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Current Concepts in the Diagnosis and Treatment of Pulmonary Emphysema

Current Concepts in the Diagnosis and Treatment of Pulmonary Emphysema Abstract Since Laennec 1 described the clinical and pathological features of pulmonary emphysema, more than a century ago, much has been learned about its pathologic physiology and its progressive clinical course, with cardiac and metabolic complications. However, the initial inciting factors and early pathogenesis still are poorly understood. Because of this hiatus in knowledge, the clinical recognition of emphysema in its early stages is frequently difficult and the results of treatment, once the diagnosis is made, often are disappointing. DEFINITION Numerous types of emphysema have been described, as have many concepts concerning their relative clinical importance. Thus, an attempt at definition appears advisable before the clinically diagnostic criteria are considered. Pulmonary emphysema is characterized pathologically by large alveolar spaces with attenuated septa, many of which are fragmented; as a result, larger air spaces (blebs or bullae) are formed, thus altering the mechanical (viscoelastic) properties and ventilation of the lungs, as well References 1. Comroe,5 Vol. 2, pp. 76-244. 2. Comroe,5 Vol. 2, pp. 188-197. 3. References 11 and 12. 4. References 13 and 14. 5. Laennec, R. T. H.: A Treatise on the Diseases of the Chest, in Which They Are Described According to Their Anatomical Characters and Their Diagnosis Established on a New Principle by Means of Acoustick Instruments , translated by John Forbes, Philadelphia, James Webster, 1823, p. 87. 6. Monroe, R. T.: Diseases in Old Age: A Clinical and Pathologic Study of 7941 Individuals Over 61 Years of Age , Cambridge, Harvard University Press, 1951. 7. Christie, R. V.: Emphysema of the Lungs , Brit. M. J. 1:105-108 ( (Jan. 15) )Crossref 8. 143-146 (Jan. 29) 1944. 9. Fry, D. L.; Ebert, R. V.; Stead, W. W., and Brown, C. C.: The Mechanics of Pulmonary Ventilation in Normal Subjects and in Patients with Emphysema , Am. J. Med. 16:80-97 ( (Jan.) ) 1954.Crossref 10. Comroe, J. H., Jr.: Methods in Medical Research , Chicago, The Year Book Publishers, Inc., 1950. 11. Motley, H. L., and Tomashefski, J. F.: Treatment of Chronic Pulmonary Disease with Intermittent Positive Pressure Breathing: I. Evaluation by Objective Physiological Measurements , A. M. A. Arch. Indust. Hyg. 5:1-9 ( (Jan.) ) 1952. 12. Miller, R. D.; Fowler, W. S., and Helmholz, H. F., Jr.: The Treatment of Pulmonary Emphysema and of Diffuse Pulmonary Fibrosis with Nebulized Bronchodilators and Intermittent Positive Pressure Breathing , Dis. Chest , to be published. 13. Barach, A. L., and Beck, G. J.: The Ventilatory Effects of the Head-Down Position in Pulmonary Emphysema , Am. J. Med. 16:55-60 ( (Jan.) ) 1954.Crossref 14. Miller, W. F.: A Physiologic Evaluation of the Effects of Diaphragmatic Breathing Training in Patients with Chronic Pulmonary Emphysema , Am. J. Med. 17:471-477 ( (Oct.) ) 1954.Crossref 15. Kountz, W. B., and Alexander, H. L.: Emphysema , Medicine 13:251-316 ( (Sept.) ) 1934.Crossref 16. Carter, M. G.; Gaensler, E. A., and Kyllonen, A.: Pneumoperitoneum in the Treatment of Pulmonary Emphysema , New England J. Med. 243: 549-558 ( (Oct. 12) ) 1950.Crossref 17. Becklake, M. R.; Goldman, H. I., and McGregor, M.: The Effects of Pneumoperitoneum on Lung Function in Pulmonary Emphysema , Thorax 9:222-225 ( (Sept.) ) 1954.Crossref 18. Hurst, A., and Levine, M. H.: Radioactive Iodine in Treatment of Pulmonary Emphysema , Rocky Mountain M. J. 52:129-131 ( (Feb.) ) 1955. 19. Bercu, B. A., and Mandell, H. N.: Radioactive Iodine for Chronic Lung Disease , Clin. Res. Proc. 2:107 ( (April) ) 1954. 20. Nadell, J., and Kalinsky, H.: The Effects of Carbonic Anhydrase Inhibitor "6063" on Electrolytes and Acid-Base Balance in 2 Normal Subjects and 2 Patients With Respiratory Acidosis , J. Clin. Invest. 32:622-629 ( (July) ) 1953.Crossref 21. Abbot, O. A.; Hopkins, W. A.; Van Fleit, W. E., and Robinson, J. S.: A New Approach to Pulmonary Emphysema , Thorax 8:116-132 ( (June) ) 1953.Crossref 22. Cohn, J. E.; Carroll, D. G., and Riley, R. L.: Respiratory Acidosis in Patients with Emphysema , Am. J. Med. 17:447-463 ( (Oct.) ) 1954.Crossref 23. Segal, M. S., and Dulfano, M. J.: Chronic Pulmonary Emphysema: Physiopathology and Treatment , New York, Grune & Stratton, Inc., 1953. 24. Harvey, R. M.; Ferrer, M. I., and Cournand, A.: The Treatment of Chronic Cor Pulmonale , Circulation 7:932-940 ( (June) ) 1953.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Internal Medicine American Medical Association

