A
arossm
Why is COPD a progressive disease?
seriously?? how about you do your own homework...Is it really just because they don't stop smoking? So if they stopped smoking, it wouldn't be progressive? Would they return to a normal rate of decline? What are your sources?
Is it really just because they don't stop smoking? So if they stopped smoking, it wouldn't be progressive? Would they return to a normal rate of decline? What are your sources?
One of the seminal pulmonology papers, Fletcher and Peto BMJ 1977.Is it really just because they don't stop smoking? So if they stopped smoking, it wouldn't be progressive? Would they return to a normal rate of decline? What are your sources?
If you're gonna be snarky to people you should at least know what you're talking about. You also should apparently read the Fletcher and Peto paper...Did you read what I wrote?
No, they wouldn't return to a normal rate of decline. When you've smoked yourself into enough inflammation to have enough destruction of lung to now be diagnosed with COPD, there's no turning back the clock on those macrophages that have set up shop churning out IL's and all that. Decline is accelerated compared to never smokers and those that quit before COPD set in, and will stay accelerated although you slow it down with smoking cessation and tx.
The earlier in the disease course you dx it, stop smoking, and treat aggressively (actually using inhalers properly and such) the better the prognosis. Not everyone has to end up on oxygen or be life limited by the disease, it just depends.
Be sure to tell all your COPD'ers that there is no better tx for their dz than smoking cessation, and if they're not on O2 it's their best chance to slow this to try to stay off it too.
yes..apparently you are studying for the MCATs...Do my own homework? What are you talking about? I'm asking out of curiosity because I actually care enough to understand. Go look at my other questions asked and you'll know. Get outta here.
If you're gonna be snarky to people you should at least know what you're talking about. You also should apparently read the Fletcher and Peto paper...
Did you read what I wrote?
No, they wouldn't return to a normal rate of decline. When you've smoked yourself into enough inflammation to have enough destruction of lung to now be diagnosed with COPD, there's no turning back the clock on those macrophages that have set up shop churning out IL's and all that. Decline is accelerated compared to never smokers and those that quit before COPD set in, and will stay accelerated although you slow it down with smoking cessation and tx.
The earlier in the disease course you dx it, stop smoking, and treat aggressively (actually using inhalers properly and such) the better the prognosis. Not everyone has to end up on oxygen or be life limited by the disease, it just depends.
Be sure to tell all your COPD'ers that there is no better tx for their dz than smoking cessation, and if they're not on O2 it's their best chance to slow this to try to stay off it too.
yes..apparently you are studying for the MCATs...
One of the seminal pulmonology papers, Fletcher and Peto BMJ 1977.
http://www.bmj.com/content/1/6077/1645
COPD is a very heterogeneous disease. No one knows why some people quit smoking but continue to have rapid decline, while others continue to smoke and retain lung function. Some people with "mild" disease are frequent exacerbators, others with "severe" disease rarely have exacerbations, no one knows why. These are the questions that current research is trying to answer.
A little light reading,
https://www.ncbi.nlm.nih.gov/pubmed/24552242
http://www.nejm.org/doi/full/10.1056/NEJMoa0909883#t=article
hon, you have posted in 2 threads, this one and this oneHow? How am I "apparently" studying for the MCAT?
Ok, so this is what we've established:
- COPD smokers who quit smoking reduce their rate of lung deterioration - say a relative rate of 1.5
- COPD smokers who don't smoke stay at a relative rate of 2 for lung deterioration
- non-COPD nonsmokers have a rate of lung function decline of 1
The numbers are just conceptual. Is this the correct way to think about it?
hon, you have posted in 2 threads, this one and this one
Vasoconstriction in response to drop in blood pressure in the MCAT section.
The point is is that this forum is for residents and practicing physicians, and more specifically for questions related to thae practice of IM.I didn't know where else to ask that question, so I chose the MCAT section. Why would I go into that much detail if I was studying for the MCAT?
And what would be wrong with studying for the MCAT, if someone wanted to do that (which I'm not)?
I hope the pic I put up helps. Based off the Fletcher paper.
According to that, it says it slows the rate, looks like not back to normal, but I can't tell without reading the paper again which I'm not going to do right now. You should read it.
I like using the card I posted for you in talking to my patients about why they need to quit smoking and no that won't cure you but look how much it helps. Sorry if me chiming in isn't precise on this count but I won't apologize for dissenminating what has helped me get tx compliance for smoking cessation & inhalers etc with COPD pts.
The point is is that this forum is for residents and practicing physicians, and more specifically for questions related to thae practice of IM.
