Talk:Chronic obstructive pulmonary disease/GA1

GA Review

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Reviewer: Jfdwolff (talk · contribs) 21:25, 25 November 2013 (UTC)[reply]

I intend to review the article. Seeing that my editing time occurs in short stretches, I will probably review sections at a time. All going well, this shouldn't take longer than a week. If I forget, please nudge me on my talkpage. JFW | T@lk 21:25, 25 November 2013 (UTC)[reply]

Thanks for taking this on. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:46, 25 November 2013 (UTC)[reply]

I have finished the review. Looking forward to helping with the finishing touches. JFW | T@lk 16:26, 4 December 2013 (UTC)[reply]

Introduction

Comments on the introduction JFW | T@lk 21:25, 25 November 2013 (UTC)[reply]

All sections from the article are represented.
Done The terms "chronic airflow limitation" (CAL) and "chronic obstructive respiratory disease" (CORD) are unfamiliar to me. Do they require the prominence that we're giving them, or can the terminology be moved to a subsection?

Agree and will move to the history section. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:46, 25 November 2013 (UTC)[reply]

Done Emphysema redirects here, but the term is not mentioned in the introduction and not bolded anywhere in the article.

Mentioned. Not sure if it needs bolding though. It is a lot less emphasized now. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:05, 26 November 2013 (UTC)[reply]

I would, if only for the reason that some people might primarily search for "emphysema" and find themselves on the page about COPD. Here in the UK, many older people have not heard of COPD but state that they have "emphysemia" (sic). JFW | T@lk 15:17, 26 November 2013 (UTC)[reply]

Okay bolded both emphysema and chronic bronchitis as they were historically considered the two main subtypes. Doc James (talk · contribs ·email) (if I write on your page reply on mine) 10:59, 27 November 2013 (UTC)[reply]

Done I would not want the intro to omit indoor cooking on open fire, which in countries such as India is a major cause of COPD in women. I realise that it is subsumed under the broader term of "air quality", but this is already too abstract. The GOLD consensus guideline place substantial emphasis on this.

Agree and I give a fair bit of coverage both in the cause and the prevention section to this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:10, 26 November 2013 (UTC)[reply]

Done "The definition includes most cases of chronic bronchitis" - which cases would it not include? Not sure what this sentence adds.

Supposedly there is something called "chronic bronchitis without airflow limitation" I had never heard about it before either. Have merged chronic bronchitis into this article. Will comment on this is the differential diagnosis section.Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:49, 25 November 2013 (UTC)[reply]

Done "In contrast to asthma, this poor airflow is not as significantly improvable" - I presume this is a reference to reversibility. How about: "In contrast to asthma, the airflow reduction does not improve significantly with the administration of medication."

Sounds good. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:49, 25 November 2013 (UTC)[reply]

Signs and symptoms

Comments on "signs and symptoms": JFW | T@lk 21:58, 25 November 2013 (UTC)[reply]

Done The section does not seem to separate signs from symptoms. This is not a large problem, but might be tricky for readers who struggle with the terminology. Is wheeze required for the diagnosis, or is it heard by stethoscope?

Yes I sort of divided it around the two main symptoms. Than have a section for the other stuff and tired to touch on exacerbations. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:21, 26 November 2013 (UTC)[reply]

I have made it a bit more specific which features are found on physical examination. JFW | T@lk 15:17, 26 November 2013 (UTC)[reply]

Done Exertional dyspnoea is an important omission. Many people in the early stages of COPD are comfortable at rest but find their exercise limited. The NICE guideline places emphasis on using MRC breathlessness grade as a marker of severity (rather than spirometric parameters)

Already state "Typically the shortness of breath is of a prolonged duration, worsens over time, and is worse with exercise" Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:21, 26 November 2013 (UTC)[reply]

I felt it might benefit from a bit more prominence, as many people with milder stage COPD appear to be fine at rest but can't make it to the bus stop without pausing several times for breath. JFW | T@lk 15:17, 26 November 2013 (UTC)[reply]

Done In "Other", the mechanism for cor pulmonale is stated to be pressure-related. What is the role of hypoxic pulmonary artery vasoconstriction? (Or is this best mentioned elsewhere?)

