A challenge to the seven widely believed concepts of COPD

Figures & data

Table 1 Characteristics of irreversible asthma and COPD groups (derived from ref ¹⁰)

Final Diagnosis	Median (IQR) (range)
	Irreversible asthma (n = 8) Presumed irreversible asthma (normal KCO) (n = 5)	COPD (n = 16) Presumed COPD (low KCO) (n = 3)
Age (years)	55 (12.5)	67 (16)
	(42 to 61)	(49 to 70)
Age at onset of chronic cough (year)	40 (19)	49.5 (12.7)
	(22 to 57)	(30 to 60)
Age at onset of exercise intolerance/dyspnea (year)	45 (22)	59 (15.5)
	(9 to 57)	(40 to 66)
History of allergic rhinitis	11 (84.6%)	4 (21.1%)
Hypertrophy of nasal turbinates upon examination	12 (92.3%)	5 (26.3%)
KCO (% predicted)	91.6 (10.5)	49.6 (20.6)
	(81.2 to 117.6)	(18.7 to 65.3)
Change in FEv1 following ICS/LABA therapy (mL)	350 (250)	–26.5 (84)
	(–260 to 600)	(–120 to 91)

Abbreviations: ICS, inhaled corticosteroids; LABA, long-acting β2-agonists.

Figure 1 Panlobular emphysema with multiple bullas.

Figure 2 (A) Diffuse thickening of basement membrane (≥6.5 μm) in irreversible asthma. (PAS stain, ×20). (B) Squamous cell metaplasia with epithelial/subepithelial inflammation without thickening of basement membrane (H/E stain, ×20).

Figure 3 Absolute increase in post-bronchodilator (FEv₁) and total Chronic Respiratory Disease Questionnaire (CRQ) score after mometasone compared with placebo for each tertile of sputum eosinophilia. Reprinted from Brightling CE, McKenna S, Hargadon B, et al. Sputum eosinophilia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease. Thorax. 2005;60(3):193–198.⁴⁵ © with permission BMJ 2005.

Note: *P < 0.05 (paired/test).

Table 2 Qualitative CT scan changes in asthma and COPD (compiled by the authors)

	Asthma	COPD
Wide branching and thinning of blood vessels	May be present	Common
Centrilobular or paraseptal emphysema	Occasionally described (0%–10%); usually limited^Citation59,Citation60	Common and usually diffuse
Panlobular emphysema	Never described	Common (more in 1-α-antitrypsin deficiency than in smoker’s COPD)^Citation64
Bullas	Rare/anecdotal reports; usually single^Citation61^–^Citation63	Common

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