017 (UTC)

Hey SarahSV just looked over the article you suggested. I can see the support for the current text in the abstract, however the conclusion goes on to state:

"Given the achievements to date, the goal of regenerating diseased lungs and curing destructive pulmonary diseases such as COPD seems to be within our grasp. Although there are numerous obstacles to be overcome, lung regeneration therapy is expected to be translated safely and effectively from the laboratory to the bedside."

Do you see what I mean when I say balance? The general through-line of what I've read in many medical papers of the field tend to emphasize the point that although more research is necessary to prove significant efficacy in human application, the potential of the field itself is promising.

What are your thoughts? Ckennerly (talk) 17:51, 14 March 2017 (UTC)

What I see in that paper (PMID 28119741) is: "However, despite the advances made in recent decades, we are still far from our goals and there are substantial hurdles to be overcome." And:

In addition to the safety issue, the efficacy issue is another important hurdle that should be surpassed. In contrast to animal models that have shown promising results, all of the current clinical trials aimed at regenerating the damaged lung in human subjects, irrespective of the modality, have been unsuccessful in terms of efficacy29,30,31,32,33,34,35. Since the sources of these discrepancies between the laboratory and clinical results are unclear, it is crucial to assess the possible causes of the recent disappointing results in clinical fields and to identify the possible ways to surmount the barriers.

That reflects what our current article says: "While there is tentative data that it is safe, and the animal data is promising, there is little human data as of 2014.[162][163][164] Some of the human data has shown poor results."[165]

In fact, we should probably remove "some of" from that sentence. SarahSV ^(talk) 20:36, 14 March 2017 (UTC)

Removed here Doc James (talk · contribs · email) 01:55, 15 March 2017 (UTC)

Break 2

SarahSV Were you able to review the PDF that I sent you through email? I understand that the article you listed is the most recent source (2017) but given that references [161, 162, 163, 164, and 165] range in years beginning in 2013, and the article that I sent you showing positive efficacy in a stem cell treatment clinical trial is from 2015, would that not warrant a change to the sentence "Human data has shown poor results?" It seems a bit disingenuous given the scope of other research currently available demonstrating positive efficacy.

This article: http://www.jhltonline.org/article/S1053-2498(15)00708-1/abstract

Ckennerly (talk) 03:01, 15 March 2017 (UTC)

The new source (PMID 28119741) is from January 2017 so that gives us an up-to-date overview. This would be easier to follow if you could give the pmid for sources, or at least a name (e.g. Tzouvelekis 2013), because I can't follow which refs are or were 165 etc. Having the pmid lets us see quickly which are review articles. SarahSV ^(talk) 03:12, 15 March 2017 (UTC)

The source you linked to is a primary source and I can't find it on PubMed. SarahSV ^(talk) 03:16, 15 March 2017 (UTC)

Hey SarahSV so just for clarification on the standards you've put forth, an article that shows a positive clinical result in humans, is on PubMed, is a secondary source, and was published any time after January 2017 should result in the replacement of reference 162 (PMID 28119741)? I just want to be clear moving forward.

Cameron, first, the link you posted above – http://www.jhltonline.org/article/S1053-2498(15)00708-1/abstract – goes to the abstract, not the full text, so I can't read the article you're referring to.

I don't know what your question means. SarahSV ^(talk) 18:57, 15 March 2017 (UTC)

I'd also like to propose a final edit to the current text as its brevity seems to belie the full state of the field.

Current text:

"While there is tentative data that it is safe, and the animal data is promising, there is little human data as of 2017.[162][163][164][165] The human data has shown poor results."

Proposed text:

"While there is tentative data that it is safe, and the animal data is promising, there is little human data as of 2017.[162][163][164][165] There are numerous obstacles to overcome in the field of stem cell therapy, however, although current human trials have yet to demonstrate regenerative efficacy, lung regeneration therapy has demonstrated a growing potential for the treatment of COPD requiring further study."[166]

After reading reference 162 (PMID 28119741) in full, I believe that it--coupled with the other sources listed within this excerpt--have a general through-line of hesitant potential regarding the field of stem cell therapy in the treatment of COPD.

From reference 161 (PMID 23992090)

"Availability of MSCs from different sources provides a safe, rich and inexpensive source of MSCs for treatment of lung diseases. Their unique properties in homing, immunomodulation, regeneration, and secretion of anti-inflammatory cytokines make them an ideal candidate for the treatment of challenging lung conditions like chronic asthma, ARDS, COPD, and ILD and considered to be well placed in reducing morbidity and mortality associated with such lung conditions."

From reference 162 (PMID 28119741)

"Given the achievements to date, the goal of regenerating diseased lungs and curing destructive pulmonary diseases such as COPD seems to be within our grasp. Although there are numerous obstacles to be overcome, lung regeneration therapy is expected to be translated safely and effectively from the laboratory to the bedside."

From reference 164 (PMID 25450456)

"Salient information arising from seminal clinical observations gives credence to the view that cell-based therapies may be a fruitful therapeutic strategy for lung repair and remodeling after injury. In the past 5 years, we witnessed major advances that increased our current state of knowledge from theoretical discussions to practical considerations. It is anticipated that the few ‘brave’ pilot investigations of the safety of stem cell treatment in chronic lung diseases will excite new fields of research to improve our current understanding of the mechanisms orchestrating lung renewal and sparking the design of large multicenter clinical trials, as it happens in other fields of medicine. Lastly, but most importantly, we should always bear mind that separating the hope from the hype when informing end-stage lung disease patients represents the most crucial step for the moment."

From reference 166 (PMID 23256721)

"Understanding the molecular mechanisms regulating mobilization and activation of resident progenitor cells is of critical importance to identify novel therapeutic targets. Reducing systemic inflammation and reprogramming developmental pathways to induce lung regeneration may be proven a risky but promising pathway. Nevertheless, we should always keep in mind the potential side-effects of these stem cell based therapies since many of the current neoplastic diseases arise from stem cells. Therefore, it is crucial when you inform the patients regarding stem cell therapeutic applications to separate the hope from the hype. There is plenty of room for technical improvements, further development, and more widespread acceptance and accessibility. For these cell-based therapies to become truly evolutionary there is only one approach: large, multicentric, randomized safety and efficacy clinical trials."

Do you see what I'm getting at here? This is the common through line of the field of stem cell therapy for COPD and I believe the statement "The human data has shown poor results," is a redacted view of the full-scope of the field currently present within these articles' concluding remarks.

