ABSTRACT
Throughout history, in their efforts to understand disease and treat patients effectively, physicians have noted that similar symptoms are likely to be caused by similar precipitating factors. During the 1950s in America and Britain, physicians noted that patients with a history of smoking often presented with symptoms that amounted to ‘‘having difficulty breathing.’’ In the United Kingdom, physicians tended to diagnose the condition as chronic bronchitis, while in the United States the same symptoms would probably have resulted in a diagnosis of emphysema. On both sides of the Atlantic, clinicians would also find their diagnoses complicated by patients presenting with asthma alone or in conjunction with other lung impairments. Compounding the problem of definition and nomenclature, the UK population in general (not just smokers) tended to experience more respiratory symptoms because of environmental factors. Investigators from the Netherlands further complicated the issue with their theory, the so-called Dutch hypothesis, that the patients who had mild asthma and smoked were more prone to develop significant airflow limitation. Thus, clinicians and laypersons alike on each side of the Atlantic tended to view chronic obstructive
MD: MASSARO, JOB: 03313,
MD: MASSARO, JOB: 03313,
pulmonary disease (COPD) differently This undoubtedly slowed the research and understanding of the diseases themselves, as well as their subsequently established connection to precipitating-and preventable-factors such as smoking. This chapter will be written from the perspective of a pulmonologist also trained in pulmonary physiology, and will reflect experience and insights into the development of the terminology and the evolution of our understanding of the disease process over the last three to four decades.
