**12. Comorbidity and differential diagnosis**

Comorbidity in COPD is controversial. In fact, it has been so exaggerated to name as chronic inflammatory syndrome, including in the same process other systemic manifestations. It is much more common that the vascular comorbidity in patients with COPD due to chronic exposure to tobacco that systemic inflammation secondary to COPD. Table 3 lists the mechanisms of comorbidity and Table 4 summarizes the comorbidities of COPD.

Introduce comorbidity in the differential diagnosis have done difficult in many cases the appropriate affiliation to the patient. In a smoker of 65 years with a cumulative consumption of 40 pack / year comes to a vascular surgeon for a pulsatile abdominal mass is likely to

diseases, most of them genetic disease, they can cause airflow obstruction and pulmonary

In half the cases, a rare disease such as vasculitis with urticaria and hypocomplementemia syndrome could present with severe emphysema. Its mechanism is could be local

Systemic diseases such as rheumatoid arthritis, lupus erythematosus, diffuse scleroderma, polymyositis and mixed connective tissue disease can cause bronchiolitis at some point in its evolution. Söjgren syndrome can provide images similar in CT of emphysema and

Although, Sarcoidosis in advanced stages is present as pulmonary fibrosis, in the initial and/or mild stages is present as mild obstruction because hyperresponsiveness or

The connective tissue diseases such as Marfan syndrome and Ehlers-Danlos syndrome, among others, may present with lesions of emphysema, usually paraseptal. Simultaneously, may present with tracheobronchomegaly and hipercolapsabilidad tracheobronchial. CT and test of forced expiration have increased the diagnosis of bronchial hipercolapsabilidad. It

Likewise, tracheal tumors, the Wegener, vocal cord paralysis and vocal cord dysfunction

Parentage of a patient with obstruction initially suffered from asthma and who

The combination of smoking and disease interstitial chronic or pulmonary fibrosis has been highlighted in several recent publications. A recent epidemiological study in area cardiology, MESA study, performing CT lung, indicates that this match will be anecdotal in

Respiratory bronchiolitis with interstitial respiratory disease (RB / ILD) is another example of interstitial and bronchial disease secondary to smoking. Some patients who do not meet the criteria for COPD are patients with severe by accelerating their natural evolution.

Comorbidity in COPD is controversial. In fact, it has been so exaggerated to name as chronic inflammatory syndrome, including in the same process other systemic manifestations. It is much more common that the vascular comorbidity in patients with COPD due to chronic exposure to tobacco that systemic inflammation secondary to COPD. Table 3 lists the

Introduce comorbidity in the differential diagnosis have done difficult in many cases the appropriate affiliation to the patient. In a smoker of 65 years with a cumulative consumption of 40 pack / year comes to a vascular surgeon for a pulsatile abdominal mass is likely to

mechanisms of comorbidity and Table 4 summarizes the comorbidities of COPD.

probably is one of the main causes of airway obstruction in healthy people.

subsequently becomes a smoker can be a clinical problem almost insoluble.

emphysema.

inactivation of alpha-1-antitrypsin.

additionally present with airflow obstruction.

involvement of the bronchial mucosa.

also cause of airflow obstruction.

**12. Comorbidity and differential diagnosis** 

**11. Special situations** 

the future.

(Figure 3)

Fig. 3. High resolution computerized tomography (HRCT) of the same patient. A) Presence of paraseptal emphysema and subpleural bullae (white arrowheads) and centrilobular emphysema (arrows) in both upper lobes. B) Reticular interstitial disease with intralobular thickening and images of subpleural honeycombing and traction bronchiectasis (black arrowheads) C) Reticular interstitial disease in middle and right lower lobes, with interlobular septal thickening, subpleural honeycombing and traction bronchiectasis. D) Coronal reconstruction in the posterior regions of both lungs: Bilateral paraseptal emphysema (white arrowheads) and reticular interstitial disease and honeycombing in right lower lobe. (Used with permission MD Portillo)

COPD: Differential Diagnosis 115

unless they had simultaneous deficiency of alpha-1-antitrypsin disease. In obvious cases of airway obstruction in people younger than 40 years, it is unusual that this was secondary to smoking. If the annual decline of FEV1 was greater than 75 ml, an additional cause should be suspected. A familial aggregation might suggest cystic fibrosis in adults. The coexistence of joint, skin or ophthalmic symptoms, mucosal dryness and thyroid disease should alert us about other causes of COPD. Bronchiectasis, mostly in women, with *Micobacterium avium complex* is associated with low body mass index. Finally, laboral and hobbies history should be complete in the first interview in pneumologic specialty. Table 5 shows signs and

[1] Pauwels RA, Buist AS, Calverley PMA, Jenkins CR, Hurd SS, et al. Global strategy for

[3] Snider GL. Nosology for our day. Its application to chronic obstructive pulmonary

[4] Coultas DB, Samet JM. Cigarette smoking. In: Hensley MJ, Saunders NA (eds) Clinical

[6] Fabbri LM, Hurd SS, For the GOLD Scientific Committee. Global strategy for the diagnosis, management and prevention of COPD update. Eur. Respir. J. 2003; 22: 1–2. [7] Celli BR, MacNee W, and committee members. Standards for the diagnosis and

[8] Mastora I, Rémy-Jardin M, Sobaszek A, Boulenquez C, Remy J, et al. Thin-section CT

[9] Lundbäck B, Lindberg A, Lindström M, Ronmark E, Jonsson AC, et al. Not 15 but 50% of

[10] Hardie JA, Buist AS, Vollmer WM, Ellingsen I, Bakke PS, et al. Risk of over-diagnosis of COPD in asymptomatic elderly never-smokers. Eur. Respir. J. 2003; 20: 1117–22.

[2] Scadding JG. Principles of definition in medicine. Lancet 1959; 1: 323–5.

disease. Am. J. Respir. Crit. Care Med. 2003; 167: 678–83.

the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am. J. Respir. Crit. Care Med. 2001; 163: 1256–76.

Epidemiology of Chronic Obstructive Pulmonary Disease. Ch 7, Vol. 43. Lung Biology in Health and Disease. Marcel Dekker, Inc., New York, 1989; 109–37. [5] Hill AB. The environment and disease: association or causation? Proc. R. Soc. Med. 1965;

treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur.

finding in 250 volunteers: assessment of the relationship of CT findings with smoking history and pulmonary function test results. Radiology 2001; 218: 695–702.

smokers develop COPD. Report from the obstructive lung disease in Northern

symptoms to help to exclude COPD.

History of smoking <10 pack-year

Decline of FEV1 >75 mL per year Autoimmune or collagenous disease

Progression of the obstruction years after smoking cessation

Table 5. Signs and symptoms to help to exclude COPD

Onset before 40 years old

Ambiental exposure Systemic symptoms

**14. References** 

58: 295–300.

Respir. J. 2004; 23: 932–46.

Sweden studies. Respir. Med. 2003; 97: 115–22.


Table 3. Mechanisms underlying the comorbidity of COPD


Table 4. Comorbidity of COPD

delay the practice of spirometry. Recently, Remy-Jardin et al have made an interesting proposal to TC (dual-energy) for the simultaneous evaluation of pulmonary and vascular damage smoking.