In the proposed text above, I believe I've accurately represented the questionable variables present in current stem cell research while still giving credence to the potential of this form of treatment in a fair and accurate way. Ckennerly (talk) 15:06, 15 March 2017 (UTC)

Also I appreciate you hanging with me through all this SarahSV this has been an epic back-and-forth and I appreciate your willingness to continue to engage in a reasoned and rational dialogue. — Preceding unsigned comment added by Ckennerly (talk • contribs) 18:31, 15 March 2017 (UTC)

The proposals are just putting a positive spin (I would say a PR spin) on the bottom line, which is that there has been no evidence yet of efficacy in humans. SarahSV ^(talk) 19:33, 15 March 2017 (UTC)

Can you meet me halfway here SarahSV? You can suggest the edit yourself if my COI is too egregious, but what part of what I referenced above tells a narrative different than one of potential and optimism for stem cell treatment? That's the only thing I believe is misrepresented. And it's obvious (and again, referenced) in every single article that currently references stem cell therapy within the current text. Ckennerly (talk) 19:58, 15 March 2017 (UTC)

Sorry, I can't see a reason to add anything about promise. What matters is whether efficacy in humans has been demonstrated, and it hasn't, according to the secondary sources. If that changes, we'll report it. As one source said, what is needed are "large, multicentric, randomized safety and efficacy clinical trials". SarahSV ^(talk) 20:17, 15 March 2017 (UTC)

Fair enough. Ckennerly (talk) 20:25, 15 March 2017 (UTC)

Lancet seminar

doi:10.1016/S0140-6736(17)31222-9 JFW | T@lk 20:50, 14 May 2017 (UTC)

Pulmonary emphysema

Is there a reason why pulmonary emphysema redirects here? My personal opinion is that it warrants its own page, as this just doesn't offer enough space to go into detail. — Preceding unsigned comment added by Decthost (talk • contribs) 07:24, 4 May 2017 (UTC)

@Decthost: What makes you think it is a distinct disease entity? JFW | T@lk 20:51, 14 May 2017 (UTC)

I've also wondered why emphysema redirects here. Emphysema is a structural abnormality that may not be present in patients with COPD, and it can be present without airflow obstruction. A separate article could be very helpful. SarahSV ^(talk) 21:03, 14 May 2017 (UTC)

In practical terms, most people with COPD have elements of both. The treatment is the same (although those with emphysema are more likely to have bullous disease and may be candidates for bullectomy or lung volume reduction surgery). JFW | T@lk 22:03, 14 May 2017 (UTC)

My understanding is that emphysema is simple part of the pathophysiology of COPD while chronic bronchitis is one of the most common symptomatic presentations. Doc James (talk · contribs · email) 22:22, 14 May 2017 (UTC)

Jfdwolff and Doc James, there's quite a bit of confusion about this in the literature and among patients. It would be helpful if Wikipedia could sort it out with separate articles explaining the differences and relationships. GOLD 2017 says (pp. 6–7):

Many previous definitions of COPD have emphasized the terms “emphysema” and “chronic bronchitis”, which are not included in the definition used in this or earlier GOLD reports. Emphysema, or destruction of the gas-exchanging surfaces of the lung (alveoli), is a pathological term that is often (but incorrectly) used clinically and describes only one of several structural abnormalities present in patients with COPD.

Chronic bronchitis, or the presence of cough and sputum production for at least 3 months in each of two consecutive years, remains a clinically and epidemiologically useful term, but is present in only a minority of subjects when this definition is used. However, when alternative definitions are used to define chronic bronchitis, or older populations with greater levels of smoke or occupational inhalant exposure are queried, the prevalence of chronic bronchitis is greater.

SarahSV ^(talk) 22:56, 14 May 2017 (UTC)

User:SlimVirgin I agree with all of that and I think we say something similar in this article. The three terms are closely intermingled. Doc James (talk · contribs · email) 23:01, 14 May 2017 (UTC)

I may not have this analogy quite correct, but redirecting the terms here feels like redirecting to AIDS all the diseases that can occur as a result of that. SarahSV ^(talk) 23:10, 14 May 2017 (UTC)

Are there any diseases than have emphysema that are not COPD? Doc James (talk · contribs · email) 21:12, 15 May 2017 (UTC)

Emphysema can accompany industrial diseases such as asbestosis and silicosis, and there's combined pulmonary fibrosis and emphysema syndrome. Also, having emphysema redirect here causes problematic links, such as in Subcutaneous emphysema, where the lead says "emphysema refers to trapped air" and links to COPD.

Perhaps Emphysema (disambiguation) could be developed into an article. SarahSV ^(talk) 00:18, 16 May 2017 (UTC)

First sentences

Doc James, you changed "persistent respiratory symptoms and long-term poor airflow" to "long-term breathing problems due to poor airflow". Respiratory symptoms can be present without abnormal spirometry, and (if I've understand the sources correctly) there can be poor airflow without respiratory symptoms.

Also, you restored "Eventually everyday, such as walking up stairs, activities become difficult." I removed the stairs example, because stairs are often an early sign that there's a problem, not something that happens eventually. It's better as "Eventually everyday activities become difficult" without specifying. SarahSV ^(talk) 21:40, 27 September 2017 (UTC)

Ref says "persistent respiratory symptoms and airflow limitation"

"Persistent" = "long term"

"Respiratory symptoms" = "breathing problems"

"airflow limitation" = "poor airflow"

Agree we should change "due to" to "and"

Doc James (talk · contribs · email) 21:46, 27 September 2017 (UTC)

Persistent isn't quite the same as long-term, and it would be better to stick to the language of the source. When someone seeks a diagnosis, they may not have had the symptoms long-term; the question is whether they're persistent. If you prefer "breathing problems", could we say "persistent breathing problems"?

What's your feeling about the stairs? That was the first thing that jumped out at me about the article when I first read it ages ago, that the stairs example was wrong. It's a bit like saying "Eventually you won't be able to run for the bus." SarahSV ^(talk) 21:58, 27 September 2017 (UTC)

I disagree with you on the first point. The breathing problems are long-term thus the chronic in the name.

What would you prefer to see on the second point? Do you want to give another example of an "Activity of daily living"? IMO it is usually to have an example as it is a technical term. Doc James (talk · contribs · email) 05:10, 28 September 2017 (UTC)

With "persistent" and "activities of daily living", I'm thinking of how an ordinary reader will understand them. A reader will not think he has a long-term cough if he's only had it for a few months, but it is persistent/chronic. I think for that reason we should stick to the terms the sources use. Re: everyday activities, readers know what that means for them. But if you want to stick to the technical definition, you could say "such as walking and getting dressed". SarahSV ^(talk) 05:36, 28 September 2017 (UTC)

Agree with the second bit and have altered to "walking and getting dressed" Doc James (talk · contribs · email) 15:54, 28 September 2017 (UTC)

Citation format

I'm thinking of slowly going through this and updating from GOLD 2013 to GOLD 2017. The current format uses the long citation in the text and repeats it for chapter 1, chapter 2, etc, giving the page ranges of the chapters. Would anyone mind if I moved the long ref to the end (under "Works cited" or similar), then added short cites (GOLD 2017) with page numbers using {{sfn}}? This would mean we not only avoid repeating the long citation, but we could also add page numbers instead of ranges. SarahSV ^(talk) 00:09, 27 September 2017 (UTC)

