Talk:Diffuse panbronchiolitis

Dx before Rx?

I think there's enough in both the signs & symptoms section and the diagnosis subsection that each could stand on their own. You might consider putting Diagnosis before Treatment per WP:MEDMOS. But I'll leave it to you to decide what flows better (and whether you need any of the info in the Dx section for understanding of pathophysiology). delldot ∇. 22:22, 2 October 2009 (UTC)

COPD

I've been doing a terminology paper on COPD, and I must conclude that characterizing DPB as "a type of chronic obstructive pulmonary disease", or even talking about "a type of" COPD seems to grossly misrepresent current understanding of COPD (while mildly excusable given this is about DPB, it is still unacceptable on a global level). The only papers actually referring to DPB as a COPD date back some 10 years, and their basis is the following (from Homma et al. 1983, PMID 6848335, 1st ref in the article):

"A report of the ACCP-ATS Joint Committee on Pulmonary Nomenclature in 1975 recommended that a more specific term, such as chronic obstructive bronchitis or chronic obstructive emphysema, be used whenever possible, and a term such as COPD, which represents a group of diseases, should be used less."

This is NOT current terminology and I challenge anybody to find a recent work that treats COPD as a spectrum. At best there are discussions whether to include asthma in COPD, but bronchiolitis and its variants (i.e. bronchiolitis obliterans) are quite systematically discussed as a completely separate disease, quite understandably, since COPD has not been treated as a group of disease (besides, obviously, emphysema and bronchitis) since the mid-90s! Note that, for example, the abstract in ref 8 seems to explicitly discuss DPB and COPD as separate disease. Circéus (talk) 02:41, 19 November 2009 (UTC)

Yeah, this is a serious concern, and a bad oversight on my part. Thanks for catching it, Circeus. I'm leaving a note for User:Rcej, hopefully s/he can address it quickly. I'm also happy to help, and of course others are welcome to make whatever corrections are necessary. Is there a time frame you're expecting to have this fixed by before bringing to GAR or straight delisting? delldot ∇. 04:39, 19 November 2009 (UTC)

I've been a slow and shamefully lazy editor, so most likely they'll have plenty time before I get off my ass to do anything about it XD Circéus (talk) 07:22, 19 November 2009 (UTC)

Hmm. This can likely be resolved by a ce. In the article, though, I did not assert beyond PMID 9731015, 1998; nor PMID 9927368, 1999; both of which refer to DPB as a COPD. But, let me do a band-aid ce for the time being. heh.-- Robert/Rcej (talk) 09:02, 19 November 2009 (UTC)

Great, thanks for working on this Rcej. This article seems to call it a "chronic inflammatory airway disease": PMID 19118228. This one calls it an "inflammatory lung disorder": PMID 18990961. delldot ∇. 16:38, 19 November 2009 (UTC)

Erythromycin

I believe that the use of erythromycin as an anti-inflammatory macrolide is a little outdated. The frequency of treatment with erythromycin (four times a day) and its side-effect profile (mainly gastro-intestinal) have caused it to be replaced by azithromycin & clarithromycin. Axl ¤ [Talk] 20:08, 20 October 2011 (UTC)

I attempted to remedy this [1], only to have damnatio memoriae pronounced on my efforts, labelled as a "minor edit" with the summary "ce". I asked User:Rcej about this and was then told "Not a mistake; I felt those edits were counterproductive, and the src you used had a broken doi and didn't appear to be secondary." Actually the source had primary data (the small study I mentioned of azithromycin, since you'd mentioned it) but I was also using it for secondary information; in any case there should be no problem, as I was citing authors' major conclusions, not reinterpreting snippets of primary data. But if you want to fix it, do it yourself - I'm done with this article. I'm going to go work on something copyrighted instead. If you can't defeat the evil empire or its agents, might as well ask for your boots of spanish leather. Wnt (talk) 15:19, 16 January 2012 (UTC)

Rcej, you reverted wholesale a significantly large good-faith edit along with a procedural bot edit, using the summary "ce" and you tagged the edit as "minor". That is particularly poor form. Your reversion was neither a copyedit nor minor. If you truly believe that the information added was inappropriate, the best course of action would have been to move the contentious text to the talk page and invite the editor (Wnt) to discuss the matter.

