Nihon rinsho. Japanese journal of clinical medicine
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Although chronic obstructive pulmonary disease (COPD) has high prevalence and mortality, there are underestimated and many COPD patients still remain not diagnosed worldwide including Japan. In spite of high prevalence in Western countries, it had been reported that COPD patients were estimated about 200,000 in Japan. Here, the prevalence of COPD in Japan is discussed according to the NICE Study.
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Lung volume reduction surgery (LVRS) for severe pulmonary emphysema was started more than 10 years ago. However, its indication and durability of effects had not been clear. The National Emphysema Treatment Trial (NETT) defined patients at high risk of death after LVRS and subgroups of patients with severe emphysema in whom LVRS improved survival and function. ⋯ However, only one-fourth of LVRS candidates are belonging to such a preferable subgroup. Although most of the patients with severe pulmonary emphysema are over 60 years old in Japan, candidates for lung transplantation are limited under 60. Under such a condition, only two patients with severe pulmonary emphysema have undergone lung transplantation in Japan.
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Chronic obstructive pulmonary disease (COPD) is a cigarette smoking-related disorder characterized by chronic inflammation of the airways and progressive destruction of lung parenchyma, leading to airway remodeling and pulmonary emphysema. Several mechanisms have been proposed to be involved in the pathogenesis of pulmonary emphysema, including an imbalance of proteases and antiproteases, and oxidative stress. In addition to these mechanisms, recent studies suggest another mechanism involved in the development of pulmonary emphysema: apoptosis of alveolar wall cells. ⋯ Studies with animal models suggest that caspases, vascular endothelial growth factor (VEGF) deficiency, oxidants, ceramide, CD8+ T-lymphocytes, elastases, and interferon-gamma may be responsible for the induction of apoptosis of alveolar wall cells. Furthermore, defective clearance of apoptotic cells in the lungs of patients with emphysema may promote inflammation. In this review, recent data on the role of apoptosis in emphysema from both animal models as well as from studies on human subjects will be discussed.
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Differential diagnosis of chronic obstructive pulmonary disease (COPD) from asthma is not a difficult task for many clinicians. Patients with COPD have a history of heavy smoking and show a slowly progressive dyspnea on exertion and there is little variability in symptoms, and they show a poor response to bronchodilators and corticosteroids. Asthma usually begins in early childhood with atopy, shows episodic dyspnea with wheezing, especially during night and early morning. ⋯ Chronic airway diseases are also possible candidates for differential diagnosis of COPD. Bronchiectasis, sinobronchial syndrome, diffuse panbronchiolitis, obliterative bronchiolitis, and other chronic airway diseases should be considered. Some interstitial lung diseases, such as smoking-related interstitial lung diseases and lymphangioleiomyomatosis, often show obstructive ventilatory impairment, and therefore should be considered in differential diagnosis of COPD.