In the absence of objections, I'll slowly start converting. SarahSV ^(talk) 02:21, 28 September 2017 (UTC)

fwiw i strongly prefer the standard format. that way the link clickable link is there as one reads, as opposed to the SfN style, in which a click keeps you trapped in the article and requires a second click once you jump. I don't care where the one full length version is - for the rest, the "ref name" repeaters are not longer than the sfn format. if you want to do specific page numbers that can be with ref name + the template:rp. Jytdog (talk) 02:28, 28 September 2017 (UTC)

The current version keeps on repeating the long citation, ch 1, ch 2, and still no precise page numbers. {{Rp}} is untidy looking, and it splits the ref up—half the information when you click down, and half in the text. SarahSV ^(talk) 02:43, 28 September 2017 (UTC)

I agree that one citation to the whole work will be better. I agree that page numbers are better. Not sure what you mean by "click down". If you hover the cursor over a ref it pops up, and then you can right click on the links in the ref to open it in new tab, and you never have to leave the spot in the text where you are. That is how i use refs anyway. That is impossible with Harvard refs....

These style matters are never easy. Which is a reason why WP:CITEVAR says keep it the same unless you get consensus, as you know. But perhaps others here will want to go with harvard refs. Jytdog (talk) 03:08, 28 September 2017 (UTC)

The reader will hover and click through if they know to do that, or will click down, but either way may not notice {{rp}}. So then they're without the page number. I'm only suggesting {{sfn}} for the GOLD report, by the way, because it's used so often. I'm not suggesting converting everything. SarahSV ^(talk) 04:06, 28 September 2017 (UTC)

Okay, no response, so I will start converting to refname=GOLD2017, with {{rp}} for page numbers. This will avoid the long citation being repeated for chapters, but it will mean (a) the ref name (eventually) being repeated a lot, and (b) the ugly numbers after the refs. SarahSV ^(talk) 20:58, 28 September 2017 (UTC)

I've done a few, but it's ugly. The report will be cited a lot, and {{rp}} will be repeated throughout the text, especially given the desire to repeat refs after every sentence. Are you sure you prefer that to GOLD 2017, 6, using {{sfn}}? Pinging Doc James. Here's an example of the latter. It's neat, there are no long cites to repeat, you've got precise page numbers rather than chapters, no mess in the text with {{rp}}, and the link takes you to the report at the end. SarahSV ^(talk) 03:40, 29 September 2017 (UTC)

User:SlimVirgin we have installed the "cite journal", "cite book", and "cite web" templates in more than 150 languages. I am not supportive of adding more templates as they will than need to be installed for translation to work smoothly. Installing these 3 templates was a huge amount of work. Thus I restored the prior formating. Doc James (talk · contribs · email) 05:21, 29 September 2017 (UTC)

Doc James, can you say what you mean by more templates? I used the cite book template that was in the article already, with the addition of {{rp}}. Is it {{rp}} that you object to or something else? SarahSV ^(talk) 05:45, 29 September 2017 (UTC)

Yes "rp" is another template to confuse the translators and another template that likely will not work in all the languages we are translating into. Doc James (talk · contribs · email) 05:47, 29 September 2017 (UTC)

I agree. I don't like {{rp}} either. But we do need to provide page numbers. The chapter page ranges are too large. Would you support using {{sfn}} to produce a clickable link, "GOLD 2017, 1", to the full citation at the end? If not, what do you suggest? SarahSV ^(talk) 05:50, 29 September 2017 (UTC)

I do not see a problem with having a 10 to 20 page range. A lot of journal articles are of this length and we do not state the exact page number within them. Doc James (talk · contribs · email) 06:21, 29 September 2017 (UTC)

The report chapters are too long. GOLD 2017 chapter 1 is 6–17 without references. Chapter 2 is 24–39. It isn't fair to expect readers to hunt through them when we can easily provide page numbers, which are helpful for editors too. SarahSV ^(talk) 06:31, 29 September 2017 (UTC)

Many journal articles are that length. As mentioned it is mainly the leads I want to see keep in the more common formating. Doc James (talk · contribs · email) 16:06, 29 September 2017 (UTC)

Okay, understood. The length of the report (123 pages) means we should treat it as a book. So to summarize (if I've understood correctly):

• Doc James wants to keep the lead free of sfn for translators, but wouldn't mind it elsewhere, and doesn't want rp anywhere
• Jytdog does not want sfn anywhere and doesn't mind rp.
• I would like to use sfn for the GOLD report (and books if used repeatedly), and I don't like rp.

Doc James, are you willing to allow sfn if we keep it out of the lead?

Jytdog, are you willing to allow sfn for reports and books used more than once, if the long cite is kept in the text rather than at the end? And with no short cites in the lead. (Note: the only report is GOLD 2017, because it will replace GOLD 2013 and GOLD 2007.)

See Parkinson's disease for an example of what I'd like to do, where short cite 90, with page numbers, points to long cite 35. But journal articles are long cites only.

In the meantime, to make progress, I will start adding GOLD 2017 with chapters, and page numbers commented out to help editors (but note that this doesn't help readers). Then we can take our time to choose the best system. SarahSV ^(talk) 17:05, 29 September 2017 (UTC)

What is the difference between Template:Sfn and Template:Harv?

I am okay with one of these used in the body but not the lead. Doc James (talk · contribs · email) 18:20, 29 September 2017 (UTC)

Okay, thank you (re: in the body, but not the lead). Re: the difference, they are almost the same. Harv can be used in the body to create Harvard refs (Smith 2017, p. 1) in brackets. Sfn is used for clickable footnotes, and it has a period at the end, whereas harv doesn't. SarahSV ^(talk) 18:40, 29 September 2017 (UTC)

Recent revert

Doc James, can you explain the revert? I changed: "When compared to tiotropium, the LAMAs including aclidinium, glycopyrronium, and umeclidinium, appear to have a similar level of effectiveness" to "A 2015 network meta-analysis indicated that aclidinium, glycopyrronium, tiotropium, and umeclidinium were more effective than placebo." And added a quote from the source to support it. SarahSV ^(talk) 03:10, 9 March 2018 (UTC)

Sure. The more interesting bit of this meta analysis is not so much that they are better than placebo but that they are similar to the current standard therapy tiotroprium.

