• The History of COPD
  • By Dr. Tom Petty

    COPD is finally finding its rightful place amongst the diseases that must be solved in our society. Now fourth amongst the killers in the USA, COPD will be the third most common cause of mortality in the world in just a few years. Much credit for this can be given to the tobacco industry that continues, unrelentlessly, to promote addiction, suffering and death around the world, for profit.

    I am just finishing writing the fascinating history of COPD for a new journal, The International Journal of COPD. In this review, I cite the four centuries of evolving knowledge about COPD that has occurred. Two landmark inventions, the stethoscope by Laennec in France in 1819 and the spirometer by Hutchinson, the Englishman, in 1846 offered new opportunities to begin to discover the basic nature of COPD. Laennec, both a clinician and a pathologist, recognized that COPD was different from asthma, and quite different from tuberculosis. The latter was the most common cause of death in the World, and in the USA, at the turn of the 19th century. TB still ranks as a top killer, worldwide. Laennec was one of the first to recognize that emphysema, which is part of COPD, is a condition where the lungs have lost their elasticity and thus they empty poorly and trap air within the chest. He also realized that there was an accompanying abnormality of the small air passages, that serve the alveoli of the lungs. "Perhaps both processes conspire to create the abnormality," he wrote. What wisdom, from an early clinician and scientist.

    Chronic Bronchitis was known as the "catarrh," a word that can be easily found in old textbooks of medicine and health manuals for the public. Numerous remedies and nostrums were widely promoted to quell the troublesome cough and mucus that plagued patients of antiquity as well as today. Grandmothers would use chicken soup for colds that "settled in the chest." How wise these women were. Scientific studies have shown that chicken soup helps the body's immune system to deal with infections! How fitting a tribute to women on Mother's Day!

    Emphysema and chronic bronchitis were not well defined in clinical or scientific terms until the 1960s. Indeed the term COPD, itself, was not used until it was first suggested at an Aspen Emphysema Conference in 1966. Now COPD has become a household word yet not well understood by the public, and alas, many physicians. But things are improving rapidly. New science has defined the basic abnormalities that cause emphysema and chronic airway irritation and inflammation, the chronic bronchitis that is part of the problem. Most patients with COPD have both. Many also have increased irritability of the air passages, that creates bronchial spasm and increased mucus and cough. These scientific discoveries are creating new strategies for treatment.

    COPD is now recognized as a total body or systemic disease. An effect on the heart, muscles of the body, bony skeleton, and even mental processes is part of the COPD process. COPD has an underlying inflammatory condition that affects almost every organ of the body. Patients with COPD often have a genetic component that underlies the processes. One heritable abnormality is the alpha-one deficiency. But COPD still clusters in families beyond the alpha-one problem. I believe that COPD should be considered a heritable disorder, that is precipitated by the environment (personal and general), that worsens with age. Although COPD is irritated if not caused by smoking in 85% of sufferers, 15% have never smoked. Thus we must look further for the genetic causes. Perhaps gene therapy will solve the problem in the future.

    For now, we must promote early identification and intervention. The National Lung Health Education Program, launched in 1997 promotes the widespread use of spirometry to find COPD in early and non-symptomatic stages. Here is where smoking cessation, vaccination against influenza and one common cause of pneumonia will do the most good. A consensus recommendation of the NLHEP is to do spirometery in all current or former smokers age 45 or older and in anyone with chronic cough, dyspnea on exertion, excess mucus or wheeze. It is well known that we have 16 million Americans who have COPD now and many are not receiving any treatment at all! But worse than this is that another 16 million have it and do not even know it. Now is the time to change all of this by promoting simple office spirometry as recommended by the NLHEP and a new global initiative known as the GOLD.

    We do have good things to offer patients with all stages of COPD. Smoking cessation is important, indeed critical in all patients, if at all possible. But we must all remember that some patients with COPD simply cannot stop because of the depression and anxiety that nicotine helps control. Switching to nicotine replacement products helps some, but not all, desperately addicted smokers. We must be compassionate and not punitive to those who are hopelessly addicted.

    We have a growing number of good bronchodilators, anti-inflammatory drugs, antibiotics and other agents to prescribe to all symptomatic patients today. Long term home oxygen, particularly with light weight systems to allow the patient to wear the oxygen and be active outside of the home, improves both the length and quality of life. Pulmonary rehabilitation is of established value to those who participate in a comprehensive program for COPD. Lung volume surgery helps a select few, as does lung transplantation. But surgery is not the answer in the long term.

    We at PERF have just completed a detailed booklet, written for patients that we are proud to offer not only the readers of Second Wind, but also EVERYONE. You may read and download it from our web site, www.perf2ndwind.com. We hope this will help increase COPD awareness.

    Fraternally,

    Dr Tom Petty

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