From my understanding hypoxia causes pulmonary artery vasconstriction which causes rt heart strain which causes cor pulmonal / right sided heart failure secondary to pulmonary causes. I could add it to the patho section? Or it could simply be left to cor pulmonal. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:50, 27 November 2013 (UTC)[reply]

I agree that this is potentially better left for the "pathophysiology" section. I suspect that the pathogenesis of cor pulmonale might be more complex than just chronic hypoxia. JFW | T@lk 15:19, 27 November 2013 (UTC)[reply]

Done In "Exacerbations", might there be good cause to mention decreased level of consciousness due to severe acute hypercapnia and type 2 respiratory failure? Do the sources cover this?

Mention "confusion" is there. Have added that they are combative. Typically described as an "altered level of consciousness" Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:46, 27 November 2013 (UTC)[reply]

Cause

Overall a strong section. Some small comments: JFW | T@lk 15:17, 26 November 2013 (UTC)[reply]

DoneThe URL for the "Ward2012" source generates a search result rather than an individual page in the book.

This one was tough but fixed Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:17, 27 November 2013 (UTC)[reply]

Done The percentages, all added up, exceed 100% - depending on which percentages are included. Not sure how this could be improved.

Yes physicians are generally not good at math. This is however what the sources say. Every source like to over emphasis a bit their particular issue. Check out Talk:Common cold for another example. I am happy for suggestions. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:17, 27 November 2013 (UTC)[reply]

Who isn't sure whether COPD is more prevalent in poor because they're poor or because environmental conditions? I've never heard of any disease being more prevalent simply because of someone's socioeconomic status. If there is a higher rate of any disease in those in poverty, it's due to diet or environmental causes. I'm gonna change that, revert if it makes sense to anyone else. — Preceding unsigned comment added by 76.113.38.98 (talk) 10:04, 4 March 2014 (UTC)[reply]

Pathophysiology

This is generally a strong section. I fixed some typos ("degree of airway hyperresponsiveness" rather than "decrease"). Just this: JFW | T@lk 16:10, 28 November 2013 (UTC)[reply]

Done At the moment the article suggests that hypercapnia is caused by destruction of alveolar surface. Physiologically this might not be sufficient explanation; alveolar hypoventilation (probably due to air trapping). Does the discussion about hypercapnia need to be moved to the paragraph about dynamic hyperinflation?

Yes hypercapnia is due to a number of different mechanisms. Have clarified and moved. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:36, 2 December 2013 (UTC)[reply]

Done Do we need a short paragraph about the pathogenesis of cor pulmonale? (See discussion above.)

Done Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:51, 2 December 2013 (UTC)[reply]

Done We don't talk much about the role of infection in the progression of COPD. Is there a good source that outlines the direct effect of infection (usually as part of exacerbations) on the "downward spiral" of COPD?

Okay added some to the section on causes under exacerbations. The role of infections in stable COPD is less clear. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:51, 2 December 2013 (UTC)[reply]

Diagnosis

This is all for this section: JFW | T@lk 16:10, 28 November 2013 (UTC)[reply]

Done Do we need to explain what "bronchodilator" in the opening paragraph refers to? For the lay reader this might imply something mechanical... Similarly, we have not fully introduced the concept of "spirometry", and perhaps an image of a handheld spirometer might help here.

Have added a picture of a spirometry machine. Have added a link to bronchodilator. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:04, 29 November 2013 (UTC)[reply]

Done The paragraph starting with "It is unclear" could conceivably be moved to "signs and symptoms", where it seems relevant, or another relevant section.

Done Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:58, 2 December 2013 (UTC)[reply]

Done In the "differential diagnosis" subsection, I would recommend a degree of rephrasing. Clearly, jugular distention and pedal oedema occur in cor pulmonale (unless the COPD is otherwise mild); I would want additional evidence of left ventricular dysfunction before considering pulmonary oedema as the cause of dyspnoea. Similarly, leg oedema is often asymmetrical to some degree, and I would want to consider pulmonary embolism only in the face of additional evidence. Perhaps the secret of this section is not to attempt to say too much about the clinical considerations made by doctors at the time of assessment, but focus on the possible causes of dyspnoea.

