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Wikipedia:Featured article candidates/Diffuse panbronchiolitis/archive1

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The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted by Ucucha 20:56, 22 December 2011 [1].

Diffuse panbronchiolitis edit

Diffuse panbronchiolitis (edit | talk | history | protect | delete | links | watch | logs | views)

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Nominator(s): Rcej (Robert) – talk 06:52, 30 October 2011 (UTC)[reply]

I am nominating this for featured article because it is featured article worthy, and the peer review has been completed. Rcej (Robert) – talk 06:52, 30 October 2011 (UTC)[reply]

Source review - spotchecks not done. Check italicization on FN 24; otherwise fine. Nikkimaria (talk) 15:09, 30 October 2011 (UTC)[reply]

Nikkimaria (and Rcej), have you checked for correct use of secondary reviews relative to primary sources, per WP:MEDRS? The way to check for this is to (time consumingly) click on each PMID, expand the info at the bottom of the PMID and make sure source is not primary, and if it is, check that it's used correctly. Rcej, I assume you know the article should be mainly written from reviews, avoiding inappropriate use of primary sources? SandyGeorgia (Talk) 15:15, 1 November 2011 (UTC)[reply]
No, I didn't check that, apologies. Nikkimaria (talk) 14:59, 3 November 2011 (UTC)[reply]

Comment: I hope you are a little more sure of the article's FA-worthiness than simply feeling it has "potential", otherwise the nomination is premature. I will assume you are expressing yourself modestly. I don't know anything about this subject, but when I see a section headed "History" with less than two lines of text, I start thinking of comprehensiveness issues. Is that really all there is to be said on the history of this disease? And is the bottom of the article the best place for this section? Brianboulton (talk) 22:21, 30 October 2011 (UTC)[reply]

Thanks for your comments! "Potential" is just my unfortunate, probably humble, and hopefully benign choice of words. On the history section and its placement, much context of the disease history is assocciated with the evolution of its prognosis, and it would be repetitive to include that content in both secctions; and the placement is per MEDMOS suggestion. :) Rcej (Robert) – talk 03:40, 31 October 2011 (UTC)[reply]
OK. I see you have added a little. The "History" section deals essentially with pre-1980 and the "Prognosis" section follows on. So to my unpractised eye, the sequence suggested by MEDMOS appears illogical, but I won't press the point. Brianboulton (talk) 20:27, 1 November 2011 (UTC)[reply]
Seem my note below about section order. Colin°Talk 08:46, 3 November 2011 (UTC)[reply]

(Graham Colm) I haven't had time to read the article yet, but I put it and this page on my Watchlist when it was nominated. It's recommended by the Wikipedia medics that the history section should be at the end, and although I don't always agree, the editors there will expect this. This is a relatively newly recognised disease that was first described about forty odd years ago, so its history is short. I agree that the use of "potential" is a possible cause for concern, but I think it's just modesty. Graham. Graham Colm (talk) 22:59, 30 October 2011 (UTC)[reply]

PS. On my first reading I was impressed with the comprehensiveness of the article and the sources used. It's highly informative and well written. But, I am worried that some readers will not understand much of the genetics, immunology and microbiology. But given that this is rare disease, and that good writers know their readers, we should ask ourselves who will look this up? I'm a clinical microbiologist and will recommend this article to my students. I am tempted to add my support but must wait to see what other reviewers have to say. Graham Colm (talk) 23:57, 30 October 2011 (UTC)[reply]

Copyscape check - No issues were revealed by Copyscape searches. Graham Colm (talk) 23:22, 30 October 2011 (UTC)[reply]

First glance, no time for more, I see lots of underlinking and undefined terms (that sorta ties in with Graham's mention of reader understanding-- I'm accustomed to reading med articles, and want to understand the differential diagnosis of this condition, but had a hard time with some of the jargon/lingo/lack of linking and undefined terms). I'm encouraged that the very old GA was passed by Delldot, encouraged that Graham endorses the article, but I am always concerned when there is only one reviewer at peer review and there hasn't been wide participation at WT:MED (there may have been and I may have missed it). SandyGeorgia (Talk) 15:24, 31 October 2011 (UTC)[reply]

Hi Sandy, I was the single editor who was involved in the peer review. I'm not sure I agree with you on the underlinking; by the time one gets to the Differential diagnosis section, most of the technical terms have been linked previously. I thought Rcej did a pretty good job with the jargon, but one has to read the article from beginning to end to catch all the definitions. This is difficult subject matter, and not an easy read for the average Randy—I think Graham's comments about audience are spot-on. Rcej did try to solicit input from the medics, but didn't get much response other than Axl, who had a few words to say about antibiotic therapy (see talk page). I'll go through the article again and see if I can help with any further improvements to assuage your concerns about jargon. Sasata (talk) 16:52, 31 October 2011 (UTC)[reply]
Thanks, Sasata-- all of that is reassuring (and I appreciate you doing the homework for me :) As the FAC gets further underway, I'll recheck to see if there are any sections going over my head-- I went straight to differential diagnosis for a scan, which raises one question-- is there any need for repeat linking if terms are first defined a long way apart in the text? (I dunno-- haven't checked-- asking ... ) SandyGeorgia (Talk) 16:57, 31 October 2011 (UTC)[reply]
I'm sorry that I didn't have the time for a for thorough review then. I shall try to give a more complete assessment below. Axl ¤ [Talk] 20:26, 31 October 2011 (UTC)[reply]

Comment—This disease sounds ghastly. The article appears to be in pretty good condition (although I got a little lost in some of the genetic terminology). Here are a few points I noticed:

  • The text switches between serial commas and non-serial commas in a few places. Please be consistent, where possible.
  • Done. I try to use serial commas only to seperate lists, i.e. "A, B and C, and D, E and F." Rcej (Robert) – talk 08:10, 1 November 2011 (UTC)[reply]
  • "...and excessive production of pus-filled sputum prone to occur with...": I think this statement is missing an article (the), as in either "the excessive production" or "the pus-filled spetum prone to occur".
  • "This eventually becomes life-threatening...": 'eventually' is vague. Perhaps an average interval from onset could be listed?
  • Copy edited. Rcej (Robert) – talk 08:10, 1 November 2011 (UTC)[reply]
  • "...between HLA-B an HLA-A...": 'and'?
  • "Another gene, though not a part of...": "candidate gene"?
  • Done. Copy edit, as this one is not referred in the texts as a candidate gene. Rcej (Robert) – talk 08:10, 1 November 2011 (UTC)[reply]
  • "...asthma and chronic bronchitis by its rapid progression...": 'rapid' is vague.
  • Chopped. Rcej (Robert) – talk 08:10, 1 November 2011 (UTC)[reply]
  • "purulent" seems to be unlinked jargon.
  • Changed to "pus-filled". Rcej (Robert) – talk 08:10, 1 November 2011 (UTC)[reply]
  • "The diagnosis of DPB requires analysis of the lungs and bronchiolar tissues...": does this usually involve taking a biopsy?
  • There are a couple of overly long paragraphs (beginning with the wording listed below). Can these be split for less tiresome reading?
    • "DPB and bronchiolitis obliterans..."
    • "The successful results of macrolides in DPB and similar lung..."
    • "Around 1985, when long-term treatment with the macrolide..."
  • Has this disease been observed in descendants of East Asian immigrants to the U.S., Canada, or elsewhere? It would be interesting to mention this in either case.
  • Done. Yes there is :) I added this, cited from another secondary src. Rcej (Robert) – talk 08:14, 5 November 2011 (UTC)[reply]
  • Some information on current research efforts would be good, if available.
  • Working on.... Rcej (Robert) – talk 08:14, 5 November 2011 (UTC)[reply]
  • Okay, I'll wait for this. Thanks. RJH (talk) 22:58, 9 November 2011 (UTC)[reply]
  • Well, the research is basically the search for a DPB-causing gene. I can't really go further than the basic fronts. Rcej (Robert) – talk 08:29, 17 November 2011 (UTC)[reply]

