CHRONIC OBSTRUCTIVE LUNG DISEASE .I. CLINICAL AND PHYSIOLOGIC FINDINGS IN 175 PATIENTS AND THEIR RELATIONSHIP TO AGE AND SEX

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Abstract
Clinical and physiologic findings in 175 patients with chronic airways obstruction of uncertain etiology (patients often designated as having "emphysema" or "chronic bronchitis") have been reviewed. These patients presented a wide range of clinical, physiologic, and roentgenologic characteristics, supporting the contention that there may be more than 1 pathogenic mechanism in their disease. Severe blood gas abnormalities and polycythemia were relatively infrequent in these ambulant patients, who were studied during a stable phase of their disease. Evidence of peptic ulceration was noted in 23% of the gastrointestinal roentgenograms made on 69 of the patients. Dupuytren''s changes in the palmar tendons were encountered in a 1/3 of the patients, and frank contractures were present in 10%. The male to female ratio was 9 to 1. Women revealed a high frequency of a family history of chronic bronchopulmonary disease and, in general, tended to have less of a "bronchitic" or "inflammatory" component to their disease than did the men. Younger patients in the study revealed a higher frequency of frank purulent bronchitis than did the older subjects, and the younger group more often showed severe blood gas abnormalities and cor pulmonale. It appears that older subjects more frequently have an "emphysematous type" of syndrome (type A) whereas younger subjects are likely to reveal a more "bronchitic type" of chronic obstructive lung disease (type B). There were only a few patients in the study in whom the entire clinical picture suggested that allergic bronchial asthma might be important in the pathogenesis of their disease.