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April 29, 1968

The Many Faces of Emphysema

Author Affiliations

Washington, DC

JAMA. 1968;204(5):406. doi:10.1001/jama.1968.03140180056027

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To the Editor:—  The question is pertinent and reflects our inability to relate morphologic and physiologic alterations to specific disease categories based on certain clinical presentations in the absence of a well-defined etiology. The clinical expressions of chronic bronchitis and emphysema may overlap and indeed both conditions frequently coexist. Furthermore, other diseases may have similar clinical features requiring their exclusion, thereby further compounding the nosologic dilemma.Chronic bronchitis and emphysema are characterized by airway obstruction and cannot be differentiated by tests measuring ventilatory function. Chronic bronchitis is usually defined on the basis of clinical features of chronic, recurrent cough with excessive mucus production. Pulmonary emphysema is best defined by certain anatomical alterations in the distal air spaces rather than on clinical, radiological, or physiological abnormalities. Immediately, the limitations of these definitions becomes apparent—the nonspecificity of the clinical findings in chronic bronchitis and the clinical uselessness of a definition dependent on