The citations seem to be in good shape. Nice work. Regards, RJH (talk) 17:53, 31 October 2011 (UTC)[reply]

  • Comments by Axl

The picture (Respiratory system complete en.svg) has three errors in the labelling: "Cricoid cartilage", "Lingular division bronchus" and "Intermediate bronchus". I first tried to draw attention to these in June 2011. I have now posted a message on the Wikimedia Commons talk page. Axl ¤ [Talk] 20:08, 31 October 2011 (UTC)[reply]

From the lead section, paragraph 3: "If left untreated, DPB quickly progresses to bronchiectasis." I am struggling to find a source that uses the adverb "quickly". Homma includes the statement "it may often show rapid progression with fatal outcome". Poletti states "If left untreated, DPB progresses to bronchiectasis, respiratory failure and death." Axl ¤ [Talk] 20:24, 31 October 2011 (UTC)[reply]

From "Classification": "DPB can be distinguished from these by the presence of lesion-like nodules." "Lesion-like nodules"? Is that really what the sources say? Axl ¤ [Talk] 10:52, 1 November 2011 (UTC)[reply]

From "Signs and symptoms" describes wheezing, crackles, dyspnoea, etc. However the most common problem is chronic sinusitis, affecting over 75%. Sinusitis often precedes chest symptoms by months or even years. The next most common symptom is chronic cough with sputum. Axl ¤ [Talk] 11:02, 1 November 2011 (UTC)[reply]

From "Signs and symptoms": "These include ... severe cough with large amounts of sputum (saliva with coughed-up phlegm)." Sputum is not saliva with coughed-up phlegm. Axl ¤ [Talk] 11:04, 1 November 2011 (UTC)[reply]

  • Fixed. But do you know how to keep your spit out of your hack-ups? Rcej (Robert) – talk 09:01, 2 November 2011 (UTC)[reply]

From "Signs and symptoms": "Other symptoms include ... hypoxemia." Hypoxemia is not a symptom. Axl ¤ [Talk] 12:15, 1 November 2011 (UTC)[reply]

From "Signs and symptoms": "DPB is a life-threatening condition, and leads to respiratory failure." This is a rather alarmist statement, given that the untreated five-year survival is 62% and ten-year survival is 33%. Axl ¤ [Talk] 13:36, 1 November 2011 (UTC) [reply]

From "Signs and symptoms": "... bronchiectasis, a life-threatening condition that can lead to respiratory failure." Again, this looks rather alarmist. Bronchiectasis is not usually a life-threatening condition. Axl ¤ [Talk] 10:10, 2 November 2011 (UTC)[reply]

From "Cause", paragraph 2: "A subset of the human MHC is human leukocyte antigen (HLA)." HLA is human MHC. Axl ¤ [Talk] 13:41, 1 November 2011 (UTC)[reply]

"MHC controls human leukocyte antigen (HLA)." No! HLA is human MHC. Axl ¤ [Talk] 11:14, 2 November 2011 (UTC)[reply]
No, HLA is part of MHC. Rcej (Robert) – talk 07:24, 3 November 2011 (UTC)[reply]
After some digging around, I have found that technically you are right. My apologies to you. In my defence, many sources conflate HLA and MHC, as indicated in the first paragraph here. (Really we're both right, depending on the definition used.) Axl ¤ [Talk] 11:23, 3 November 2011 (UTC)[reply]

From "Cause", paragraph 3, I don't think that the passive voice speculation is helpful. Why not just state "the candidate gene is likely to be within a 200 kb (kilobase, or 1,000 base pairs) region of the 300 kb telomeric class I HLA, near the HLA-B locus at chromosome 6p21.3"? Axl ¤ [Talk] 19:06, 1 November 2011 (UTC)[reply]

Huh? I don't see much change at all. Axl ¤ [Talk] 17:02, 2 November 2011 (UTC)[reply]
  • If I supercede the source, that is speculation. I have "After further study of this localized area between HLA-B and HLA-A, it was concluded that a DPB susceptibility gene is located within a 200 kb (kilobase, or 1,000 base pairs) region of the 300 kb telomeric class I HLA, near the HLA-B locus at chromosome 6p21.3.". That was the conclusion, and for context purposes, we need "After further study of this localized area between HLA-B and HLA-A, it was concluded that...". If we just have "The gene is located...", the reader would feel like we left something out. Rcej (Robert) – talk 07:24, 3 November 2011 (UTC)[reply]


From "Cause", I wonder how relevant the extended discussion of candidate genes actually is to this article. Poletti discusses Bw54 and A11. (Homma doesn't mention these, but it is a rather old paper.) Fishman's Pulmonary Diseases and Disorders (my preferred respiratory text) mentions Bw54. Many of the references for the candidate genes look like primary sources. Axl ¤ [Talk] 20:24, 1 November 2011 (UTC)[reply]

  • Copy edited. Rcej (Robert) – talk 09:01, 2 November 2011 (UTC)[reply]
There hasn't been much change here either. I don't think that these details about candidate genes should be in this article. Much of it could/should be moved to articles about the genes themselves. Axl ¤ [Talk] 17:07, 2 November 2011 (UTC)[reply]
  • I removed the phrase "candidate gene"; but are you suggesting I remove all mention of the genes themselves from the cause section? The journals haven't from the etiology. Rcej (Robert) – talk 07:54, 3 November 2011 (UTC)[reply]

Primary sources:-

6: Giannoli, "HLA and transfusion: new approaches with Luminex™ technology"

  • Removed. Rcej (Robert) – talk 08:03, 11 November 2011 (UTC)[reply]

7: Pedersen, "Porcine major histocompatibility complex (MHC) class I molecules and analysis of their peptide-binding specificities"

  • Removed. Rcej (Robert) – talk 08:03, 11 November 2011 (UTC)[reply]

8: Matsuzaka, "Identification of novel candidate genes in the diffuse panbronchiolitis critical region of the class I human MHC"

  • Removed. Rcej (Robert) – talk 09:16, 13 November 2011 (UTC)[reply]

9: Keicho, "Contribution of HLA genes to genetic predisposition in diffuse panbronchiolitis"

  • Removed. Rcej (Robert) – talk 08:03, 11 November 2011 (UTC)[reply]

10: Park, "Association of HLA class I antigens with diffuse panbronchiolitis in Korean patients"

  • Removed. Rcej (Robert) – talk 08:03, 11 November 2011 (UTC)[reply]

11: Keicho, "Fine localization of a major disease-susceptibility locus for diffuse panbronchiolitis"

  • Removed. Rcej (Robert) – talk 08:03, 11 November 2011 (UTC)[reply]

12: Keicho, "Contribution of TAP genes to genetic predisposition for diffuse panbronchiolitis"

  • Removed. Rcej (Robert) – talk 09:16, 13 November 2011 (UTC)[reply]

17: Emi, "Association of diffuse panbronchiolitis with microsatellite polymorphism of the human interleukin 8 (IL-8) gene"

  • Removed. Rcej (Robert) – talk 09:16, 13 November 2011 (UTC)[reply]

18: Mocci, "Microsatellites and SNPs linkage analysis in a Sardinian genetic isolate confirms several essential hypertension loci previously identified in different populations"

  • Removed. Rcej (Robert) – talk 09:16, 13 November 2011 (UTC)[reply]

22: Oda, "Leukotriene B4 in bronchoalveolar lavage fluid of patients with diffuse panbronchiolitis"

  • Removed. Rcej (Robert) – talk 09:31, 12 November 2011 (UTC)[reply]

23: Kadota, "High concentrations of beta-chemokines in BAL fluid of patients with diffuse panbronchiolitis"

  • Removed. Rcej (Robert) – talk 10:00, 12 November 2011 (UTC)[reply]

24: Hiratsuka, "Increased concentrations of human beta-defensins in plasma and bronchoalveolar lavage fluid of patients with diffuse panbronchiolitis"

  • Removed. Rcej (Robert) – talk 10:00, 12 November 2011 (UTC)[reply]