Thus the conclusions are "The new LAMAs studied had at least comparable efficacy to tiotropium, the established class standard." Doc James (talk · contribs · email) 03:14, 9 March 2018 (UTC)

My sentence included tiotropium. But what I was really getting at with the edit was two things: (1) you restored "the LAMAs including". Which LAMAs other than the ones named? And (2) "have a similar level of effectiveness" could mean "they're all the same and they're wonderful." In fact, the source says "more efficacious than placebo". I think it's important to say that. SarahSV ^(talk) 03:20, 9 March 2018 (UTC)

How about this? "When compared to tiotropium, the LAMAs aclidinium, glycopyrronium, and umeclidinium appear to have a similar level of efficacy. A 2015 network meta-analysis indicated that all four were more effective than placebo." SarahSV ^(talk) 03:24, 9 March 2018 (UTC)

I've gone ahead and added it. SarahSV ^(talk) 00:02, 10 March 2018 (UTC)

Good point. Have simplified it a bit further. Let me know what you think. Doc James (talk · contribs · email) 15:55, 10 March 2018 (UTC)

Chronic bronchitis and emphysema

"Traditionally two common types of COPD were known as chronic bronchitis and emphysema"

https://books.google.com/books?id=li1VCwAAQBAJ&pg=PA913

WHO says "The more familiar terms “chronic bronchitis” and “emphysema” have often been used as labels for the condition."[2]

User:Mikael Häggström the definition you added was an older one?

Doc James (talk · contribs · email) 00:29, 24 March 2018 (UTC)

Video sources

Are the sources for the two Knowledge Diffusion videos available anywhere? File:Chronic bronchitis.webm and File:Emphysema.webm. SarahSV ^(talk) 15:53, 28 March 2018 (UTC)

Sorry, forgot to ping Doc James. SarahSV ^(talk) 18:49, 28 March 2018 (UTC)

What about the Dutch hypothesis?

I found an article called the "Dutch hypothesis" in the list of orphaned articles. According to its last paragraph, it's one of the four main hypothesis for the pathogenesis of COPD. I find that strange, since it's not listed in here at all, despite this being considered a GA-class article. I'm no medical professional, so I don't know the proper way to incorporate it into the article, especially since there's no section comparing COPD hypothesis by name. — Preceding unsigned comment added by Matthew V. Milone (talk • contribs) 20:52, 24 July 2018 (UTC)

What ref do you have? Doc James (talk · contribs · email) 03:05, 14 November 2018 (UTC)

Dutch hypothesis has it all. Not sure whether this is still considered a valid theory. JFW | T@lk 22:23, 15 November 2018 (UTC)

References

There is a mix of styling for just one reference the GOLD 2013 report, resulting in a dead link for several of these. One is cited as a book giving chapters and page numbers (dead link ref) it is not usual for a journal to be broken up into chapters and page numbers they are easy enough to scroll through and item-searchable. I shall list them as the one searchable ref.--Iztwoz (talk) 08:40, 4 May 2019 (UTC)

There were too many listed so changed to journal entries and kept page numbers.--Iztwoz (talk) 11:51, 4 May 2019 (UTC)

References

Chronic bronchitis versus emphysema

The distinction is 1) the terms chronic bronchitis and emphysema are no recommended officially for COPD 2) chronic bronchitis is a clinical symptoms 3) emphysema is a pathological finding.

"It is unclear whether different types of COPD exist. While previously divided into emphysema and chronic bronchitis, emphysema is only a description of lung changes rather than a disease itself, and chronic bronchitis is simply a descriptor of symptoms that may or may not occur with COPD."

GOLD is a way better source than either ADAM or the NHS for this. We need discussion before changing User:Iztwoz.

Doc James (talk · contribs · email) 17:50, 30 April 2019 (UTC)

The problem is the statement that chronic bronchitis and emphysema are older terms that are no longer used....this is very misleading to a general reader who will come across these terms in abundance. As stated on Bronchitis talk page not every case of chronic bronchitis will be classed as a COPD, same goes for emphysema which leaves both conditions as separate conditions.

Again most sources define COPD as an umbrella term - which if used on the page would stop this confusion. Have just looked on British lung foundation website and it is clearly stated there that COPD is an umbrella term....that includes chronic bronchitis, emphysema and small airway disease. On the Bronchitis page had also added a good review ref citing COPD as a spectrum with chronic bronchitis on one end and emphysema at the other - which was reverted. There are so many refs that also define COPD as a covering term.

Also by placing these items in the lead as bolded - implying redirects - emphysema which is mentioned some 30 times on the page has no dedicated section. And the next sentence in the lead states that the term "chronic bronchitis"..... It's not a term but a condition.

In Signs and symptoms last few unclear sentences are not retrievable from ref given. --Iztwoz (talk) 19:39, 30 April 2019 (UTC)

Ref says "Many previous definition of COPD have emphaszied the terms "emphysema" and "chronic bronchitis" which are not included in the defintion used in this or ealier GOLD reports. Emphysema is a pthological term that is often but incorrectly used clinically... Chronic bronchitis, or the presense of cough and sputum production for at least 3 months in teach of two consecutive years"[3]

Doc James (talk · contribs · email) 06:12, 1 May 2019 (UTC)

WHO states "The more familiar terms of chronic bronchitis and emphysema are no longer used; they are now included within the COPD diagnosis."[4]

Doc James (talk · contribs · email) 06:13, 1 May 2019 (UTC)

Text is still in the 2019 edition of the GOLD report. Will update.[5]

The WHO report is just saying that the two terms are not used for COPD as COPD includes them - clearly both terms are still used in differing contexts. Seems like the very problematic wording in the lead hinges on this interpretation. The two terms together now refer to COPD. Since the mainstream defines COPD as comprising two conditions of chronic bronchitis and emphysema it is very amiss to not acknowledge this. The GA review of 2013 did not contain this phrasing.--Iztwoz (talk) 08:23, 4 May 2019 (UTC)

Basically Chronic bronchitis is used in two different ways. 1) it is used to mean COPD and is the most common usage 2) it is used to mean a productive cough that lasts more than three month in each of two years.

Chronic bronchitis is technically not a condition but a symptom. Doc James (talk · contribs · email) 06:16, 1 May 2019 (UTC)

The 2019 report states - "it is important to recognise that chronic cough and sputum production (chronic bronchitis) is an independent disease entity.." --Iztwoz (talk) 08:14, 4 May 2019 (UTC)

Thanks. The term is used in different ways. One term is to mean COPD the other is to mean chronic cough with sputum. That point still thanks. Doc James (talk · contribs · email) 12:28, 22 May 2019 (UTC)

Also, if it is just a symptom why is it listed several times in ICD classifications - J41.8; J42;J44. and emphysema has several listings J43.--Iztwoz (talk) 08:32, 4 May 2019 (UTC)

Chest pain is listed a bunch of times in the ICD11.[6] Doc James (talk · contribs · email) 12:28, 22 May 2019 (UTC)

obstructive bronchiolitis

User:Iztwoz Which ref says this is "Bronchiolitis obliterans" or "obliterative bronchiolitis"? Doc James (talk · contribs · email) 05:45, 20 May 2019 (UTC).