Agree and adjusted. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:15, 2 December 2013 (UTC)[reply]

Prevention

Limited comments on this strong section: JFW | T@lk 17:01, 2 December 2013 (UTC)[reply]

Done Smoking cessation: this is quite detailed content that is covered elsewhere to a large extent.

It is three short paragraphs and such a key aspect of COPD. The refs in question are also commenting on smoking cessation in relation to COPD. What do you recommend removing / condensing? Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:37, 4 December 2013 (UTC)[reply]

Fair enough. The sources do focus on COPD. JFW | T@lk 20:32, 4 December 2013 (UTC)[reply]

Done Occupational health: the sentence "If a worker develops COPD" has no reference. This may be found in occupational health manuals/textbooks.

Added ref. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:46, 4 December 2013 (UTC)[reply]

Management

Comments on this section: JFW | T@lk 16:26, 4 December 2013 (UTC)[reply]

Done In the "bronchodilators" subsection, the terms "short acting" and "long acting" are not hyphenated. Almost all sourced that I've seen use hyphenated terms.

Done Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:50, 4 December 2013 (UTC)[reply]

Done I am unsure if there might be a secondary source available to replace the primary source reference for the TORCH trial

Hum yes the secondary sources are not as positive. Need to read further. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:19, 4 December 2013 (UTC)[reply]

Done Karner2012 is cited as suggesting mortality differences between the tiotropium preparations. This has been displaced by doi:10.1056/NEJMoa1303342, so I wonder if it might be better to omit this sentences altogether.

Hum. So does this mean both formulations are associated with a risk of death or neither formulation? Have reworded. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:39, 4 December 2013 (UTC)[reply]

Done With regards to macrolides for prophylaxis, doi:10.1016/j.rmed.2012.12.019 suggests a cost benefit, and might be cited in addition or indeed instead of the current source.

Added. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:48, 4 December 2013 (UTC)[reply]

Done With regards to harms from excessive oxygen, I wonder if you might consider the Jindal source with doi:10.1136/thx.2008.102947 (the BTS emergency oxygen guideline) which covers the problem well. Unfortunately doi:10.1136/bmj.c5462, which provides excellent proof, is a primary source.

Added some more. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:20, 5 December 2013 (UTC)[reply]

Done With regards to acute exacerbations, there is no mention on the delivery of bronchodilators; while using spacer devices might be sufficient, those admitted to hospital will typically require nebulised therapy.

Done Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:27, 5 December 2013 (UTC)[reply]

Prognosis

No comments on this section. JFW | T@lk 16:26, 4 December 2013 (UTC)[reply]

Epidemiology

Comments on this section: JFW | T@lk 16:26, 4 December 2013 (UTC)[reply]

Done The fivefold increase in prevalence (from 64 to 329 million) over 6 years really probably does require a better explanation. Does this reflect screening and increased awareness? Or more effective treatment and hence better prognosis and thus longer time between diagnosis and death?

Have tried to discuss this. I am unable to find a clear explanation. I guess we could simply remove the 2004 estimate. It is here [1] and mentions that it is only symptomatic? But all COPD has to sort of be symptomatic for the diagnosis. There is good evidence it is increasing in prevalence though. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:51, 5 December 2013 (UTC)[reply]

Done The sentence "Some developing countries have seen increased rates [...]" might be more informative if it was made clear whether the factors the influence these rates are recognised.

Should have read "some developed countries" Fixed Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:34, 5 December 2013 (UTC)[reply]

History

No comments on this section. Well researched and presented. JFW | T@lk 16:26, 4 December 2013 (UTC)[reply]

Society and culture

Comments: JFW | T@lk 16:26, 4 December 2013 (UTC)[reply]

Done I wonder if the distinction "blue bloaters and pink puffers" is better suited for the "signs and symptoms" section. The phenotypes were (up until recently) propagated in medical school tutorials.

This has really fallen out of favor. The 2013 GOLD guidelines do not mention it. Thus why I put it in the section on society and culture. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:50, 4 December 2013 (UTC)[reply]

Okay, seems reasonable. JFW | T@lk 13:35, 5 December 2013 (UTC)[reply]

Done In "economics", is it possible to give a breakdown as to whether the costs reflect medical care or loss of productivity? I notice that one figure is broken down as mostly reflecting hospital care, but not the others.