25: Yamamoto, "Influence of human T lymphotrophic virus type I on diffuse pan-bronchiolitis"

  • Removed. Rcej (Robert) – talk 09:31, 12 November 2011 (UTC)[reply]

26: Homma, "Comparative clinicopathology of obliterative bronchiolitis and diffuse panbronchiolitis"

  • Removed. Rcej (Robert) – talk 08:37, 15 November 2011 (UTC)[reply]

27: Sculte, "Diffuse panbronchiolitis. A rare differential diagnosis of chronic obstructive lung disease"

  • Removed. Rcej (Robert) – talk 08:37, 15 November 2011 (UTC)[reply]

28: Homma, "Diffuse panbronchiolitis in rheumatoid arthritis"

  • Removed. Rcej (Robert) – talk 08:37, 15 November 2011 (UTC)[reply]

30: Hayakawa, "Diffuse panbronchiolitis and rheumatoid arthritis-associated bronchiolar disease: similarities and differences"

  • Removed. Rcej (Robert) – talk 10:01, 14 November 2011 (UTC)[reply]

33: Shirai, "Analysis of cases allowed to cease erythromycin therapy for diffuse panbronchiolitis--comparative study between patients with cessation of the therapy and patients continuing the therapy"

  • Removed. Rcej (Robert) – talk 08:29, 17 November 2011 (UTC)[reply]

34: Kudoh, "Improvement of survival in patients with diffuse panbronchiolitis treated with low-dose erythromycin"

  • Removed. Rcej (Robert) – talk 08:03, 11 November 2011 (UTC)[reply]

35: Nagai, "Long-term low-dose administration of erythromycin to patients with diffuse panbronchiolitis"

  • Removed. Rcej (Robert) – talk 08:03, 11 November 2011 (UTC)[reply]

38: Oda, "Erythromycin inhibits neutrophil chemotaxis in bronchoalveoli of diffuse panbronchiolitis"

  • Removed. Rcej (Robert) – talk 08:03, 11 November 2011 (UTC)[reply]

39: Saito, "Tiotropium ameliorates symptoms in patients with chronic airway mucus hypersecretion which is resistant to macrolide therapy"

  • Removed. Rcej (Robert) – talk 09:16, 13 November 2011 (UTC)[reply]

Given the rarity of this disease, it is unsurprising that Rcej has relied on many primary sources to collate information. Our guideline recommends use of secondary sources in preference. However there just isn't enough detail in secondary sources alone to make a good encyclopedia article.

The information in the primary sources is not controversial, but I do wonder if some of it (such as the candidate genes) really should be included in an encyclopedia article. Axl ¤ [Talk] 21:21, 8 November 2011 (UTC)[reply]

Just curious, but if I can't write as comprehensive of an article without primary sources, what can be done? I think the secondary review texts probably are covering everything we have in some way; if those are citing the same primary sources I was once citing, would not citing those secondary sources suffice whether or not they explicitly state the corresponding information from the primary source that is covered in the Wikipedia article? Rcej (Robert) – talk 06:43, 9 November 2011 (UTC)[reply]
WP:MEDRS is only a guideline. There is room for editorial discretion.

" if those are citing the same primary sources I was once citing, would not citing those secondary sources suffice whether or not they explicitly state the corresponding information from the primary source that is covered in the Wikipedia article? "

I'm not sure what you mean by that. If secondary sources contain the same info as primary sources, it is preferable to use secondary sources as the references. If primary sources contain info that is not present in secondary sources, this casts doubt over the relevance/inclusion of that info in this general encyclopedia. Axl ¤ [Talk] 10:36, 12 November 2011 (UTC)[reply]

I have been rather busy recently and I have only just come back to this FAC. My thanks to Rcej for good progress on this article, especially removal of the primary sources and speculation about putative genes. Axl ¤ [Talk] 15:13, 22 November 2011 (UTC)[reply]

From "Cause", last paragraph: "This mutation in the CF-causing gene is not a factor in DPB, but a different form of this gene is known to occur in many Asians not necessarily affected by either disease." I'm not sure what the "different form of this gene" is. Presumably an allele? Different to the wild-type? Axl ¤ [Talk] 15:13, 22 November 2011 (UTC)[reply]

  • Fixed. Rcej (Robert) – talk 08:21, 23 November 2011 (UTC)[reply]

From the same paragraph: "It is wondered if this gene in any form could contribute to lung disease including DPB. However, because DPB does not cause disturbances of the pancreas nor the electrolytes, as does CF, the two diseases are entirely different and thought to be unrelated." These two sentences seem to be contradictory. Axl ¤ [Talk] 15:27, 22 November 2011 (UTC)[reply]

  • Fixed. Rcej (Robert) – talk 08:21, 23 November 2011 (UTC)[reply]

From "Diagnosis": "Analysis of lung tissues can require a lung biopsy, or the more preferred high resolution computed tomography (HRCT) scan of the lungs, and blood tests include the blood gas." I don't think that blood gas is a useful test for the diagnosis of DPB, is it? Axl ¤ [Talk] 15:56, 22 November 2011 (UTC)[reply]

  • Fixed. Rcej (Robert) – talk 08:21, 23 November 2011 (UTC)[reply]

From "Diagnosis", subsection "Differential diagnosis": "obstructive respiratory functional impairment is synonymous with emphysema." That's not true. Emphysema is one cause of obstructive impairment, but it is certainly not the only one. Indeed asthma ans chronic bronchitis also cause obstruction (among others). Technically, emphysema refers to damage to the respiratory epithelium distal to the respiratory bronchioles. Axl ¤ [Talk] 16:10, 22 November 2011 (UTC)[reply]

  • Fixed. Rcej (Robert) – talk 08:21, 23 November 2011 (UTC)[reply]
I changed the wording. Axl ¤ [Talk] 10:25, 23 November 2011 (UTC)[reply]

In "Diagnosis", subsection "Differential diagnosis", why isn't cystic fibrosis mentioned? Axl ¤ [Talk] 22:06, 22 November 2011 (UTC)[reply]

I asked this question on 1 November. See below. Graham Colm (talk) 22:14, 22 November 2011 (UTC)[reply]
  • Done. Rcej (Robert) – talk 08:21, 23 November 2011 (UTC)[reply]

From "Treatment", paragraph 1: "Erythromycin therapy over an extended period has been shown to have a curative effect in some cases of DPB." Really curative? Axl ¤ [Talk] 10:32, 23 November 2011 (UTC)[reply]

  • Fixed. Yes, the primary study had asserted "curative", but when I cut that src, I forgot to rewrite. ;) Rcej (Robert) – talk 08:48, 24 November 2011 (UTC)[reply]

From "Treatment", paragraph 2: "The antibiotic effects of macrolides are not believed to be involved in their beneficial effects toward reducing inflammation in DPB." Why not say "The antibiotic effects of macrolides are not involved in their beneficial effects toward reducing inflammation in DPB."? Axl ¤ [Talk] 11:16, 23 November 2011 (UTC)[reply]

  • Fixed. Rcej (Robert) – talk 08:48, 24 November 2011 (UTC)[reply]

From "Prognosis": "In DPB cases where successful treatment with erythromycin has resulted in a curative effect.... In spite of the improved prognosis, DPB still has no cure." These two statements appear to be contradictory. Axl ¤ [Talk] 15:16, 30 November 2011 (UTC)[reply]

  • Fixed. Rcej (Robert) – talk 08:52, 1 December 2011 (UTC)[reply]

From "Epidemiology": "The disease is slightly more common in males, with the male to female ratio at 1.4:2.1." The reference (Anthony) does indeed state a ratio of 1.4:2.1. I believe that this a mistake. Why state a ratio of 1.4:2.1? Why not 2:3? Moreover, the M:F ratio 1.4:2.1 indicates fewer affected males: a contradiction by Anthony. Poletti states a ratio of 1.4–2:1. Poletti's ratio range is actually sensible and therefore more likely to be accurate. It is likely that Anthony misunderstood/misread Poletti's figure. Axl ¤ [Talk] 14:07, 1 December 2011 (UTC)[reply]

