**10. Other disease**

Bronchiectasis, cystic fibrosis, bronchiolitis and alveolitis extrinsic allergic are disease or syndromes very often manifested with chronic airflow obstruction, as well as occupational exposures. Occupational exposures, in particular, are syndromes that constantly incorporating new disease. An example would be an extrinsic allergic alveolitis called hot tub, which is related to recreational activities whit contact hot water, as in water parks. Mycobacterium avium could have a main role.

Paradoxically, until recently it discussed the evidence that pneumoconiosis of miners could be the cause of pulmonary emphysema in the absence of smoking, which is currently shown. Other occupational exposure disease is obliterative bronchiolitis in microwave popcorn plant workers. It was observed when the additives to provide flavor was replaced. The patients had a very aggressive clinical course.

Another microepidemic is bronchiolitis obliterans associated with sauropus androgynus, it also led to an extremely aggressive bronchiolitis and is not by respiratory exposure. The intention to lose weight was the reason of ingestion of extract of Sauropus androgynus.

Recently, CT scan has shown that patients with anorexia nervosa could be associated with emphysema. This observation was already known in the Nazi death camps. However, there is not evidence that emphysema cause by anorexia nervosa has airflow obstruction.

Patients infected with the human immunodeficiency virus (HIV) may have some respiratory disorders including pulmonary emphysema with airflow obstruction. It is accepted that the combination of smoking and inflammatory reactions caused by HIV accelerates the presentation of emphysema in 10 to 20 years. Recently it has tended to take an important role to *Pneumocystis jiroveci* in the obstruction of patients with HIV, but even this pathogen has been isolated in patients with COPD from smoking.

The eosinophilic granuloma, lymphangioleiomyomatosis (figure 2), histiocytosis X, tuberous sclerosis syndrome, Birt-Hogg-Dubé and deposition disease heavy chains are some orphan

It is considered that the population at risk of inhaling smoke from biomass could reach 3000 million people worldwide, mostly female. Anatopatology, COPD from inhalation of smoke from biomass has been becoming well known, has important similarities with COPD from

Although its natural evolution is not well known yet, COPD from exposure to biomass smoke has some features in common with COPD from smoking. Romieu et al designed a study with methodology of trial in a group of Mexican women was divided into two groups: the control group cooking with the traditional open fire and the treatment group cooking with Patsari stove. After 6 years, confirmed a dramatic difference in the evolution of FEV1: the control group decline 62 ml FEV1 per year, while the intervention group only lost half. Orozco et al demonstrated that COPD in Spain by exposure to biomass smoke should

The impact of this disease is usually not epidemiologically relevant in developed countries, although some cases have been identified in countries as the United States, for example, in New Mexico, USA reported that 26% of subjects had been exposed to smoke from biomass fuel.

Bronchiectasis, cystic fibrosis, bronchiolitis and alveolitis extrinsic allergic are disease or syndromes very often manifested with chronic airflow obstruction, as well as occupational exposures. Occupational exposures, in particular, are syndromes that constantly incorporating new disease. An example would be an extrinsic allergic alveolitis called hot tub, which is related to recreational activities whit contact hot water, as in water parks.

Paradoxically, until recently it discussed the evidence that pneumoconiosis of miners could be the cause of pulmonary emphysema in the absence of smoking, which is currently shown. Other occupational exposure disease is obliterative bronchiolitis in microwave popcorn plant workers. It was observed when the additives to provide flavor was replaced.

Another microepidemic is bronchiolitis obliterans associated with sauropus androgynus, it also led to an extremely aggressive bronchiolitis and is not by respiratory exposure. The intention to lose weight was the reason of ingestion of extract of Sauropus androgynus.

Recently, CT scan has shown that patients with anorexia nervosa could be associated with emphysema. This observation was already known in the Nazi death camps. However, there is

Patients infected with the human immunodeficiency virus (HIV) may have some respiratory disorders including pulmonary emphysema with airflow obstruction. It is accepted that the combination of smoking and inflammatory reactions caused by HIV accelerates the presentation of emphysema in 10 to 20 years. Recently it has tended to take an important role to *Pneumocystis jiroveci* in the obstruction of patients with HIV, but even this pathogen

The eosinophilic granuloma, lymphangioleiomyomatosis (figure 2), histiocytosis X, tuberous sclerosis syndrome, Birt-Hogg-Dubé and deposition disease heavy chains are some orphan

not evidence that emphysema cause by anorexia nervosa has airflow obstruction.

**9. COPD from exposure to biomass smoke** 

be considered especially in older women from rural areas.

Mycobacterium avium could have a main role.

The patients had a very aggressive clinical course.

has been isolated in patients with COPD from smoking.

smoking, but also significant differences.

**10. Other disease** 


Fig. 2. A 36-year old woman was seen in pneumology clinic because of dyspnea. She had a 5-pack-year history of smoking but had stopped smoking 4 year earlier CT: thin-walled cystic. Pulmonary function testing reveals an obstructive pattern. Lung biopsy: Lymphangioleiomyomatosis.

COPD: Differential Diagnosis 113

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)

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

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 inactivation of alpha-1-antitrypsin.

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 additionally present with airflow obstruction.

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 involvement of the bronchial mucosa.

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

Likewise, tracheal tumors, the Wegener, vocal cord paralysis and vocal cord dysfunction also cause of airflow obstruction.