Added breakdown for the total. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:13, 5 December 2013 (UTC)[reply]

Research

I think the discussion of infliximab should be removed unless there are secondary sources discussing the evidence base; the current reference is a primary source. JFW | T@lk 16:26, 4 December 2013 (UTC)[reply]

Done Secondary source now present. There might be scope for expanding this paragraph, but that's not crucial for GA. JFW | T@lk 20:32, 4 December 2013 (UTC)[reply]

Other animals

I wonder if there are veterinary substrates of poor air quality-related COPD. Do the sources mention anything about this? JFW | T@lk 16:26, 4 December 2013 (UTC)[reply]

Done I have been able to find very little regarding COPD in animals other than horses. This ref is not good but talks about it [2] and we have this [3] Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:23, 5 December 2013 (UTC)[reply]

Okay have found a couple of more papers. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:30, 5 December 2013 (UTC)[reply]

General comments

Some general comments JFW | T@lk 15:17, 26 November 2013 (UTC)[reply]

Done Some references have capitalised titles, while others do not. Consistency would be welcomed.

There must be a bot to do this no? Have asked User:Chris Capoccia who does lots of ref work. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:47, 27 November 2013 (UTC)[reply]

some works are published with capital letters in the titles and some are not. Is there any standard about recapitalizing titles? Or should they only be cited with the capitalization as published? —Chris Capoccia ^T⁄_C 18:58, 27 November 2013 (UTC)[reply]

My personal preference has always been to use consistency within each article, but this is not a breaking point for GA as long as the relevant parameters all follow the same style. JFW | T@lk 23:06, 27 November 2013 (UTC)[reply]

Done Some references (e.g. GOLD references) quote chapters rather than pages, and yet this parameter is prefaced with "p."

Can put in page numbers. For some e-book now there are no page numbers just chapters and they change the number of pages depending on what size you view it at. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:26, 27 November 2013 (UTC)[reply]

so the request would be to cite the whole page range of the chapter? Or should the citation be reformatted without a chapter if the intent is to only cite one page? —Chris Capoccia ^T⁄_C 19:00, 27 November 2013 (UTC)[reply]

Page range for the whole chapter. I have used all the chapters a number of times.Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:58, 27 November 2013 (UTC)[reply]

Another option would be to use GOLD as a reference, the same way we organised the citations to WHO in the dengue fever article. JFW | T@lk 23:06, 27 November 2013 (UTC)[reply]

Done For some web-based references, the citation templates might still be populated a bit more (particularly the accessdate= parameter).

I think this has been done. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:16, 2 December 2013 (UTC)[reply]

Finishing points

Just a few things. I have cleaned up a couple of links to redirects and rephrased some stuff in places. The following remains: JFW | T@lk 23:31, 7 December 2013 (UTC)[reply]

The Kissell source (2003) is cited as a reference for occupational measures in dusty environments. There's currently a {{page needed}} tag that I cannot resolve (I managed two other ones). This should be sorted before GA.

Not the greatest ref. Replaced with two better ones. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:40, 8 December 2013 (UTC)[reply]

We speak little of the role of hospital admission, and "hospital at home schemes" and admission prevention programmes (run by "community matrons") currently very popular. Do the sources say anything about this?

Have added some info. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:38, 9 December 2013 (UTC)[reply]

Is Vestbo the only author of the GOLD document, or do we need to list other authors?

There are a bunch per page ii and iii. The person listed is the chair. How do you propose we ref this guideline? Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:39, 9 December 2013 (UTC)[reply]

I'm not entirely sure how to attribute authorship of this resource, considering it is a consensus document. I don't know how medical journals refer to it. Does Rodriguez-Roisin (second signatory of the introduction) need attribution? I am happy to pass for GA without this being addressed. JFW | T@lk 21:43, 9 December 2013 (UTC)[reply]

Have all 50 names is simply too much IMO. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:55, 9 December 2013 (UTC)[reply]

Agree. Perhaps the first three and "et al", as we do with articles that have >5 authors in many articles? JFW | T@lk 22:13, 9 December 2013 (UTC)[reply]

In "society and culture", one of the sources has a {{page needed}} tag

Fixed sort of. Did not add this bit. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:52, 8 December 2013 (UTC)[reply]