  • Fixed. Rcej (Robert) – talk 08:16, 2 December 2011 (UTC)[reply]
Your correction is accurate. However I am concerned that general readers may misunderstand "1.4–2:1", like Anthony did. Would it be reasonable to say "about 1.7:1"? Or perhaps even "about 4:3"? Axl ¤ [Talk] 12:40, 2 December 2011 (UTC)[reply]
  • How's it now? ;) Rcej (Robert) – talk 08:02, 3 December 2011 (UTC)[reply]
Ack, did I say "4:3"? I meant to say "5:3". I have fixed that. I see that Uploadvirus has changed the syntax, which is fine by me. Axl ¤ [Talk] 01:07, 4 December 2011 (UTC)[reply]

WP:MEDMOS suggests that "Epidemiology" should come before "History". Is there any reason why that isn't the case here? Axl ¤ [Talk] 20:20, 6 December 2011 (UTC)[reply]

Thanks for re-arranging it, Rcej. Axl ¤ [Talk] 15:06, 12 December 2011 (UTC)[reply]
  • Comments by Looie496

I believe that the primary target of medical articles on Wikipedia is people who know somebody who has the condition, and want to know more about what is happening to them. The primary target is not medical students or MDs. Thus, a medical article, especially at the FA level, should make an effort to describe the symptoms, treatment, and prognosis in terms that an ordinary reader can grasp, especially in the lead. There is no harm in having additional info at a more technical level, but this basic information ought to be accessible. I doubt that an ordinary reader going through the lead of this article will pick up much more than that the disease has something to do with the lungs and is pretty serious. It should be possible to do better. Looie496 (talk) 05:09, 1 November 2011 (UTC)[reply]

Respectfully, I beg to differ. I am a layperson, and I believe the average literate adult could grasp the lead as well as I. Terminology is clearly linked or defined; but if you will specify the problematic content, I will certainly edit accordingly :) Thx! Rcej (Robert) – talk 08:10, 1 November 2011 (UTC)[reply]
I agree with Looie that we can do better in some sections, and will go through as the FAC advances ... but in the lead for now, is it possible to do a better job of explaining the immune susceptibility without obliging the reader to click on the haplotypes? I recognize it's not always possible, but we can try, and it's not always necessary to give specifics in the lead:
SandyGeorgia (Talk) 15:11, 1 November 2011 (UTC)[reply]
Let me note that I've placed a draft for a revised lead on the talk page of the article, see Talk:Diffuse panbronchiolitis#Proposed draft of revised lead. Looie496 (talk) 16:15, 1 November 2011 (UTC)[reply]
  • Addressed on article talk. Rcej (Robert) – talk 09:01, 2 November 2011 (UTC)[reply]


Why are pulmonology and COPD listed in "See also"? Generally, in an FA, links worth mentioning are incorporated into the text-- wouldn't pulmonology be a basic link somewhere in the text, and wouldn't COPD be covered under differential diagnosis? My first foray into the article was for just that purpose-- to try to understand how we distinguish this condition from other common pulmonary diseases. Is there material to beef up Differential diagnosis? SandyGeorgia (Talk) 20:31, 1 November 2011 (UTC)[reply]

And should Cystic fibrosis be specifically mentioned in the Differential diagnosis? It is a similar disease that does not occur in east Asians. Graham Colm (talk) 20:44, 1 November 2011 (UTC)[reply]
  • No. CF is not a dd consideration with DPB. Rcej (Robert) – talk 07:54, 3 November 2011 (UTC)[reply]
  • Done. Rcej (Robert) – talk 08:21, 23 November 2011 (UTC)[reply]
Some sourcing upgrading may be needed-- we shouldn't be using primary studies except in limited situations (see WP:MEDRS).

For example, there is a free full-text recent (2009) review that should probably be used:

  • Anthony M, Singham S, Soans B, Tyler G (October 2009). "Diffuse panbronchiolitis: not just an Asian disease: Australian case series and review of the literature". Biomed Imaging Interv J. 5 (4): e19. doi:10.2349/biij.5.4.e19. PMC 3097723. PMID 21610988.
  • Good src, and contains four case reports. It is a peer among the large number of secondary src review papers I cite in the article. I'll definitely use it if the disease status quo can be updated from it, or replace a primary :) Rcej (Robert) – talk 08:14, 5 November 2011 (UTC)[reply]
and the genetics material is currently citing primary studies, case reports, and comparative studies, when there is a recent review (2011) by some of the same authors:
  • Will do!! Rcej (Robert) – talk 08:14, 5 November 2011 (UTC)[reply]
  • Ok, this 2011 abstract is less than the full text secondary src journal reports I'm citing, and asserts the same info. I'm not certain which sources would be beneficial to swap out for this one. :) Rcej (Robert) – talk 05:23, 7 November 2011 (UTC)[reply]
Please check over your sources carefully to make sure you aren't using primary studies, and are accessing secondary reviews when they are available. To find reviews, go to PubMed, type "Diffuse panbronchiolitis" in to the search engine, and when you get the results, click on "Reviews" at the upper left. For any given PMID, click on the + to expand "PUblication type" in PubMed to see if it's a review (some are misidentified). SandyGeorgia (Talk) 00:31, 2 November 2011 (UTC)[reply]
I am saving the ref overhaul for last! btw, I've been a PubMedaholic since '07 ;) Rcej (Robert) – talk 07:54, 3 November 2011 (UTC)[reply]
That's confusing-- I can't support a med article that is based on primary sources, and I would think correcting the sourcing would be the first priority, alternately, withdrawing the FAC while the sourcing is upgraded? The one review I posted above seems to indicate that the text is incorrect or outdated ?? SandyGeorgia (Talk) 14:52, 3 November 2011 (UTC)[reply]
I've gotten rid of one more case report that was cited, then re-cited with a secondary; but the majority of my sources are either secondary or just there for reference purposes without being cited for content (i.e. some in the Epidemiology section). But if you are asserting that the majority of the sources for the article are primary and/or outdated, you'll need to point them out. I can't completely re-reference a 48-source article based on a non-specific claim. I'd greatly appreciate your help in weeding them out :) Rcej (Robert) – talk 08:13, 4 November 2011 (UTC)[reply]
What do you mean by "just there for reference purposes without being cited for content". If they aren't the sources you used to supply and verify the article content, take them out of the references section. If you can explain more why you want to cite those papers, then perhaps we can find an alternative section for them to go in, if necessary. Colin°Talk 08:47, 4 November 2011 (UTC)[reply]
Whoa! All that I mean is, i.e. in Epidemiology, I am using refs PMID 1504438 and PMID 10511794 to merely establish, respectively, that DPB has been reported in Korea and Thailand. Rcej (Robert) – talk 06:38, 5 November 2011 (UTC)[reply]
Generally looking very nice, though this is certainly not a subject about which I know anything.
  • "an irreversible lung condition that involves enlargement of, and damage to the bronchioles, and pooling of mucus in the bronchiolar passages" Could this be rephrased? "enlargement of, and damage to the bronchioles," is the problem bit, I think
  • "confused with bronchitis" Link?
  • Fixed. Rcej (Robert) – talk 07:20, 6 November 2011 (UTC)[reply]
  • "primary bronchiolitis include bronchiolitis obliterans, follicular bronchiolitis, respiratory bronchiolitis, mineral dust airway disease" Are primary bronchiolitis and/or the unlinked conditions worth linking/redlinks?
  • "In DPB, a variation of TAP2 was found very likely to be associated with the disease." Odd phrase
  • Perhaps consider a picture of one of the bacteria species mentioned? Visual interest can't hurt. Your call.
They are both Gram-negative bacilli – just tiny, red, rod-shaped bacteria - I don't think pictures would be informative.File:Haemophilus influenzae Gram.JPG and File:Pseudomonas aeruginosa Gram.jpg Graham Colm (talk) 22:53, 2 November 2011 (UTC)[reply]
  • "neutrophil granulocytes" Link?
I agree a link might help, but these are just the type of white blood cell that constitutes pus so a definition in brackets might be enough for some readers. Graham Colm (talk) 22:53, 2 November 2011 (UTC)[reply]
  • "include strong cough with large amounts" a strong cough?
  • You mention blood gas a few times before explaining it.
You are right, this needs to be explained earlier. (It's just the oxygen and carbon dioxide levels). Graham Colm (talk) 22:53, 2 November 2011 (UTC)[reply]
  • I'm not keen on the history section at the bottom, but if that's what the WikiProject says, go with it, I guess. I think it needs to be reworded a little if it is placed there; the opening seems odd for something so far down the article.
The article is very well written, and, despite my non-expertise, I didn't have too much trouble following. I will have to defer to experts, but I would be inclined to support if the small issues I've raised are resolved. J Milburn (talk) 22:36, 2 November 2011 (UTC)[reply]
The Wikipedia:Manual of Style/Medicine-related articles#Sections does not specify an order. It states "The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition" It goes on to give examples or cases where varying the order can help, including an example where the history section is at the top. If editors think an article is improved by having different headers or a different ordering, then they should feel free to make the change. Colin°Talk 08:46, 3 November 2011 (UTC)[reply]
Support Comments from Cryptic C62. I intend to do a full prose review, but before I do, there is one structural unrelated comment I must make: I believe the History section should be expanded. This can be partly resolved by stealing the historical content from Prognosis, which I think is a necessary step anyway. Any subsection which is not called History should describe the current state of knowledge in that area. It is confusing to just arbitrarily litter the entire article with historical tidbits when there is a section which is intended to cover such information. It may also be helpful to add to the History section some snippets about the history of treatment, or perhaps how our understanding of the causes of DBP has changed. I like broccoli.
  • "In spite of the improved prognosis, DPB still has no cure" Why is this sentence not in the lead? I would think that the availability of a cure is one of the most important pieces of information available about any disease.
  • "DPB can be distinguished from these by the presence of lesions that appear on X-rays as nodules in the bronchioles of both lungs" I don't see why the X-rays bit should be mentioned here. That is better suited for Signs and Symptoms or Diagnosis rather than Classification. Ten years from now, the way in which the disease is diagnosed may have changed, but the classification may stay the same.
  • "Signs revealed via lung X-rays and blood gas evaluation, respectively..." This seems like a very weird way of constructing this sentence. I'd prefer to see it the other way around: "Other signs include dilation (enlargement) of the bronchiolar passages and hypoxemia (low levels of oxygen in the blood), which can be detected via lung X-rays and blood gas evaluation, respectively."
  • "HLA-B54 is associated with DPB in Japanese" Might there be some way to disambiguate the language from the people? Even putting "the" in front of "Japanese" would be sufficient, I think. Another option would be to swap out "Japanese" with "those from Japan".
  • "by allowing increased disease susceptibility" Susceptibility to this disease? Or to diseases in general?
  • "Further, it was possible that a number of..." Not sure that I understand why this is in the past tense. Is this no longer possible? Perhaps the phrase "believed to be" is missing...?
  • "Genes within this area of HLA include TAP2 and C6orf37." I am of the opinion that paragraph-opening sentences should not use "this" to refer to items in the previous paragraph. There are two options to avoid this: rewrite the sentence to explicitly state what "this area" refers to, or rejigger the paragraph splitting for great justice.
  • "TAP2 (Transporter, ATP-binding cassette, MHC, 2)" Err... who exactly is the intended audience of the parenthetical content? I suggest deleting it. If the reader is curious to know what seemingly-arbitrary string of characters are associated with TAP2, he or she can navigate to TAP2 and find out there.
  • The same is true of "C6orf37 (Chromosome 6 open reading frame 37)", although this one is slightly less mysterious.
  • "Inflammation is a normal part of the immune response" I may be the only person who thinks this, but I think it may be helpful to insert "human" before "immune response". It's entirely possible that a reader will jump down to Pathophysiology without reading anything else, in which case it would not be clear what species is/are being referred to.
  • "The diagnosis of DPB requires analysis of the lungs and bronchiolar tissues, the sinuses, blood and sputum." I'm not sure I understand why there are two instances of "and" in this list.
  • "Severe inflammation in all layers of the respiratory bronchioles, and lung tissue lesions that appear as nodules within the terminal and respiratory bronchioles in both lungs are the distinguishing features of DPB, and confirm its diagnosis." The first comma in this sentence confuses the crap out of me. Assuming I've interpreted this correctly, here is how I would rephrase it: "The distinguishing features of DPB which confirm its diagnosis are severe inflammation in all layers of the respiratory bronchioles, and lung tissue lesions that appear as nodules within the terminal and respiratory bronchioles in both lungs."