The term obstructive bronchiolitis did not bring up any result on search, and assumed it was meant to be the link chosen as the same link is used later in the text - as it stood (probably stands) it was (is) totally undefined. --Iztwoz (talk) 06:48, 20 May 2019 (UTC)

Also the page Bronchiolitis obliterans describes it as a disease which results in obstruction of the smallest airways of the lungs.....which probably helped in my choice of that link. Surely the aim of the encyclopedia is to provide information and not to leave things to guesswork as the unlinked term used does.--Iztwoz (talk) 07:01, 20 May 2019 (UTC)

Ref says "The chronic airflow limitation characteristic of COPD is caused by a mixture of small airways disease (obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person."[7]

This is a pathological finding not a disease.

in which case i suggest you change the wording in the text that describes it as a disease. which is why i made it a redlink that you have now puzzlingly changed to a circular link that describes nothing.--Iztwoz (talk) 13:05, 22 May 2019 (UTC)

And as much as it is your personal opinion that these conditions are not diseases - countless refs assert that they (both chronic bronchitis and emphysema) are - yet you remove their inclusion. ? This is hardly NPOV.--Iztwoz (talk) 13:05, 22 May 2019 (UTC)

How does the inclusion of the quote that is not visible to a reader validate the inclusion of this ref that does not refer to being older terms. The writers of these reports are experienced enough to be aware of their choice of words - if they had wanted to say they were older terms they would have.--Iztwoz (talk) 13:05, 22 May 2019 (UTC)

BO on the other hand is a disease. From my understanding they are not the same. Do you have a reference that says they are? Doc James (talk · contribs · email) 08:30, 21 May 2019 (UTC)

see above response

misreading of sources

User:Doc James Where does it state that Chronic bronchitis and Emphysema are older terms for the condition.? As earlier attempts have been made to reword this and been reverted - once by myself and previously by another - (Mikael Haagstrom) I'll try again here. As suggested to you earlier the use of the word "older" implies that the conditions separately do not exist, which is patently not true. It would seem that you have tried to render these conditions as obsolete by making redirects to this page. One ref given uses the following - "Traditionally two common types of COPD were known as chronic bronchitis and emphysema..." The WHO ref says that "the more familiar terms chronic bronchitis and emphysema have been used as labels for the condition". These just point to the "newness" of the use of the term COPD and that it now covers both chronic bronchitis and emphysema. Seems like a lot of cherry-picking has been going on to support a POV or given take on a subject. For example Asthma has not been included yet the same WHO ref states that some cases of COPD are due to long term asthma. A search on WHO site for emphysema lists many refs to "COPD, such as chronic bronchitis or emphysema..." that clearly is not saying that these are older terms for the condition. Also not all countries are agreed on what to include and this fact is not to be found on the page, solely that accepted by the US. The condition of emphysema seems to have been airbrushed away - the page pneumatosis on searches seems to relate to gastric emphysema. Do you have any objections to a new page of Pulmonary emphysema being created?--Iztwoz (talk) 14:19, 20 May 2019 (UTC)

The ref from WHO says "The more familiar terms of chronic bronchitis and emphysema are no longer used; they are now included within the COPD diagnosis."[8] Doc James (talk · contribs · email) 08:37, 21 May 2019 (UTC)

Doc James re the previous suggestion i think the page Emphysema be made as related to the lungs and its previously listed items included as linked items - i did not know that the page was previously a disambiguation page - and this to me seems very strange since the term is so universally used.--Iztwoz (talk) 07:15, 21 May 2019 (UTC)

Why have you purged the term "Pneumatosis" from this article? That seems strange when Emphysema redirects to Pneumatosis. The lead of that article says they are synonyms. Or as emphysema is a specific type of COPD (pulmonary emphysema), is it also a specific type of pneumatosis (pulmonary pneumatosis)? wbm1058 (talk) 21:24, 20 May 2019 (UTC)

User:Wbm1058 Purge? it seemed that the inclusion of the aka for emphysema was an unnecessary confusion as emphysema is the most used term in relation to the lungs. Previously there was a page Emphysema but this was redirected here. i think this was a wrong move and think it needs to be reinstated. Pneumatosis has been much more widely used in the context of the colon - pneumatosis intestinalis, and emphysema universally used as related to the lungs. On occasion the term Gastric emphysema is used. (i was unaware that there was a redirect page of Pulmonary emphysema to COPD). --Iztwoz (talk) 06:57, 21 May 2019 (UTC)

Have just looked at previous page for Emphysema which was a disambiguation page - still think these were wrong redirects - the page could have covered the main usage of it as related to the lungs and included (made reference to) all the other items listed.--Iztwoz (talk) 07:07, 21 May 2019 (UTC)

The term "emphysema" is used in two ways, the more common use is to mean COPD. The less common use is to mean specific pathological findings in COPD. Another common use is pneumatosis. Chronic bronchitis is also used in two different ways, one to mean COPD and one to mean a chronic productive cough over a few years. Doc James (talk · contribs · email) 08:37, 21 May 2019 (UTC)

You quote things entirely relevant to the US definition of COPD. Both the British and Australian authorities define it very differently as an umbrella term for the two conditions and sometimes more. I intend to note the differing definitions.--Iztwoz (talk) 13:15, 22 May 2019 (UTC)

We could have an article called "Pathophysiology of COPD" were we could discuss the pathophysiological details of "emphysema" at greater length (if anyone is interested in doing so). The problem with creating an article on "Pulmonary emphysema" is that it may simple get filled full of content duplicating COPD with efforts to present it as a disease in and of itself rather than simple a pathological finding. Doc James (talk · contribs · email) 08:48, 21 May 2019 (UTC)

I see its non-inclusion as a separate page for emphysema as a discredit to the encyclopedia there are something like 8 million hits for emphysema and no Wiki page.--Iztwoz (talk) 13:15, 22 May 2019 (UTC)

This ref provide a similar statement. https://books.google.co.jp/books?id=wGclDwAAQBAJ&pg=PA299#v=onepage&q&f=false

Specifically that emphysema and chronic bronchitis are synonyms for COPD.

That they are also use for their own specific technical meanings

And that traditionally they were used as types of COPD but that this is no longer the case. Doc James (talk · contribs · email) 08:58, 21 May 2019 (UTC)

Added the direct quote from WHO. Doc James (talk · contribs · email) 12:23, 22 May 2019 (UTC)

Guys, I just checked back in on the lead of this article and it is much improved (when I drop in on an article like this, it is often because it's thrown a red flag that I patrol for, and thus is generally in a bit of a mess). "Chronic bronchitis and emphysema are older terms used for different types of COPD". I would say that they are older terms for the two primary symptoms of COPD, Chronic obstructive pulmonary disease § Cough and Chronic obstructive pulmonary disease § Shortness of breath. "Cough" (chronic bronchitis) is what keeps the tobacco victim in the bathroom so long, with their endless hacking and spitting into the sink. "Shortness of breath" (emphysema) is what keeps them tethered to their oxygen machine or mobile tanks. I'd guess that the vast majority (over 90%) of (advanced) COPD patients experience both symptoms, and that's why the two older "separate" diseases were lumped together in order to give them a single disease called COPD. If I'm right, then maybe you could update the article to say so. Or say whatever the percentage is, it's probably not exactly 90%. Actually, the lead of the "Signs and symptoms" section summarizes that in a way that makes sense to me. – wbm1058 (talk) 10:23, 5 June 2019 (UTC)

User:Wbm1058 what references would support that? Emphysema is not shortness of breath but an underlying finding see on imaging or examination of lung tissue. Chronic bronchitis is a chronic cough yes.

