Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.
Emphysema is a form of chronic obstructive pulmonary disease (COPD). It is often caused by exposure to tobacco smoke. It may progress to may to bullous emphysema. A bulla is an air space defined as being at least 1cm in diameter, and with a wall less than 1mm thick. The imaging findings in two cases of bullous emphysema are shown below.
CXR PA and lateral, close-up view (click to enlarge the images), CXR report, CD4/CD8 count.
CBC, CMP, ABG (click to enlarge the images).
CT of the chest, CT report (click to enlarge the images).
A giant bulla in a patient with COPD.
A giant bulla in a COPD patient. Close-up of the bulla (click to enlarge the images).
The same bulla two years later (click to enlarge the images).
Mind map of Chronic Obstructive Pulmonary Disease (COPD)
The average annual rate of decline in FEV1 is 20 to 30 mL in normal persons and double that (50 to 60 mL) in smokers with COPD. Smoking cessation delays decline in FEV1 to near normal levels. Stopping smoking is the most effective method to prevent progression of COPD.
Telling smokers their spirometry "lung age" improves quit rates at 12 months from 6.4% to 13.6% according to a study of 561 UK smokers. The "lung age" concept (the age of the average person who has an FEV1 equal to the patient) was developed in 1985 to help patients understand complex PFTs and to show how they are prematurely aged by smoking.
Unaware of the UK study, the 2007 U.S. Preventive Services Task Force guidelines recommended against screening for COPD using spirometry.
Chronic Obstructive Pulmonary Disease (COPD). AllergyCases.org.
Desperate to Cry, Desperate Not To. NYTimes.
Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ, doi:10.1136/bmj.39503.582396.25 (published 6 March 2008).
Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force. Annals of Int Med, 1 April 2008 | Volume 148 Issue 7.