  • "the bronchiolar nodular shadows visible on lung X-rays" I assume that "shadows" has some particular meaning in the context of X-rays, but as a non-medical dude, I don't know what it is.
  • Done. Rcej (Robert) – talk 09:27, 10 November 2011 (UTC)[reply]
  • "When either disease is diagnosed in a Japanese individual, the differentiation between them is routinely examined." I don't understand the significance of this sentence. It reads as though it will be elaborated upon in the sentences that follow it, but it immediately transitions to rheumatoid arthritis. Confuzzled!
  • The context is from above, but made a copy edit. Rcej (Robert) – talk 09:27, 10 November 2011 (UTC)[reply]
  • "In DPB, the nodules are noticeably and typically more restricted to the respiratory bronchioles" The adverbs "noticeably" and "typically" seem to contradict each other in this context. The former implies that the restriction is always true and is always noticeable, while the latter implies that the restriction is generally true, but there may be exceptions. Which is correct?
  • Fixed. Rcej (Robert) – talk 09:27, 10 November 2011 (UTC)[reply]
  • "Long-term treatment in DPB denotes that an individual with the disease has been or will be treated with erythromycin for an indefinite period lasting longer than two or three years, depending upon the success of treatment." This sentence is just a giant mess o' words. I can't suggest improvements because I really have no idea what it is trying to convey. Perhaps you would be so kind as to try and explain it here?
  • Fixed in the article. But seriously, do you want a perfectly qualifed english sentence, of which you have not identified a syntax nor grammatical error, explained to you here? :) Rcej (Robert) – talk 09:27, 10 November 2011 (UTC)[reply]
  • Much better. And seriously: while it is often the case that incomprehensibility is the result of grammatical or syntactical errors, it is still possible for a correctly-structured sentence to be confusing. Modern legalese contains plenty of examples of sentences which are correct without being comprehensible.
  • "and stopping treatment for a while in such cases has been studied." I don't think this clause is necessary.
  • Axed. Rcej (Robert) – talk 09:27, 10 November 2011 (UTC)[reply]
  • "This curative effect is considered to be in play" I'm not a fan of the highly informal and somewhat ambiguous phrase "in play".
  • Done. Rcej (Robert) – talk 09:27, 10 November 2011 (UTC)[reply]
  • Done. Rcej (Robert) – talk 09:27, 10 November 2011 (UTC)[reply]
  • "A journal report from 1983 indicated that untreated DPB had a five-year survival rate of 62.1%" I'm not sure how I feel about this. On the one hand, this report is so old that its findings hardly seem relevant in 2011. A lot changes in 28 years! On the other hand, it's true that the treatment options will have improved, but that wouldn't have any effect on the untreated survival rate, right? But on the first hand, it's possible that our diagnostic capabilities have gotten better, which would mean that DPB would be identified earlier, which would inflate the statistic of how long it is possible to survive untreated. Merh. I would love to see a more recent source for this kind of statistic, but I'm also open to other suggestions or arguments.
  • "In DPB cases where successful treatment with erythromycin has resulted in a curative effect, which sometimes happens after a treatment period lasting longer than two years, treatment has been allowed to end for a while." This seems a bit redundant, as the cessation of treatment was mentioned just a few paragraphs earlier.
  • "DPB has a high prevalence among Japanese, at 11 per 100,000 population" I wouldn't describe that as "high". Perhaps "the highest" would be better?
Review complete. --Cryptic C62 · Talk 12:53, 3 November 2011 (UTC)[reply]
Link check - no DAB-links, no dead external links, no overlinking (considering the topic's length and complexity). GermanJoe (talk) 21:52, 3 November 2011 (UTC)[reply]
Comment—The bottom half of the article has a "wall-of-text" feel to it. What do you think about breaking up the flow with a picture of erythromycin in the Treatment section? Adds a bit of visual interest and is certainly of relevance, as a major treatment option. Sasata (talk) 06:08, 7 November 2011 (UTC)[reply] Comments - Overall, the article looks good. Here are some things that are commonly mentioned in other sources that may warrant inclusion:
  • Japanese diagnostic criteria
  • CT findings (perhaps the image from this article can be included as well, it seems to have a suitable license: [2])
  • I'm not the most proficient with the image license stuff, so if anyone wants to jump in and get it, much appreciated. :) Rcej (Robert) – talk 09:10, 8 November 2011 (UTC)[reply]
Thanks! I have added it to the article. Some text about the role of CT still needs to be added. --WS (talk) 00:26, 9 November 2011 (UTC)[reply]
  • Relationship with smoking
  • Done. Rcej (Robert) – talk 08:32, 17 November 2011 (UTC)[reply]
  • Prognosis with Pseudomonas aeruginosa infection (very bad)
Some other remarks:
  • The list of symptoms probably only needs one or two reference instead of four.
  • "DPB is not age-related." - what does this mean? (especially considering the article also says onset is around age 40, and other sources quote peaks around 20 and 50 and almost no cases <20)
  • "The disease is slightly more common in males, the difference above females being negligible." - what is negligible? the ratio seems to be around 1.4-2:1
  • Why have the epidemiology and history sections been merged? I think they can easily stand on their own.
  • The diagnosis section could use some attention, with the diagnosis part explained a bit clearer.
  • Done. Rcej (Robert) – talk 09:33, 10 November 2011 (UTC)[reply]
  • The differential diagnosis part should be shortened a bit.
  • The first paragraph of the treatment section contains some vague statements like "stopping treatment for a while in such cases has been studied." and "curative effect" (some of it explained later in the prognosis section).
  • Done. Rcej (Robert) – talk 09:33, 10 November 2011 (UTC)[reply]
  • Current survival figures should be in the prognosis section, not under history.
--WS (talk) 20:08, 7 November 2011 (UTC)[reply]
  • I will have to rewrite much of the Cause section, to get rid of primary sources, and mainly to be concurrent with the state of things as per the 2011 review of the genetics of DPB (PMID 21303426). I'll have it ready in a few days. :) Rcej (Robert) – talk 06:30, 13 November 2011 (UTC)[reply]
  • Done. Rcej (Robert) – talk 08:29, 17 November 2011 (UTC)[reply]
Support --WS (talk) 08:32, 18 November 2011 (UTC)[reply]
Support – It would be nice to see those two red links "stubified". Graham Colm (talk) 17:42, 19 November 2011 (UTC)[reply]
Comments from delldot ∇.
Hey, here are a bunch of kind of random notes, take from them what you will. A lot of this I’m not sure whether it’s a problem but I’m noting it so others can figure it out. Sorry I’m not around a lot lately so may not be able to respond quickly.
  • Good job defining unfamiliar terms throughout the article. You might want to add definitions to chemokines, haplotypes, neutrophil, pathogenesis, lumen, etc. (or use simpler words instead).
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • The classification section is three sentences long. One sentence you could add is something that explains "as opposed to what" after this sentence: "DPB is classified as a form of "primary bronchiolitis", which means that the underlying cause of bronchiolitis is originating from or is confined to the bronchioles." You could also expand on the "and a number of others" in the classification. What makes this condition different?
  • Fixed. Rcej (Robert) – talk 10:07, 6 December 2011 (UTC)[reply]
  • The respiratory diagram has a lot of stuff labeled in it. Maybe you could take out the stuff that's not that relevant to the article, e.g. the pharynx, and enlarge the print on the relevant stuff.
  • Good idea... but editing images is outside of my skillage ;) Rcej (Robert) – talk 10:07, 6 December 2011 (UTC)[reply]
  • It seems like there's a lot of repetition throughout the article, e.g. with the first two sentences both using "inflammatory", and this sentence in Treatment: “…by erythromycin and other macrolides. Macrolides are especially effective… Macrolides also reduce…”
  • Fixed. Rcej (Robert) – talk 10:07, 6 December 2011 (UTC)[reply]
  • Maybe someone could correct me if I'm wrong, but I think this belongs in the diagnosis section: "Signs of DPB that include dilation (enlargement) of the bronchiolar passages and hypoxemia (low levels of oxygen in the blood) are revealed via lung X-rays and blood gasses (a blood test from an artery, used to measure the oxygen and carbon dioxide content of the blood), respectively."
  • Fixed. Rcej (Robert) – talk 10:07, 6 December 2011 (UTC)[reply]
  • Unnecessarily wordy: "signs of bronchiectasis begin to present themselves."
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • The first four sentences in s/s have no references. Then the fifth and sixth have them. Does this mean the refs for the fifth sentence cover the previous four as well? I kind of prefer to use the refs at the end of every sentence they cover because then you can add something in the middle or rearrange stuff without losing your refs or misrepresenting them as covering something they don’t.
  • Whenever I ref only at the end of several sentences or a paragraph, the ref(s) are covering everything. For that section, it would be redundant and unnecessary to ref more. :) Rcej (Robert) – talk 10:07, 6 December 2011 (UTC)[reply]
  • This sentence is confusing: "several known factors are suspected to be involved with the pathogenesis of DPB." Does this mean they're known to be factors in DBP? Or are they known phenomena, and suspected to be factors in DBP? If they're known to be factors, why are we saying the cause is unknown?