Most people have a combination of three main findings.

We currently say "The poor airflow is the result of breakdown of lung tissue (known as emphysema) and small airways disease (known as obstructive bronchiolitis).[9] The relative contributions of these two factors vary between people.[9]" Doc James (talk · contribs · email) 20:17, 5 June 2019 (UTC)

Review request

Just a few notes on the GA review request made: The GA was given in 2013. In 2019 the page has almost doubled with no further review. Also i think the size of the page has increased needlessly due to the 'merging' of emphysema - an important page in its own right that has now disappeared. A search for emphysema redirects here. Likewise think the redirection of Chronic bronchitis to here completely unnecessary as it has its own home on the Bronchitis page and find constant references to it being just a cough confusing and unnecessary - many other conditions or diseases could be equally short changed for example a runny nose could do away with the condition of rhiinitis - ? It has since been made into a disambiguation page after i changed the redirect to Bronchitis section? this dab page is a nonsense as the topics are the same. was hoping that another review would look at these issues. And the confusing use of that sentence being older terms, (making those previous terms redirects here) which was already tried to be addressed has not been. Talk on the pages here and on Bronchitis do not seem to make much headway. --Iztwoz (talk) 14:52, 5 June 2019 (UTC)

I disagree. Harrison's textbook of internal medicine does not deal with them seperately. The CDC does not deal with them separately per "It includes emphysema and chronic bronchitis". WHO does not deal with them seperately per "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." Doc James (talk · contribs · email) 20:20, 5 June 2019 (UTC)

As pointed out below the material has changed from the 2015 page to the Dec 2017 fact sheet.

As brought up before - the umbrella term definition has changed in accord with the GOLD document. Also as brought up before the differences in defining COPD have not been addressed, when i added something from the ALA you reverted saying that the ALA was a charity yet it is used in the GOLD report - the first ref in fact. Can i ask you now - is the ALA an acceptable source? And is Medscape an acceptable source? --Iztwoz (talk) 17:28, 7 June 2019 (UTC)

Medscape is also not a very good source. Not sure what you mean by "the umbrella term definition has changed in accord with the GOLD document" Doc James (talk · contribs · email) 00:23, 10 June 2019 (UTC)

Refs

This ref has NOT been updated and is still present as of 2019. https://www.who.int/respiratory/copd/en/

Yes I understand you do not agree with the WHOs wording but please stop removing it. Restored again. Doc James (talk · contribs · email) 14:56, 7 June 2019 (UTC)

It's not a question of agreeing or not with the info it's a question of providing the most up to date information. https://www.who.int/en/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd) --Iztwoz (talk) 16:39, 14 June 2019 (UTC)

The link you give goes to the same info on the same page as the fact sheet no 315 dated January 2015. The fact that you accessed it on 6 June 2019 is neither here nor there. And a big problem arises here - the relevant ref is WHO2015 - The archived copy goes to fact sheet 315 of January 2015 archived in 2016. Yet the link on the WHO2015 ref (of which there are many) goes to the fact sheet dated December 2017 - which does in fact differ from the 315 page and is more in line with later sources which is why it must be considered as an update. The ref i added WHO2017 is actually the same ref as as should be the one you added since December 2017 is clearly more recent than January 2015. The fact sheet is available from the 315 page link to fact sheet. Seems like the whole reference needs to be redone - see no reason to include archived older info page. or its older info ? --Iztwoz (talk) 17:17, 7 June 2019 (UTC)

This is not an archive of an old page. Doc James (talk · contribs · email) 00:06, 10 June 2019 (UTC)

The archive goes to 2015 - the link on the ref goes to December 2017 fact sheet which has somewhat different wording. ??--Iztwoz (talk) 16:14, 14 June 2019 (UTC)

If it was not current they would remove it. Doc James (talk · contribs · email) 16:25, 14 June 2019 (UTC)

as above https://www.who.int/en/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd) --Iztwoz (talk) 16:39, 14 June 2019 (UTC)

Strangely the page can no longer be found - from 30 minutes ago.--Iztwoz (talk) 16:42, 14 June 2019 (UTC) https://www.who.int/en/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

but now it does ?--Iztwoz (talk) 16:45, 14 June 2019 (UTC)

Paywall

There are 33 refs (at 2) to a Lancet article that is paywalled - is there a way around this or ought other more accessible refs be looked for with like content.--Iztwoz (talk) 07:49, 15 June 2019 (UTC)

There is no rule that we must use sources that are not behind a paywall. Doc James (talk · contribs · email) 03:16, 16 June 2019 (UTC)

OR

In section that i had placed cn's in yesterday you removed these and used the same ref - can you please point out exactly where these items are - the archived link is a dead link - the other link goes to a page that is unsearchable [9] PMID 22878278. This link gives a searchable document and i can find no ref at all to these included items. --Iztwoz (talk) 07:36, 10 June 2019 (UTC)

Doc James (talk · contribs) - i have redid the GOLD 2013 ref again - what is your reasoning for reverting back to the link that has an archive deadlink and one that is not searchable - the ref is exactly the same just now searchable - i would point out again that the ref used to support all the info in the Cough section does not support the info - so it is OR. It makes no sense to change back to a ref that is not so transparent. The ref now goes to the exact material as the other but is now searchable.  Without even searching - why would the GOLD report talk of rib fractures, and cultural custom, and the common cold, for example?--Iztwoz (talk) 16:10, 14 June 2019 (UTC)

So the original ref is 99 pages.

