The history of COPD

Thomas L Petty, Thomas L Petty

Abstract

The evolution of knowledge concerning COPD and its components--emphysema, chronic bronchitis, and asthmatic bronchitis--covers 200 years. The stethoscope and spirometer became important early tools in diagnosis and assessment. Spirometry remains the most effective means of identification and assessment of the course of COPD and responses to therapy, and is grossly underused for this purpose. Knowledge of the pathogenesis, course and prognosis, and new approaches to therapy have dramatically improved our understanding of this important clinical entity. Smoking cessation improves the early course of disease. Long-term oxygen improves the length and quality of life in selected patients with hypoxemia. Surgery benefits a select few. Today, COPD is a steadily growing global healthcare problem, with increasing morbidity and mortality. Early identification and prevention, and treatment of emerging stages of disease through smoking cessation and a growing number of bronchoactive drugs promises to change the outcome.

Figures

Figure 1
Figure 1
Small respiratory bronchiole with surrounding alveolar attachments. These alveolar attachments serve to tether small airways. Source: Petty T. 2002. COPD in perspective. Chest, 121 Suppl:116S–120S. Reproduced with permission from The American College of Chest Physicians.
Figure 2
Figure 2
A drawing describing the mechanisms of airflow obstruction due to the losss of elastic recoil and airway narrowing. Source: Petty T. 2002. COPD in perspective. Chest, 121 Suppl:116S–120S. Reproduced with permission from The American College of Chest Physicians.
Figure 3
Figure 3
The natural history of COPD. Source: Petty T. 2002. COPD in perspective. Chest, 121 Suppl:116S–120S. Reproduced with permission from The American College of Chest Physicians.
Figure 4
Figure 4
Mean post-bronchodilator forced expiratory volume at 1 second (FEV1) for participants in the smoking intervention and placebo group who were sustained quitters (○) and continuing smokers (●). The two curves diverge sharply after baseline. Source: Anthonisen NR, Connett JE, Kiley JP. 1994. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA, 272:1497–505. Copyright © 2004. American Medical Association. All rights reserved. Reproduced with permission from AMA.

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