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • This sentence is confusing: “unique to Asians, particularly of East Asian descent.” “particularly unique” doesn’t make sense to me. Is it unique just to East Asians? Or unique to Asians but more often found in East Asians? Also is “descent” necessary or is that just wordy?
  • Fixed. Descent is necessary. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • The word “individuals” is used a lot in the causes section and I can’t figure out whether it’s being used for a reason or just as a substitute for ‘people’ or something. It’s particularly confusing in this sentence, because it seems like you’re talking about populations, not individuals: “The common genetic background and similarities in the HLA profile of Japanese and Korean individuals were considered in the search for a DPB gene.”
  • Fixed. But genetic profiles within populations are done on individuals. Unless they're the Borg! ;) Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • The causes section is tough because it’s dealing with difficult material, and I’m finding a lot of sentences in it that I think are awkward and could use a copy edit. For example: “After further study of this localized area between HLA-B and HLA-A, it was concluded that a DPB susceptibility gene is located within a 200 kb (kilobase, or 1,000 base pairs) region of the 300 kb telomeric class I HLA, near the HLA-B locus at chromosome 6p21.3.”
  • Fixed. Rcej (Robert) – talk 10:07, 6 December 2011 (UTC)[reply]
  • I’m not sure whether this sentence fits in with the rest of the paragraph: “Environmental factors such as inhaling toxic fumes and cigarette smoking are not believed to play a role in causing the disease.” I’m also not totally clear whether we’re talking about DBP or the other disease introduced in this paragraph, BLS I.
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • In pathophysiology, is there a reason why it’s written “P. aeruginosa and Haemophilus influenzae”, with one abbreviated and the other spelled out?
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • would you say “excess mucus production in the airway”, or “airways”?
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • I’m not sure the definition of chemotaxis is correct. Do the chemicals the cells are attracted to have to be specifically designed to attract them (leaving aside the notion of “design”), or can they be attracted to pathogens, toxins, and other incidental stuff? And is it necessarily attraction, or can cells also go away from the molecules?
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • I’m not sure how this sentence fits in with the rest of the paragraph: “The leukotrienes are an important contributor to inflammation in the respiratory tract.” Are the other chemicals being discussed also leukotrienes?
  • The article’s tough for a layperson to follow with all the abbreviations and gene names. I guess it can’t be helped with the specific genes you’re talking about but I wonder if in the case of CD4+ if you’d lose anything by just calling them helper T cells? Or do you need to mention the protein they present for a reason?
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • Another confusing use of “individuals”: “Conversely, in individuals with human lymphotropic virus, onset of DPB increases the frequency of adult T-cell leukemia.” Surely you’re talking about populations not individuals when you’re talking about “frequency”?
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • This sentence is too long and needs a citation: “Erythromycin therapy over an extended period has been shown to dramatically improve the effects of DPB, apparent when an individual undergoing treatment for DPB, among a number of disease-related remission criteria, has a normal neutrophil count detected in BAL fluid, and blood gas (an arterial blood test that measures the amount of oxygen and carbon dioxide in the blood) readings show that free oxygen in the blood is within the normal range.”
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • I’m confused by this sentence: “In those cases where treatment can be stopped for a time, however, DPB symptoms eventually return, and treatment would need to be resumed.” Does this mean that the return of symptoms is certain to happen? Why the use of “would” then? If symptoms return, treatment needs to be resumed, right? I’m confused because I expect to see “would” paired with a concept like “if this happens, then you would have to do that”.
  • Fixed. Rcej (Robert) – talk 08:22, 9 December 2011 (UTC)[reply]
  • I think you should ask someone who owes you a favor to give the whole article a copy edit with an eye toward simplifying and cutting out unnecessary wording. There are a number of cases where I think something could be said more simply and concisely, here are some examples: “untreated DPB has progressed to the point where respiratory failure is occurring”, “for an indefinite period lasting two to three years”; “Mucus production in the airways is a major culprit in the morbidity and mortality of DPB and other respiratory diseases. The significant reduction of inflammation in DPB attributed to erythromycin therapy also greatly inhibits the production of excess mucus.”
  • Fixed. I would rather spank my kid myself, if I may. I have trimmed ~500 b from the wordage. Rcej (Robert) – talk 09:15, 12 December 2011 (UTC)[reply]
  • In one part of the treatment section it says “erythromycin may not prove successful in all individuals with the disease, particularly if macrolide-resistant P. aeruginosa is present” then later it says “in DPB cases with the occurrence of macrolide-resistant P. aeruginosa, macrolide therapy still produces substantial anti-inflammatory results.” Does this mean ‘except in the aforementioned cases where it doesn’t’, or does it always produce those substantial results, but they’re just not substantial enough to be effective when the macroglide-resistant bugs are there?
  • Fixed. Rcej (Robert) – talk 09:15, 12 December 2011 (UTC)[reply]
  • “Rare cases of DPB in individuals with non-Asian lineage have also been noted” How rare? Are we talking a handful of people? Because the rest of the article stresses that it’s unique to Asians.
  • Fixed. Rcej (Robert) – talk 09:15, 12 December 2011 (UTC)[reply]
  • This sentence is confusing: “DPB has been reported in a few Asian immigrants and residents in western countries”. Does “a few” mean a handful? i.e. it’s incredibly rare? Or does this sentence really mean to say “in remarkably few” or some such?
  • Fixed. Rcej (Robert) – talk 09:15, 12 December 2011 (UTC)[reply]
  • The epidemiology section kind of seems to contradict the causes section, saying non-genetic causes may be involved after all. And the causes section says “Environmental factors such as inhaling toxic fumes and cigarette smoking are not believed to play a role in causing the disease” (which is wordy by the way) but then in the epidemiology section it suggests a third of sufferers are smokers. Does a third of the general population smoke, or is this a higher rate? Well, I guess it’s unfair of me to ask you to figure this out if it’s not mentioned in any of the literature.
  • Fixed. Rcej (Robert) – talk 09:15, 12 December 2011 (UTC)[reply]
  • I think it would be good to learn more about ages of onset and how that breaks down into age categories if that info is available. I noticed the article in Thorax by Høiby mentioned that cases are often in elderly patients.
Anyway, good work in general, good info. I think the copy editing thing to reduce wordiness and simplify where possible is the main thing holding this article back right now. I don’t know how much info is really out there but if it’s very limited it might not be possible to flesh the article out any more. If it is available though it would be good to see more detail in sections like epidemiology and classification. Apologies in advance if I’m tough to get a hold of in upcoming days, feel free to email me if you need to to get my attention. delldot ∇. 08:02, 4 December 2011 (UTC) A couple more notes:[reply]
  • In diagnosis, I think it would be good to mention what tests are used to detect the white blood cells, immune globulins, etc mentioned in the last few sentences.
  • Fixed. Rcej (Robert) – talk 07:35, 15 December 2011 (UTC)[reply]
  • In this sentence, I think you should describe in a few words what a bronchoalveolar lavage is: "Neutrophils, beta-defensins, leukotrienes, and chemokines can also be detected in bronchoalveolar lavage (BAL) fluid taken from individuals with DPB."
  • Fixed. Rcej (Robert) – talk 07:35, 15 December 2011 (UTC)[reply]
  • I'm glad you've taken care to explain the unfamiliar terms, but sometimes the parentheticals make sentences harder to read. In these cases I would suggest rephrasing. For example, i would rephrase this sentence: "In the differential diagnosis (finding the correct diagnosis between two or more suspected diseases that have common or overlapping features) of some obstructive lung diseases, DPB is often considered" perhaps like this: "When two or more diseases have common or overlapping features, a differential diagnosis is needed (or is used? is made?) to determine which disease is present (or is causing the symptoms). A diagnosis of DPB is often considered when someone is experiencing symptoms found in obstructive lung disease." Or something like that. It doesn't have to be that way, I'm just saying you can rewrite the sentence to introduce and explain difficult concepts, rather than using the words as an expert would and just sticking in a parenthetical to define it. There are a lot of parentheticals that kind of interrupt the flow of the rest of the sentence they're in, I've already gone in and changed one or two but it might be worth looking to see if there are more to change. delldot ∇. 00:46, 6 December 2011 (UTC)[reply]
  • Fixed. Rcej (Robert) – talk 09:15, 12 December 2011 (UTC)[reply]
I noticed a couple recent reviews not used in the article. Did you not find anything useful in them or were you not able to access them? If the latter, email me.