Since self identify as a premed, your post should be moved there and students and physicians who have information in regards to your question can answer it there.
I'm sorry you feel that way.Cool man, if you really badly want to move this post go ahead and do it. This has turned into such a big deal. Do whatever you want. All this irrelevant stuff about what I self identified as and where I posted my previous questions at. You guys are bullies. You're detracting from the question. With that, go ahead and blow up the post...
One of the seminal pulmonology papers, Fletcher and Peto BMJ 1977.
http://www.bmj.com/content/1/6077/1645
COPD is a very heterogeneous disease. No one knows why some people quit smoking but continue to have rapid decline, while others continue to smoke and retain lung function. Some people with "mild" disease are frequent exacerbators, others with "severe" disease rarely have exacerbations, no one knows why. These are the questions that current research is trying to answer.
A little light reading,
https://www.ncbi.nlm.nih.gov/pubmed/24552242
http://www.nejm.org/doi/full/10.1056/NEJMoa0909883#t=article
When you get a set up of chronic inflammation in the lungs, like if you don't treat plain old fashioned asthma and let it go on and on, things just sorta get worse and more difficult to control. You get to a point where you can't really shut it down.
This is true in many conditions marked by chronic inflammation, like autoimmune dzs,
Most things with an immune component are best served by aggressive treatment ASAP.
The lungs have enormous reserve capacity So the thing about COPD is by the time the lungs are appreciably ****ed by smoking you're already pretty far down the rabbit hole and there's really no turning back with the progression of destruction and scarring by chronic inflammation. All you can do is slowdown the decline.
We all have decline in lung function with age anyway, we're all breathing in stuff all the time. In the absence of other exposures though, you or I will not lose enough reserve by the time we die at 90 to ever notice. But COPD they've lost a lot and the rate of decline is seriously accelerated.
If you're going to wilfully ignore obvious forum rules at least don't act like a petulant child towards the moderators who are just doing doing their jobs.Well, the ratio is off. It was one person complaining (and he wasn't even complaining about placement as you are making it seem for him) vs. many other people participating.
I just thought doctors know more about this question than students.
And how do you know that my career status is not arbitrarily chosen?
A pre-med is not going to know anything about COPD, trust me. I wouldn't be asking about COPD if I was pre-med. Pre-meds ask about biology and organic chemistry.
This thread is SOOO misplaced. Now the thread will be ignored. Congrats.
Please move this to a Med student thread at least.
If you're going to wilfully ignore obvious forum rules at least don't act like a petulant child towards the moderators who are just doing doing their jobs.
I read the first one. So according to that, what I take from it is that COPD is not a progressive disease. It is only progressive in the sense that they don't stop smoking, meaning the "VA Hopeful Dr" wasn't joking. It says they will not recover lost function (which intuitively makes sense anyway without the need to particularly mention it since you can't fix scarring and structural damage), but the rate of loss will return to normal (in other words, like a non-smoker's rate of decline). Unless of course, normal rates of decline above the manifestation threshold are observable, unlike with healthy patients where normal rates of decline stays below the threshold and so a "manifestation of the progression is non-observable".
In other words, once I've developed COPD then normal rates of decline are manifestible because I'm already working with such a low function, whereas such normal rates of decline would otherwise not be manifestible. Is this a correct conclusion to take away? If that's the idea, then it makes sense. And the graph is really great in visualizing that.
But one thing still remains, the idea that I had coming in is that there is continuous underlying inflammation taking place even after cessation of smoking. Is that wrong? Did I pick that up incorrectly from somewhere? If not, then how come former smokers return to normal rates of decline in lung function rather than a rate that is somewhere in the middle between normal-rate and smoker-rate, not as good as normal rate but not as bad as continuous smoking either?
The response quality noticeably dropped. Mistafab, the moderator put the question here, I didn't. That is what I'm arguing, is that the thread is misplaced.
Second of all, I read up on it. I am coming here to clear up some confusion.
Cool man, if you really badly want to move this post go ahead and do it. This has turned into such a big deal. Do whatever you want. All this irrelevant stuff about what I self identified as and where I posted my previous questions at. You guys are bullies. You're detracting from the question. With that, go ahead and blow up the post...
Thank you Crayola227 and the argus for your help. I appreciate it. I have saved your resources and will read those resources tomorrow.
Well, the ratio is off. It was one person complaining (and he wasn't even complaining about placement as you are making it seem for him) vs. many other people participating.
I just thought doctors know more about this question than students.
And how do you know that my career status is not arbitrarily chosen?
A pre-med is not going to know anything about COPD, trust me. I wouldn't be asking about COPD if I was pre-med. Pre-meds ask about biology and organic chemistry.