Current Concepts in the Diagnosis and Treatment of Pulmonary Emphysema

A.M.A. Archives of Internal Medicine , Volume 96 (3) – Sep 1, 1955

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Publisher
American Medical Association
Copyright
Copyright © 1955 American Medical Association. All Rights Reserved.
ISSN
0888-2479
DOI
10.1001/archinte.1955.00250140082008
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Abstract

Abstract Since Laennec 1 described the clinical and pathological features of pulmonary emphysema, more than a century ago, much has been learned about its pathologic physiology and its progressive clinical course, with cardiac and metabolic complications. However, the initial inciting factors and early pathogenesis still are poorly understood. Because of this hiatus in knowledge, the clinical recognition of emphysema in its early stages is frequently difficult and the results of treatment, once the diagnosis is made, often are disappointing. DEFINITION Numerous types of emphysema have been described, as have many concepts concerning their relative clinical importance. Thus, an attempt at definition appears advisable before the clinically diagnostic criteria are considered. Pulmonary emphysema is characterized pathologically by large alveolar spaces with attenuated septa, many of which are fragmented; as a result, larger air spaces (blebs or bullae) are formed, thus altering the mechanical (viscoelastic) properties and ventilation of the lungs, as well References 1. Comroe,5 Vol. 2, pp. 76-244. 2. Comroe,5 Vol. 2, pp. 188-197. 3. References 11 and 12. 4. References 13 and 14. 5. Laennec, R. T. H.: A Treatise on the Diseases of the Chest, in Which They Are Described According to Their Anatomical Characters and Their Diagnosis Established on a New Principle by Means of Acoustick Instruments , translated by John Forbes, Philadelphia, James Webster, 1823, p. 87. 6. Monroe, R. T.: Diseases in Old Age: A Clinical and Pathologic Study of 7941 Individuals Over 61 Years of Age , Cambridge, Harvard University Press, 1951. 7. Christie, R. V.: Emphysema of the Lungs , Brit. M. J. 1:105-108 ( (Jan. 15) )Crossref 8. 143-146 (Jan. 29) 1944. 9. Fry, D. L.; Ebert, R. V.; Stead, W. W., and Brown, C. C.: The Mechanics of Pulmonary Ventilation in Normal Subjects and in Patients with Emphysema , Am. J. Med. 16:80-97 ( (Jan.) ) 1954.Crossref 10. Comroe, J. H., Jr.: Methods in Medical Research , Chicago, The Year Book Publishers, Inc., 1950. 11. Motley, H. L., and Tomashefski, J. F.: Treatment of Chronic Pulmonary Disease with Intermittent Positive Pressure Breathing: I. Evaluation by Objective Physiological Measurements , A. M. A. Arch. Indust. Hyg. 5:1-9 ( (Jan.) ) 1952. 12. Miller, R. D.; Fowler, W. S., and Helmholz, H. F., Jr.: The Treatment of Pulmonary Emphysema and of Diffuse Pulmonary Fibrosis with Nebulized Bronchodilators and Intermittent Positive Pressure Breathing , Dis. Chest , to be published. 13. Barach, A. L., and Beck, G. J.: The Ventilatory Effects of the Head-Down Position in Pulmonary Emphysema , Am. J. Med. 16:55-60 ( (Jan.) ) 1954.Crossref 14. Miller, W. F.: A Physiologic Evaluation of the Effects of Diaphragmatic Breathing Training in Patients with Chronic Pulmonary Emphysema , Am. J. Med. 17:471-477 ( (Oct.) ) 1954.Crossref 15. Kountz, W. B., and Alexander, H. L.: Emphysema , Medicine 13:251-316 ( (Sept.) ) 1934.Crossref 16. Carter, M. G.; Gaensler, E. A., and Kyllonen, A.: Pneumoperitoneum in the Treatment of Pulmonary Emphysema , New England J. Med. 243: 549-558 ( (Oct. 12) ) 1950.Crossref 17. Becklake, M. R.; Goldman, H. I., and McGregor, M.: The Effects of Pneumoperitoneum on Lung Function in Pulmonary Emphysema , Thorax 9:222-225 ( (Sept.) ) 1954.Crossref 18. Hurst, A., and Levine, M. H.: Radioactive Iodine in Treatment of Pulmonary Emphysema , Rocky Mountain M. J. 52:129-131 ( (Feb.) ) 1955. 19. Bercu, B. A., and Mandell, H. N.: Radioactive Iodine for Chronic Lung Disease , Clin. Res. Proc. 2:107 ( (April) ) 1954. 20. Nadell, J., and Kalinsky, H.: The Effects of Carbonic Anhydrase Inhibitor "6063" on Electrolytes and Acid-Base Balance in 2 Normal Subjects and 2 Patients With Respiratory Acidosis , J. Clin. Invest. 32:622-629 ( (July) ) 1953.Crossref 21. Abbot, O. A.; Hopkins, W. A.; Van Fleit, W. E., and Robinson, J. S.: A New Approach to Pulmonary Emphysema , Thorax 8:116-132 ( (June) ) 1953.Crossref 22. Cohn, J. E.; Carroll, D. G., and Riley, R. L.: Respiratory Acidosis in Patients with Emphysema , Am. J. Med. 17:447-463 ( (Oct.) ) 1954.Crossref 23. Segal, M. S., and Dulfano, M. J.: Chronic Pulmonary Emphysema: Physiopathology and Treatment , New York, Grune & Stratton, Inc., 1953. 24. Harvey, R. M.; Ferrer, M. I., and Cournand, A.: The Treatment of Chronic Cor Pulmonale , Circulation 7:932-940 ( (June) ) 1953.Crossref

Journal

A.M.A. Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1955

References