  • Yang, M.; Dong, B. R.; Lu, J.; Lin, X.; Wu, H. M. (2010). Yang, Ming (ed.). "Macrolides for diffuse panbronchiolitis". The Cochrane Library (12): CD007716. doi:10.1002/14651858.CD007716.pub2. PMID 21154381.
  • Keicho, N.; Kudoh, S. (2002). "Diffuse panbronchiolitis: Role of macrolides in therapy". American Journal of Respiratory Medicine. 1 (2): 119–131. doi:10.1007/BF03256601. PMID 14720066.
  • Kudoh, S. (2004). "Applying lessons learned in the treatment of diffuse panbronchiolitis to other chronic inflammatory diseases". The American Journal of Medicine. 117 Suppl 9A (9): 12S–19S. doi:10.1016/j.amjmed.2004.07.024. PMID 15586559.
  • Rubin, B. K.; Henke, M. O. (2004). "Immunomodulatory activity and effectiveness of macrolides in chronic airway disease". Chest. 125 (2 Suppl): 70S–78S. doi:10.1378/chest.125.2_suppl.70s. PMID 14872003. (free full text)
  • Siddiqui, J. (2004). "Immunomodulatory effects of macrolides: Implications for practicing clinicians". The American Journal of Medicine. 117 Suppl 9A (9): 26S–29S. doi:10.1016/j.amjmed.2004.07.026. PMID 15586561.
  • Amsden, G. W. (2004). "Anti-inflammatory effects of macrolides--an underappreciated benefit in the treatment of community-acquired respiratory tract infections and chronic inflammatory pulmonary conditions?". Journal of Antimicrobial Chemotherapy. 55 (1): 10–21. doi:10.1093/jac/dkh519. PMID 15590715. (free full text)
  • Friedlander, A. L.; Albert, R. K. (2010). "Chronic Macrolide Therapy in Inflammatory Airways Diseases". Chest. 138 (5): 1202–1212. doi:10.1378/chest.10-0196. PMID 21051396. (free full text)
  • Altenburg, J.; De Graaff, C. S.; Van Der Werf, T. S.; Boersma, W. G. (2011). "Immunomodulatory Effects of Macrolide Antibiotics – Part 2: Advantages and Disadvantages of Long-Term, Low-Dose Macrolide Therapy". Respiration. 81 (1): 75–87. doi:10.1159/000320320. PMID 20733282.
This is from a not-too-thorough pubmed search which makes me wonder if there's more out there that this article could be taking advantage of. Relying heavily on a few sources is understandable if there's not that much out there, but that doesn't seem to be too much of a problem here. delldot ∇. 01:21, 6 December 2011 (UTC)[reply]
To save Rcej from having to say it, I don't feel that explicitly using all available reviews is a reasonable thing to ask for. An article only needs to be used if it documents a statement that is not documented by any other equally good review. Furthermore, articles are more maintainable if they use the minimum number of sources needed to validate the text. Looie496 (talk) 16:18, 6 December 2011 (UTC)[reply]
Thanks, and I concur. :) Rcej (Robert) – talk 08:52, 7 December 2011 (UTC)[reply]
Delldot's search has highlighted review articles that focus on macrolide use in DPB. I think that this aspect is already well covered in the article. The question is: are any of the new references better than the existing ones in the article? I suppose that we could debate the merits of the impact factors of "American Journal of Respiratory Medicine" and "Chest" vs "Clinical Microbiology Reviews" and "Current Opinion in Pharmacology". From a PubMed search, it is impossible to tell which is the "most" authoritative review article. While I have an opinion about the general ranking of these journals, it is unreasonable to expect Wikipedia editors to use such judgement calls to influence referencing.
On the other hand, the Cochrane Database is widely regarded as authoritative, and I think that it could be used in addition to the existing references.
To address Delldot's other concern regarding "missing" information: I too have searched for references, both online and hard-copy textbooks. While macrolide usage is well documented, other information is sadly lacking. In particular I tried to find further epidemiological details such as prevalence in Koreans, and incidence in Japanese. I couldn't find any data at all. Another treatment I was hoping to include was lung transplantation. Again, there is no data.
In summary, the article already contains the information available from reliable secondary sources. It is reasonable to add the Cochrane Database reference. Axl ¤ [Talk] 17:45, 6 December 2011 (UTC)[reply]
OK, great, I'm glad someone with more knowledge of the topic feels that the article sufficiently covers it. I wasn't saying it has to use everything available, just wondering if some of the information I didn't see in the article might be in some of those articles. If not that's fine. delldot ∇. 03:47, 7 December 2011 (UTC)[reply]
  • Spotcheck: clear 5/27 checked Concerns lead me to halt spotchecking until addressed,MEDRS Primary Check: seems clear. I'm a labour historian, not a medical professional. Fifelfoo (talk) 00:46, 12 December 2011 (UTC) Fifelfoo (talk) 09:32, 13 December 2011 (UTC)[reply]
    • PRIMARY check per MEDRS:
      • Homma, H is a "1,000 cases" case report; this appears to be secondary enough for me. It appears to be used for medical review type statements. (I am not an MEDRS expert, definitely not)
      • Anthony M is an n=4 out of an unknown population case report. It is heavily relied upon. This is far less convincing to me, to the level of potentially being a problem. I am unable to adequately review the use cases as I am not a MEDRS expert. I noted above than Anthony was recommended as a review, and so am happy.
      • Yamanaka, A is a PRIMARY but used correctly.
      • The following appear to my non-expert opinion to be correctly used PRIMARIES: Kim YW; Chen Y; Chantarotorn S.; Fitzgerald, J. E; Martinez, J. A.; Sandrini, A. (Not MEDRS expert)
      • Høiby, N is miscited as "Hoiby, N."
    • Spotcheck clear 5/27 sources checked. Fifelfoo (talk) 09:32, 13 December 2011 (UTC)[reply]
      • I simply cannot find the claim "A genetic predisposition among East Asians is indicated." in Høiby, N. Given my concern over this, I'm not going to proceed to detailed spotchecking until I get a response over this point. Fifelfoo (talk) 00:46, 12 December 2011 (UTC)[reply]
      • Thanks for spotchecking...much appreciated! :-) Fixed. Rcej (Robert) – talk 09:15, 12 December 2011 (UTC)[reply]
        • I'm sorry, I must have been unclear when asking for a response. I meant to ask, "To what extent should I place my trust in the capacity of the article's sources to support their conclusions, when, the first source I check does not in any way support its conclusion?" There has a level of expectation in bringing an article to FAC that the sources support the claims, so much so that we rarely checked this before this year. When I start spotchecking an article I start with the assumption that the article editors are excellent encyclopaedists, and look for confirmation. That trust is reduced when a source doesn't support the claim, especially when the claim is fairly specific (a genetic predisposition in a group of men). Are all other citations carefully cited to support their claims? What procedure did you use when writing, or preparing for FAC, to ensure this? How did you match claims to sources, or sources to claims when editing? Could you explain your editing practice on this point? Fifelfoo (talk) 01:09, 13 December 2011 (UTC)[reply]
I believe that the statement "A genetic predisposition among East Asians is indicated" has Keicho ("Genetic predisposition to diffuse panbronchiolitis") as its reference. In its "Conclusions", Keicho states "Diffuse panbronchiolitis is a complex genetic disease affecting East Asians, and is strongly associated with class I HLA-B54 in Japan and HLA-A11 in Korea." Axl ¤ [Talk] 03:45, 13 December 2011 (UTC)[reply]
Respectfully, Firefloo, you find one statement–during 45 days of nearly constant copy edits, rearrangements, and re-referencing–that simply had the wrong citation, and after it is corrected, you respond with:
"That trust is reduced when a source doesn't support the claim, especially when the claim is fairly specific (a genetic predisposition in a group of men). Are all other citations carefully cited to support their claims? What procedure did you use when writing, or preparing for FAC, to ensure this? How did you match claims to sources, or sources to claims when editing? Could you explain your editing practice on this point?"
Fear not! I will not be a wiseguy and wikilink decaf in italics. ;) But seriously, every statement I write in a wikipedia article is supported by its citation; however, I removed nearly 30 primary sources from the article during this FAC, so a mistake that activity created is entirely possible. It is fixed now, though! Rcej (Robert) – talk 07:56, 13 December 2011 (UTC)[reply]
Thanks. I spotchecked this version thoroughly. fn:1–3; 7; 22, 5/27 spotchecked, clear of close paraphrase, clear of plagiarism, support their statements.. Fifelfoo (talk) 09:32, 13 December 2011 (UTC) From my point of view, there is only one outstanding issue: the picture "Respiratory system complete en.svg" has three errors in the labelling: "Cricoid cartilage", "Lingular division bronchus" and "Intermediate bronchus". I have previously tried to draw attention to this on its file talk page, its Wikimedia Commons talk page, and at WikiProject Medicine, without success. Delldot suggests removal of many of the irrelevant labels, which is reasonable. Axl ¤ [Talk] 15:57, 16 December 2011 (UTC)[reply]
How about removing the image? I think we could do without it. Rcej (Robert) – talk 06:15, 22 December 2011 (UTC)[reply]
It looks like this article still needs an image review. Ucucha (talk) 11:48, 17 December 2011 (UTC)[reply] Thank you to everyone who participated! I appreciate all of the direction you gave, and time and work put into this whole thing and the article! Merry Christmas, Happy Hanukkah, Happy Holidays, Go Solstice, "Festivus for the rest of us"... and when does the article get its bling, and get front paged? Rcej (Robert) – talk 06:55, 23 December 2011 (UTC)[reply]
The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.
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