The ATS Journal is 19 pages. They are not the same. That is why the one is called an "Executive Summary"

Will add exact quotes for each of the statements in a bit. Doc James (talk · contribs · email) 16:21, 14 June 2019 (UTC)

The report in the ATS Journal is exactly the same as the one you have used - the document is not page numbered - however the chapters are easily accesible as in chapter 2 the chapter being quoted, this (as the others), is easily accessed and its pages cover 9-17. Also the material as entered in the journal is much more user-friendly.--Iztwoz (talk) 17:10, 14 June 2019 (UTC)

Here is the full paper.[10]

Here is the summary [11]

Just look at the section on "Home Management of Exacerbations" in both documents. Doc James (talk · contribs · email) 04:17, 15 June 2019 (UTC)

What am i supposed to be looking at in Chapter 5 page 45?- can see nothing of any relevance and even if i did it is not related to Chapter 2 which is the reference used for the section 'Cough'.--Iztwoz (talk) 07:38, 15 June 2019 (UTC) Sorry-had already noted the difference.--Iztwoz (talk) 14:21, 15 June 2019 (UTC)

Done two of them. Not doing all of them. You can read the full reference.[12]

Doc James (talk · contribs · email) 04:23, 15 June 2019 (UTC)

Thank you for the links - the summary had looked like the whole report. Have now seen some of the queried info on the report - but i did not see ref to common colds. Also the whole section could do with a bit of re-write, the 'sputum produced can change over hours to days' does not to me equate with what the source says or inform anything, and the sentence relating to sputum 'being spat out or swallowed needs to include the difficulty of evaluating its production (if the sentence is to be included at all. Might be better as source has done, in making a bit of separation of cough and sputum, as the important note that the cough in COPD is not always productive is somehow 'lost' in section. and there is still the deadlink to the archived copy.--Iztwoz (talk) 07:22, 15 June 2019 (UTC)

Please stop removing references just because you are unable to find were in the ref it is stated. It is there. Doc James (talk · contribs · email) 03:18, 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)

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)

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[13] 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)

Bronchodilator Effect

The following article is given as a reference to the statement on this Wikipedia page that "In contrast to asthma, the airflow reduction does not improve much with the use of a bronchodilator.[3]".

However, the article (currently) doesn't say anything about the effects of a bronchodilator.

• "Chronic obstructive pulmonary disease (COPD) Fact sheet N°315". WHO. January 2015. Archived from the original on 4 March 2016. Retrieved 4 March 2016. https://www.who.int/en/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

--ScottS (talk) 18:40, 23 December 2019 (UTC)

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

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.

The survey and discussion sections below demonstrate a rough consensus in favor of the redirects as proposed in Option 1. (non-admin closure) Eggishorn (talk) (contrib) 03:28, 16 January 2020 (UTC)

---

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.[14] 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)

   How can 40 per cent of people with chronic bronchitis who do not have COPD be considered uncommon? --Iztwoz (talk) 14:42, 27 September 2019 (UTC)

   Most of the time when people say they have "chronic bronchitis" they mean they have "COPD". Well technically some people have chronic bronchitis without COPD, their cases are mild and thus less likely to complain about it. Chronic bronchitis was historically a type of COPD and still used by some in that manner. Doc James (talk · contribs · email) 23:47, 27 September 2019 (UTC)

   We have already been over this a number of times on Bronchitis page - 8.6 million Americans were diagnosed as having Chronic bronchitis 2015-2016 diagnosed by medical practitioners - not by themselves. The highest figure that you could come up with when trying to push this point of view was 60% of smokers with bronchitis had COPD. So that the sentence of "Most people..." had to be changed to "many people..." There is a realm of documentation as to the incidence of chronic bronchitis without airflow obstruction and therefore without COPD. Can you find one genuine reference to support your statement that chronic bronchitis and emphysema were historically a type of COPD. I have added a History section on the Bronchitis page (still adding to) - they were conditions in their own right and much studied, and that due to their similarity in presentation and causality, were defined as components, subtypes of the newly designated umbrella term COLD in 1959 and finally COPD in 1962. These were and still are often called phenotypes of COPD - a bronchitic type of COPD and an emphysematous type of COPD. (Type A pink puffers, and type B blue bloaters). Since that time a number of other phenotypes have been and are being recognised that is directed towards improved targeting of treatment options. Chronic bronchitis existed before the umbrella term of COPD so how can it in your words be considered an "older type of COPD".? The phrasing makes no sense at all. There is not one reference to support this as it makes no sense. To use two references - one an updated version of the other by the same source, do not support your claim. All that they state is that - to re-phrase 'COPD' was previously known by the familiar terms of chronic bronchitis and emphysema. The outstanding fact that GOLD (present and past) states clearly that Chronic bronchitis be treated as a separate disease entity is conveniently ignored. As is the fact that both conditions are no longer included in the defintion.This article page was good when it was made a GA - the sentence you added about these being previous types of COPD makes no sense. When I asked you what it means your response was to say that you would consult Harrison's about it and that was an end to it. I say again that the sentence is without meaning - what is it supposed to be informing anyone of? After adding the sentence you then decided to merge emphysema here with no discussion and to redirect Chronic bronchitis here. What is the point? COPD was listed as a Good Article referring quite rightly to the various components. I have tried to change the redirects and been overturned. Have tried to have Emphysema back to its own page - not a chance. Redirects should point to the pages that contain the most information about the subjects, where they can also be Main article hatnotes. As it is there is a lot more information both on Chronic bronchitis on the Bronchitis page, and on Emphysema on the Pneumatosis page. There are several kinds of emphysema only two of which relate to COPD.--Iztwoz (talk) 07:03, 1 October 2019 (UTC)

   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."

   Johns Hopkins states "People with chronic bronchitis have chronic obstructive pulmonary disease (COPD). This is a large group of lung diseases that includes chronic bronchitis."

   COPD Foundation says "Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma."Doc James (talk · contribs · email) 19:07, 1 October 2019 (UTC)

3. support per JFW and Doc James rationale--Ozzie10aaaa (talk) 09:37, 27 September 2019 (UTC)
4. Support per Doc James. Flyer22 Reborn (talk) 03:22, 29 September 2019 (UTC)
5. Support per rationale above. Spyder212 (talk) 01:10, 2 October 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)
2. Support redirecting Chronic bronchitis to Bronchitis#Chronic bronchitis. I think it will help people understand the subject better (it's a clearer overview of what that term means and its particular relationship to COPD), and sending them to the lay-friendly summary will lead them here soon enough. WhatamIdoing (talk) 16:04, 27 September 2019 (UTC)
3. Support. I am not an expert, but they are coded as different diagnoses UWM.AP.Endo (talk) 17:59, 27 September 2019 (UTC)
4. Conditional Support Neutral. I am not a physician or biomedical scientist, so what I write here is based on my lay-person's understanding. My understanding after a brief review of literature and websites on this topic was that COPD encompassed emphysema and chronic bronchitis. For example, “... the PCG [COPD Foundation Pocket Consultant Guide] stresses that optimal COPD care requires evaluation of all the severity domains: spirometry, symptoms, exacerbation frequency, oxygen requirements, presence of emphysema, chronic bronchitis, and comorbidities ....” Or, “Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease (COPD)” and “Chronic obstructive pulmonary disease, commonly known as COPD, refers to a group of progressive lung diseases that cause increasing breathlessness. Emphysema is one of these diseases.” However, if the above statements are imprecise, because “... a large proportion of people with chronic bronchitis do not have COPD ... [and] [t]he same holds for emphysema”, as Iztwoz said, then I agree with Iztwoz's proposal.   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 14:12, 27 September 2019 (UTC)

