The Emphysematous and Bronchial Types of Chronic Airways Obstruction

Burrows, Benjamin; Fletcher, C. M.; Heard, Brian E.; Jones, Norman L.; Wootliff, Jack S.

doi:10.1016/s0140-6736(66)90181-4

Cited by 299 publications

(77 citation statements)

References 14 publications

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“…Red cell mass, plasma volume, blood volume, and hematocrit in relation to Sao2 were investigated in a group of patients with welldocumented chronic obstructive airway disease. Four of these patients were of the "pink puffer" (PP) or class A variety (13,14), in whom alveolar ventilation is typically well maintained with minimal derangement in blood gases, little elevation in hematocrit, and no history of cor pulmonale. Three patients were of the "blue bloater" (BB) or class B type (13,14), in whom alveolar ventilation is typically reduced causing substantial hypoxemia associated with increased hematocrit and a history of past or present bouts of cor pulmonale.…”

Section: Methodsmentioning

confidence: 99%

The red cell mass-arterial oxygen relationship in normal man

Weil¹,

Jamieson²,

Brown³

et al. 1968

J. Clin. Invest.

163

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A B S T R A C T The normal relationship between red cell mass measured, with 51chromium-labeled red cells, and arterial oxygen saturation (Sao2) over the range from 97.3 to 83.4% was examined by studying 73 normal men residing at sea level and altitudes of 1600 and 3100 m. A simple, linear relationship between Sao2 and red cell mass was found over the entire range (r =-0.7524, P < 0.001). In contrast, a correlation between red cell mass and arterial 02 tension was found only over the lower half of the range of 02 tensions where Sao2 was also decreased (r = -0.7731, P < 0.005).

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Section: Methodsmentioning

confidence: 99%

The red cell mass-arterial oxygen relationship in normal man

Weil¹,

Jamieson²,

Brown³

et al. 1968

J. Clin. Invest.

163

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show abstract

“…If we want to define ''clinically relevant'' phenotypes we need to identify those phenotypes that, besides determining clinical outcomes, also characterise patients with a different or selective response to specific treatments and are prospectively validated. For example, from the seminal study by BURROWS et al [13] it is clear that patients can present with predominant emphysema or chronic bronchitis, and this now has an impact on treatment since it has been demonstrated that only patients with chronic bronchitis (and exacerbations) respond to the new phosphodiesterase-4 (PDE 4 ) inhibitor roflumilast [5]. Therefore, identification of patients with the phenotype of frequent exacerbations and chronic bronchitis is relevant in clinical practice.…”

Section: Which Are the Relevant Clinical Phenotypes?mentioning

confidence: 99%

Treatment of COPD by clinical phenotypes: putting old evidence into clinical practice

Soler-Cataluña²,

et al. 2012

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The new Global Initiative for Chronic Obstructive Lung Disease update has moved the principles of treatment of stable chronic obstructive pulmonary disease (COPD) forward by including the concepts of symptoms and risks into the decision of therapy. However, no mention of the concept of clinical phenotypes is included. It is recognised that COPD is a very heterogeneous disease and not all patients respond to all drugs available for treatment. The identification of responders to therapies is crucial in chronic diseases to provide the most appropriate treatment and avoid unnecessary medications. The classically defined phenotypes of chronic bronchitis and emphysema, together with the newly described phenotypes of overlap COPD-asthma and frequent exacerbator, allow a simple classification of patients that share clinical characteristics and outcomes and, more importantly, similar responses to existing treatments.These clinical phenotypes can help clinicians identify patients that respond to specific pharmacological interventions. For example, frequent exacerbators are the only subjects with an indication for anti-inflammatory treatment in COPD. Among them, those with chronic bronchitis are the only candidates to receive phosphodiesterase-4 inhibitors. Patients with overlap COPDasthma phenotype show an enhanced response to inhaled corticosteroids and infrequent exacerbators should only receive bronchodilators. These well-defined clinical phenotypes could potentially be incorporated into treatment guidelines.

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“…Respiratory failure with reduced oxygen saturation and raised carbon dioxide tension (Pco) and congestive cardiac failure occur only terminally. Those patients with clear radiological and post-mortem evidence of emphysema, especially of the panacinar type, fall into this group (Kahana, Aronovitch, and Place, 1963;Burrows, Fletcher, Heard, Jones, and Wootliff, 1966), these findings being associated with an increased total lung capacity (Fletcher et al, 1963) and reduced diffusing capacity (Ogilvie, 1959). Nitrogen washout techniques (Briscoe and Nash, 1965) reveal an excessively large 'slow space' which has a poor ventilation/perfusion ratio.…”

mentioning

confidence: 99%

“…For oedema the correlation was with the ventilatory response to CO2: the clinical significance of this finding is not apparent. Clinical features in chronic airways obstruction were also examined by Clark (1968), who found no relation between clinical type, as expressed by the divisions bronchitic, emphysematous, and inltermediate (Burrows et al, 1966), and ventilatory response to CO2.…”

mentioning

confidence: 99%