This thread is SOOO misplaced. Now the thread will be ignored. Congrats.
I thought your goal was to correctly place threads where they should go. How it was before was more correct and appropriate.
Unless, your decision to go down this road was in part motivated by trying to rationalize that other person who was attacking me. I hate rationalization. We humans do it a lot. We are not objective human beings.
You tried to make him appear as justified for attacking me. He was spiraling fast, so you tried to make him seem at least somewhat justified for attacking me. It's called rationalization, Dr.
How did I willfully ignore forum rules? Please don't argue with me. You won't win, trust me.
i wonder why
Oh come on, this is another one of those situations where the people who are unhappy, whine, and thus the forum ends up the way they want it. Why are people going to contact the mods just to say "hey these posts did NOT bother me"? They aren't, usually, and complaining about modding is usually ignored. Lord knows the mods always ignore me when I tell them that the constant over-modding is just as toxic to the forum as letting a few trolls slip by.I'm sorry you feel that way.
The rules about appropriate location for posts have been developed over years of formulating a strong community and seeing what works best.
Users have consistently requested stronger moderation in regards to thread placement. While this may disappoint you, it works best for the community.
Those who wish to assist you with your query, can do so there.
He's making decent points. Many of the forum rules are petty or pointless. Sure, enforce them, but don't act like it's uplifting the community to do so for some of the cases where the rules are actually getting in the way of reasonable discussion.If you're going to wilfully ignore obvious forum rules at least don't act like a petulant child towards the moderators who are just doing doing their jobs.
I read the first one. So according to that, what I take from it is that COPD is not a progressive disease. It is only progressive in the sense that they don't stop smoking, meaning the "VA Hopeful Dr" wasn't joking. It says they will not recover lost function (which intuitively makes sense anyway without the need to particularly mention it since you can't fix scarring and structural damage), but the rate of loss will return to normal (in other words, like a non-smoker's rate of decline). Unless of course, normal rates of decline above the manifestation threshold are observable, unlike with healthy patients where normal rates of decline stays below the threshold and so a "manifestation of the progression is non-observable".
In other words, once I've developed COPD then normal rates of decline are manifestible because I'm already working with such a low function, whereas such normal rates of decline would otherwise not be manifestible. Is this a correct conclusion to take away? If that's the idea, then it makes sense. And the graph is really great in visualizing that.
But one thing still remains, the idea that I had coming in is that there is continuous underlying inflammation taking place even after cessation of smoking. Is that wrong? Did I pick that up incorrectly from somewhere? If not, then how come former smokers return to normal rates of decline in lung function rather than a rate that is somewhere in the middle between normal-rate and smoker-rate, not as good as normal rate but not as bad as continuous smoking either?
No he's not. Plenty of physicians read the premed forum and could have answered here. They shouldn't have to have their subforum, which is for issues relevant to them, cluttered with premeds asking basic pathophysiology questions they aren't even willing to Google themselves.He's making decent points. Many of the forum rules are petty or pointless. Sure, enforce them, but don't act like it's uplifting the community to do so for some of the cases where the rules are actually getting in the way of reasonable discussion.
Oh, please. It's not like I haven't been on here long enough to see how the various forums are used. His post is the kind of talk I'd LIKE to see in the med forums, but instead I just don't post anymore because I don't feel like whining about med school, which seems to be all anyone will approve in them. Preallo may have physicians reading it, but they're so outnumbered it would be pointless.No he's not. Plenty of physicians read the premed forum and could have answered here. They shouldn't have to have their subforum, which is for issues relevant to them, cluttered with premeds asking basic pathophysiology questions they aren't even willing to Google themselves.
His terrible attitude towards a moderator is just the icing on the cake.
Oh, please. It's not like I haven't been on here long enough to see how the various forums are used. His post is the kind of talk I'd LIKE to see in the med forums, but instead I just don't post anymore because I don't feel like whining about med school, which seems to be all anyone will approve in them. Preallo may have physicians reading it, but they're so outnumbered it would be pointless.
And the mods could use some pushback when they get heavy handed. Sorry, but that rarely improves the forum experience.
Sent from my phone, sorry for any typos or brevity.
No, I'm saying most of the forum rules are terrible and the whole set needs to be overhauled. And until they are, some discretion could go a long way in making the forums actually enjoyable. Discretion is used in rules enforcement all the time; it's what allows actual disruptions to be handled without becoming suffocating.So the forum rules shouldn't apply because you find allo boring, and politely enforcing standards is being heavy handed and requires user push back. Got it.