The solution to a broken doi is not to delete all the text as well as the reference. The appropriate action would have been to either fix the doi or replace it with another unique code such as pmid.

While those actions could be interpreted as mistakes on your part, I am dismayed to see your reaction to Wnt's enquiry. You were rude, dismissive and did not acknowledge any wrong-doing on your part. Axl ¤ [Talk] 17:42, 16 January 2012 (UTC)

I can neither excuse nor explain my behavior; I have apologized and restored Wnt's edits. Rcej (Robert) – talk 07:05, 17 January 2012 (UTC)

Thank you, Rcej. I have edited the new text a little. The reference (Li, "Effect of Azithromycin on Patients with Diffuse Panbronchiolitis: Retrospective Study of 51 Cases") is a primary source, although the information added isn't from the "primary part" of the source. In my opinion, this information is likely to be available in a purely secondary source. It would be preferable to use a secondary source if possible. Axl ¤ [Talk] 13:37, 17 January 2012 (UTC)

In the absence of any further comment, I have edited the text, adding a new reference. Axl ¤ [Talk] 21:06, 8 February 2012 (UTC)

Proposed draft of revised lead

Here is a draft that tries to make the essential information a bit more accessible. Experience has taught me that it is a bad idea to make such large changes directly, so I place it here for consideration.

Diffuse panbronchiolitis (DPB) is a rare but life-threatening lung disease that occurs primarily in people from East Asia, especially Japan and Korea. It is a severe form of bronchiolitis, which is an inflammation of the bronchioles, small tubes that carry air into the lungs. The most common symptoms are wheezing, shortness of breath, enlargement of the bronchiolar passages, and a severe cough with large amounts of sputum. The disease is difficult to cure, but daily treatment with antibiotics such as erythromycin has been shown to ease symptoms and increase survival time to 10 years or more. If left untreated, the disease progresses to bronchiectasis, an irreversible lung condition that can lead to respiratory failure and death.

• Respectfully, the above reads more like a high school essay than what an adult would expect to read in a good encyclopedia. Are not relative proficiency of prose and its associated confidence collateral elements of a featured article? :) Rcej (Robert) – talk 07:57, 2 November 2011 (UTC)

Which basically means that it is more important to impress readers than to inform them. Not an unusual reaction, unfortunately. Oh well. Looie496 (talk) 15:49, 2 November 2011 (UTC)

That's not what I mean at all!! I just don't like the idea of writing down to our readers in what, in my opinion, reads like less than an encyclopedic style of writing. Patronage and 'dumming down' is not how we inform the Wikipedia audience. I apologize how I came across, though :) Rcej (Robert) – talk 05:38, 3 November 2011 (UTC)

The term "diffuse" refers to lesions that appear throughout both lungs, while "panbronchiolitis" refers to inflammation found in all layers of the respiratory bronchioles; these describe the common pathology for the disease. DPB causes severe inflammation of the respiratory bronchioles (the section of the bronchioles involved in gas exchange), and nodule-like lesions in respiratory and terminal bronchioles.

Susceptibility to DPB results from alterations to genes that play important roles in the immune system. Specifically, impairment of the human leukocyte antigen (HLA) system results in a reduction of immune resistance to bacteria that are carried into the bronchioles by the airstream. The HLA system contains a large number of genes, and there is not yet clear evidence for which ones are responsible, but several candidates have been identified. The implicated HLA variants occur most commonly among Japanese, followed by Koreans, followed by other East Asian populations. The disease occurs slightly more often in males, and is not age-related. It was first recognized to be a distinct disease in the early 1960s, and was formally named "diffuse panbronchiolitis" in 1969.

