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Chapter-08 Chronic Airway Disorders

BOOK TITLE: Textbook of Pulmonary Medicine

Author
1. Joshi Jyotsna M
ISBN
9788184486490
DOI
10.5005/jp/books/10889_8
Edition
1/e
Publishing Year
2009
Pages
57
Author Affiliations
1. TN Medical College and BYL Nair, Hospital, Mumbai, Maharashtra, India, TN Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India, TN Medical College and BYL Nair Hospital, Mumbai, India, TN Medical College, BYL Nair Hospital, Dr AL Nair Road, Mumbai 400 008, Maharashtra, India, TN Medical College and BYL Nair Hospital Mumbai, Maharashtra, India, T.N. Medical College, B.Y.L. Nair Hospital, Mumbai, Maharashtra, India
Chapter keywords

Abstract

The airways can be divided into 3 groups: (i) upper airways extend from the nose/mouth to the carini, (ii) large airways are airways greater than 2 mm diameter, and (iii) small airways are those less than 2 mm diameter. Disorders of upper airways usually present with symptoms of dyspnoea and stridor. Initial evaluation is best done by flow volume loops on spirometry to show upper airway obstruction. Chronic airway disease with or without chronic airflow limitation (CAL) involve the large and small airways. Several diseases cause CAL–namely bronchial asthma, chronic obstructive pulmonary disease (COPD), obliterative bronchiolitis (OB) and bronchiectasis. Atopy and improvement in spirometry after bronchodilators or glucocorticosteroids point towards the diagnosis of asthma. The term COPD is often used to include all causes for irreversible CAL, causing diagnostic confusion. However, COPD is usually related to smoking and should be diagnosed in presence of a history of heavy smoking, irreversible CAL, evidence of emphysema on imaging, decreased diffusion capacity and chronic hypoxaemia. Small airway disease may be seen in COPD, asthma and bronchiectasis; but may occur alone when it is called OB. OB is often misdiagnosed as “COPD” due to similar clinical presentation, chest radiograph showing normal or hyperinflated lung fields and physiological studies showing irreversible airflow obstruction. Characteristic high-resolution computed tomography (HRCT) shows “mosaic” pattern. Bronchiectasis though rare in the western world, is a frequent cause of CAL in the developing countries presenting in adulthood. The different sections of this chapter discuss each of the airway disorder in detail.

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