Update: Doc James in the discussion below makes some good points, which leads me to change my opinion to Neutral. If a consensus of physicians, biomed scientists, and experienced WP:MED editors (regardless of their professional background) conclude that redirecting "emphysema" and "chronic bronchitis" to this (COPD) article is more consistent with current understanding in medicine, I will support such a consensus.   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 18:13, 6 October 2019 (UTC)

References

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)

"Chronic bronchitis" and "emphysema" are old names for COPD and we need to make sure this remains clear. Doc James (talk · contribs · email) 23:49, 27 September 2019 (UTC)

I'm just not sure that's true. It appears that "COPD with chronic bronchitis" is an old sub-type, but there really does seem to be a form of non-COPD chronic bronchitis. In the ICD-10, J41 and J42 are both chronic bronchitis, and J42 explicitly excludes COPD (which are J43 and J44). "Bronchitis, chronic, NOS, excluding COPD" cannot be just another name for COPD. WhatamIdoing (talk) 22:41, 28 September 2019 (UTC)

ICD-11 is similar. CA22 Chronic obstructive pulmonary disease lists emphysema (CA21) and chronic bronchitis (CA20.1) as "exclusions".   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 16:34, 30 September 2019 (UTC)

It lists "chronic bronchitis NOS" as an exclusion rather than "chronic bronchitis". Strange that it lists emphysema as an exclusion as that is present in many cases of COPD.Doc James (talk · contribs · email) 05:23, 1 October 2019 (UTC)

Ah, I stand corrected. Thank you Doc James.   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 11:57, 1 October 2019 (UTC)

User:Markworthen with respect to "in the past decade or two medicine has been moving toward classifying chronic bronchitis and emphysema as types of COPD, but the transition is not yet complete". Chronic bronchitis and emphysema were types of COPD. And medicine is moving towards these cases being described as simple COPD. This move is not complete and people still commonly use the terms to mean COPD when COPD would be more appropriate.

The thing is that both these terms have two meanings. Chronic bronchitis also describes a symptom (chronic productive cough of more than 3 months) and emphysema describes a specific pathological change to the lungs that presents in COPD. Doc James (talk · contribs · email) 16:38, 1 October 2019 (UTC)

Ah, thank you for those insights. I can see why it's confusing! Of course, in clinical psychology & psychiatry we've got this nosology thing all figured out, neat as a pin. :^O   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 02:17, 2 October 2019 (UTC)

Doc James (talk) Where is this movement to simple COPD being discussed, proposed, carried out? If that is the case then I will stand corrected. I find it really difficult to see how that would work. The diagnosis of COPD is dependent on a certain spirometry reading, and as GOLD has stated many cases of chronic bronchitis do not give a high enough spirometry reading - are you saying that these cases will be classed as COPD? --Iztwoz (talk) 08:44, 3 October 2019 (UTC)

Not sure what you mean by "Where is this movement to simple COPD being discussed, proposed, carried out?" What I am saying is chronic bronchitis has two meanings, one is the symptom the other is a prior name for a type of COPD. Same with emphysema one is a prior name for a type of COPD and the other is a pathological change within lung tissue. Doc James (talk · contribs · email) 17:24, 3 October 2019 (UTC)

This seems to be the fundamental problem under discussion. On the one hand, we have "chronic bronchitis", which is "a symptom". On the other hand, we have "the chronic-bronchitis subtype of COPD". These are different things, and both really do exist.

So the question is: Why should Chronic bronchitis redirect to the "COPD subtype" article, instead of the "symptom" article? Personally, I think that the short section in the "symptom" article does a better job of explaining the two types. I think it's important for people to get that explanation. After all, you'd never want someone who has the non-COPD "symptom" form to type chronic bronchitis into Special:Search and then start believing that they actually have COPD.

Maybe we need a Wikipedia:Disambiguation page instead of a redirect. WhatamIdoing (talk) 18:51, 4 October 2019 (UTC)

Agree that is the fundamental issue under discussion. My opinion is it should redirect to COPD as that is a more common use than the symptom meaning. If one looks at the first hits on google for "chronic bronchitis" they related to the type of COPD meaning... Doc James (talk · contribs · email) 16:09, 5 October 2019 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

acute respiratory failure with hypercapnia

i think this is a specific condition associated with COPD that i didnt see mentioned. its an increase of CO2 in the blood, like with divers, and is itself deadly. i may add, but would appreciate someone else noticing this and adding it. 69.216.101.196 (talk) 16:56, 20 April 2021 (UTC)

Reducing the risk of death

The section on Management states that "Stopping smoking decreases the risk of death by 18%." Sadly, the risk of death is 100% for all of us. Perhaps it should say "the risk of death from COPD" or "the risk of death in a given year" or something. Aymatth2 (talk) 16:18, 10 November 2019 (UTC)

Aymatth2, I just noticed this comment. See "Risk of death" below. In fact, it seems it doesn't reduce the risk of dying "from COPD", though is certainly beneficial. The underlying study looked at risk of death after 14.5 years, and the figure of 18% relates to participating in a stop-smoking intervention, not on actually whether the person successfully stopped smoking to any degree. -- Colin°^Talk 20:10, 19 June 2021 (UTC)

Citations

Colin is it better to just include page numbers for latest Gold report, as it seems that a different format is needed for each chapter.? --Iztwoz (talk) 17:39, 28 June 2021 (UTC)

I'm experimenting. I wanted to be more precise than some existing citations, as the book is 150+ pages long. I wondered if just having the page number was less helpful if future readers had the 2025 report - at least we could tell them what chapter it was from. I've made some edits. Firstly I fixed your citations to correctly link to chapter 1 and to a new chapter 2 citation that I added. Then I merged them as you suggested, but added a loc= parameter to the sfn. What do you think? -- Colin°^Talk 19:25, 28 June 2021 (UTC)

Yes that seems to work!--Iztwoz (talk) 09:28, 29 June 2021 (UTC)

Increase in women smokers

Hi, I can't see this in the citation "The disease affects men and women almost equally, as there has been increased tobacco use among women in the developed world.[185]". Am I losing the plot? Graham Beards (talk) 11:46, 29 June 2021 (UTC)

See my comments above starting "An older version of the WHO fact sheet .." The ref 185 does additionally link to the archived version that was used at the time, and does support it. As I note above, the GOLD report refers to the WHO data and says it "must be interpreted with caution". I wonder if they are being euphemistic and have more derogatory language in their heads. -- Colin°^Talk 12:54, 29 June 2021 (UTC)

You are right. It's usually a polite way of saying something is bollocks with the bonus of not having to say why. I have used it more than once IRL.Graham Beards (talk) 13:12, 29 June 2021 (UTC)