Looie496 (talk) 16:12, 1 November 2011 (UTC)

Looks good to me. I suggest some links: lung disease, sputum, antibiotic (maybe too common?), shortness of breath, wheezing, respiratory failure, inflammation, pathology, gas exchange, immune system. Sasata (talk) 17:05, 1 November 2011 (UTC)

Perhaps put "small tubes that carry air into the lungs" in parentheses? Axl ¤ [Talk] 18:09, 1 November 2011 (UTC)

"Tubes" sounds like a medical device – I suggest "small airway passages in the lungs". Graham Colm (talk) 18:29, 1 November 2011 (UTC)

Chronic sinusitis is actually the most common feature. Axl ¤ [Talk] 18:11, 1 November 2011 (UTC)

"Impairment of the human leukocyte antigen (HLA) system results in a reduction of immune resistance to bacteria that are carried into the bronchioles by the airstream." Is that really true? Is HLA B54 an "impairment of the HLA system"? Axl ¤ [Talk] 18:24, 1 November 2011 (UTC)

It's only a draft and there's no doubt that it would need quite a bit of editing. The question at this point is whether it goes enough in the right direction to be worth placing in the article so it can be edited there, or whether it is better to continue to work with the existing lead. I don't think it would be proper to do anything major before Rcej has a chance to weigh in. Looie496 (talk) 18:29, 1 November 2011 (UTC)

DPB is not a purely genetic disease. HLA B54 certainly is a strong risk factor, but it is not the only one. Environmental factors also contribute. Axl ¤ [Talk] 18:35, 1 November 2011 (UTC)

Okay, I'll wait for Rcej to comment. Axl ¤ [Talk] 18:35, 1 November 2011 (UTC)

I have simplified the lead, specifically by condensing all mention of HLA and its haplotypes into the word "genes". But I'd prefer to leave the rest as is; the average adult can read and grasp an encyclopedic entry, and I stand by my prose in that regard. ;) But do allow me to edit the lead if required further. Thx! Rcej (Robert) – talk 07:41, 2 November 2011 (UTC)

As usual, I took it upon myself to just go crazy tweaking this article in my own idiosyncratic way. If you don't like it, please feel free to roll me back. I have some concerns about repetitiveness and organization that I did not act upon, but congrats and thanks to the major contributors for all your hard work. Nice job!

Best regards: Cliff (a/k/a "Uploadvirus") (talk) 23:16, 3 December 2011 (UTC)

Thank you :) My best to you too! Rcej (Robert) – talk 04:41, 4 December 2011 (UTC)

Image in the lead

We should have an image in the lead and half of the CT one works well. Also the diagram of the respiratory system pertains to pathophysiology. Not sure why it is in the lead.Doc James (talk · contribs · email) 09:23, 29 December 2011 (UTC)

• We reached consensus for the CT img and it was uploaded specifically for the Diagnosis section per the FA review. Rcej (Robert) – talk 10:21, 29 December 2011 (UTC)

We however should have an image in the lead. And half of that CT IMO is the best image at this point. If you mean that someone allowed Wikipedia to only use the CT img in the diagnosis section this can not be done. Anyway I do not see a good reason not to have it in both places.

Also the diagram under the disease box is a little strange. Not sure why it is so significant to belong in the lead. None of the other FAs I have worked on give an image of a body system in the lead.Doc James (talk · contribs · email) 10:26, 29 December 2011 (UTC)

Rcej, per your suggestion and my agreement, I was expecting you to remove that picture. Axl ¤ [Talk] 19:42, 29 December 2011 (UTC)

Rcej, thank you for removing the offending picture. Regarding Doc James' suggestion for an alternative image, I agree that the left half (section a) of the CT would be appropriate. The full CT (i.e. both sides) can remain in the "Diagnosis" section. Axl ¤ [Talk] 11:24, 30 December 2011 (UTC)

•  Done Rcej (Robert) – talk 02:41, 3 January 2012 (UTC)

Thanks and well done with this article... Doc James (talk · contribs · email) 02:52, 3 January 2012 (UTC)

Transplant anecdote text removed

I am reverting this edit. The source and basis of the information do not meet WP:MEDRS. Axl ¤ [Talk] 12:24, 23 November 2013 (UTC)