Proceedings of the British Thoracic Association and the Thoracic Society
Journal: Thorax (1982)

at the Royal Free Hospital, London What does "chronic bronchitis" mean?CM FLETCHER, NB PRIDE Whereas the word "emphysema" has, since the Ciba Symposium in 1959, been used with clarity to denote a pathological abnormality, confusion is still caused by the unqualified use of the words "chronic bronchitis" to describe anything from simple expectora- tion to fatal respiratory failure caused by airflow obstruc- tion.This was recognised by a report to the Medical Research Council in 1965.Since then numerous epidemiological, physiological, and pathological studies have indicated that mucous hypersecretion is probably not causally related to airflow obstruction emphasising the need for reconsidering present terminology.We suggest that "chronic bronchitis" (or, preferably, "chronic bronchial catarrh") should be used solely to denote bronchial hypersecretion, qualified by adjectives such as mucous (or simple), mucopurulent, purulent, or eosinophilic.The unqualified term should not be used to indicate accompanying obstruction to airflow, while "chronic obstructive bronchitis" is unsuitable because it suggests the same pathological process is responsible for obstruc- tion and hypersecretion.A new term is needed to indicate the common, destructive, and obstructive disorder of peripheral airways, caused almost invariably by smoking, which causes limitation of expiratory airflow.The term "chronic obstructive bronchiolitis" would be more precise than "small airways disease".Alternatively terms such as "chronic bronchitis with airflow obstruction", which do not imply any particular site or pathology, could be used. Saprophytic invasion of infarcted pulmonary tissue byAspergillus species DR BUCHANAN, D LAMB Involvement of pulmonary tissue by Aspergillus species is usually considered to include three main patterns: development of a fungal ball of mycetoma in a pre-formed cavity, allergic broncho- pulmonary aspergillosis, and true invasive aspergillosis as an opportunistic infection in patients with lowered tissue defences.We present five cases of a form of pulmonary involvement by Aspergillus species which has previously only received passing reference in the literature.All five are examples of saprophytic invasion of infarcted pulmonary tissue.The characteristic features are wide- spread invasion of the dead tissue by fungal hyphae, with in three cases liquefaction of the dead tissue resulting in cavitated lesions.Two cases were found incidentally at necropsy, two cases presented as isolated peripheral pulmonary opacities and were resected as possible tumours, and one case presented as a complication of a pneumonic episode.Only this latter case had mycological confirmation of the presence of Aspergillus fumigatus.It may be that examples of such saprophytic invasion of extensive pulmonary infarcts are the basis for some repor- ted cases of primary Aspergillus pneumonia.Familial sarcoidosis in an Irish population NJ BRENNAN, PA CREAN, D LONG, MX FITZGERALD Studies in the Republic of Ireland have demonstrated that sarcoidosis is common, with a prevalence on mass radiographs of 33-3 cases per 100 000 individuals screened.Observations in our Sarcoid Clinic suggested a high prevalence of familial cases.We therefore surveyed all patients to quantify this phenomenon.The study group comprised 85 index patients with biopsy-proven sarcoid- osis with a sibling pool of 416 individuals.Eleven siblings derived from nine families were identified as having sarcoidosis.In seven there was biopsy proof while in the remaining four there was highly suggestive clinical and radiological evidence of the disease.There was no significant difference in the mode of presentation between sibling pairs or between familial or non-familial cases.In only two instances was the temporal profile of onset of the disease suggestive ofintrafamilial spread ofa transmissible agent.The high prevalence of familial sarcoidosis reported here (10-5%) dictates that siblings of affected patients should be screened for this disease.