Talk:Chronic obstructive pulmonary disease

message: The Epidemiology section could make use of  "Epidemiology of Chronic Obstructive Pulmonary Disease". There are some fascinating statistics at British Lung Foundation: Chronic obstructive pulmonary disease (COPD) statistics but this appears to be a primary source (see methodology). The NICE guideline references a couple of facts from it and perhaps we can find another secondary source to use more. I wonder if that web page could be an external link, since it contains far more accessible information than we could use. However, apart from the chart of global deaths per country, it is fairly UK-centric. -- Colin°Talk 19:18, 9 June 2021 (UTC)
thread_title: Epidemiology

message: The article says that in those with COPD "Stopping smoking decreases the risk of death by 18%". Which would be very nice, but without some qualification is a bit daft. I looked up the source here, which is a good but old (2012) review in The Lancet. It says "The first step must be smoking cessation. This intervention lessens the decline of FEV1 by about 35 mL per year, which slows disease progression and lowers mortality by 18%." It isn't clear if this is e.g., annual mortality or mortality at some period after intervention or diagnosis. So I looked up the source: The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality. Even the title makes it clear this is looking at mortality at 14.5 years and also that it is examining "a smoking cessation intervention", which is not the same thing as "stopping smoking". The study had three large groups. One had "usual care" and the other two had an intervention consisting of "a strong physician message and 12 two-hour group sessions, using behavior modification and nicotine gum" over 10 weeks. One of the intervention groups also used a ipratropium inhaler and the other had a placebo inhaler.
What is notable is that most of the participants did not die of COPD. 33% died of lung cancer, 22% had a cardiovascular disease death, and 21% had cancer of organs other than the lung. Only 7.8% died of "respiratory disease other than cancer". The ipratropium had no effect. When comparing the intervention with usual care, the only significant improvement was of "deaths from respiratory diseases not related to lung cancer". The two treatment groups had 15 and 14 such deaths vs 28 in the other care group. Overall, "The hazard ratio for mortality in the usual care group was 1.18 (95% CI, 1.02 to 1.37) compared with the special intervention group." I think that is where the 18% figure is coming from, but I'm not confident in my statistics here. But important is that it is having a smoking cessation intervention that gives this particular number, not whether you actually stop smoking. It was also only significant for those under 45 years old and those with a heavy 40-a-day habit or worse, and in those with moderate COPD rather than low or high FEV1 values. 
So the study then examined the participants who successfully quit for a sustained period, those who intermittently quit, and those who continued smoking. Of those in the intervention groups, only 22% were sustained quitters, 29% intermittent quitters and 49% continued smoking. The numbers for the usual care group were 5.4%, 23% and 71%. The degree of quitting was strongly and significantly related to mortality: 6 per 1000 person-years, 8 per 1000 person-years and 11 per 1000 person-years respectively. This time smoking habit did not make a significant difference to death due to "respiratory deaths not related to lung cancer" -- it was the other deaths that were avoided.
There are studies that the Lancet review cite that demonstrate clearly that stopping smoking reduces the decline in lung function. Which is very important for quality of life and disability. But it seems that in terms of death, stopping smoking didn't reduce the risk of dying of COPD, but from the other things associated with smoking. That study was from 2005. I wonder if there is a newer one, cited by newer reviews, that we can use. If anyone thinks my interpretation of the stats is wrong, please let me know. -- Colin°Talk 20:05, 19 June 2021 (UTC)
thread_title: Risk of Death

message: To change Severity heading to Assessment and move section to follow Diagnosis.--Iztwoz (talk) 17:09, 29 June 2021 (UTC)
thread_title: Proposed edit

message: in treatment modalities 2400:C600:342A:6581:1:0:7588:9138 (talk) 08:45, 18 February 2023 (UTC)
thread_title:  COPD and eosinophils count 

message: For the record, an edit of mine was removed due to WP:MEDRS. However, if you look at the research paper carefully, in fact it also included a review of others' research efforts, citing at least six other papers in its discussion part:
 Alveolar lavage using antibiotics based on the bronchoscope technique has been widely applied in clinic... which can effectively increase the treatment effective rate of COPD patients complicated with pneumonia, and reduce the inflammatory response (10). Fortún et al (11) treated the COPD patients complicated with type II respiratory failure using alveolar lavage combined with mechanical ventilation, and the results showed that... improved. Gasiuniene et al (12) studied the curative effect of bronchoalveolar lavage on COPD patients... found that sputum suction and lavage via fiber bronchoscope can improve the symptoms, increase the cure rate and shorten the length of hospital stay... Studies have found that bronchoalveolar lavage can effectively remove the lung mucus and ... (15,16)... the application of bronchoalveolar lavage in removing the airway and lung mucus can significantly increase the cure rate of COPD complicated with pneumonia (17)...
So I believe it is a peer reviewed, reliable, third-party published secondary source. Anyway, I'm not going to revive my original edit.  — Preceding unsigned comment added by Dustfreeworld (talk • contribs) 17:27, 10 April 2023 (UTC)
replies: text: With a second look, I believe I was probably wrong in saying that it's a secondary source. I might have misunderstood what the authors meant. It seems that the citations didn't directly support BAL as a treatment for COPD (though they might support symptom improvements with BAL). Being too impulsive when edits were reverted is really no good. Hope I'm more thoughtful now :). It's not uncommon for BAL being used for treatment of conditions besides pulmonary alveolar proteinosis (e.g., pneumonia, pneumoconiosis and COPD) in some parts of the world though. Since it's a "relatively" safe procedure, BAL may still worth more weight in the article ... (should have posted this earlier, just too busy).  — Preceding unsigned comment added by Dustfreeworld (talk • contribs) 09:43, 28 May 2023 (UTC)
thread_title:  MEDRS?