[General concepts and the history of chronic obstructive pulmonary disease]

There is no general agreement on the concepts of chronic obstructive pulmonary disease (COPD) yet in Japan, although there have been significant advances in the understanding of its concepts in the United States and Europe. The purpose of this presentation as the opening remark to this panel discussion is to review the concepts and history of chronic obstructive pulmonary disease (Tables 1, 2), and also to summarize the general concepts concerning COPD in Japan at present. More than 30 years ago, a Ciba Guest symposium first proposed the main subdivisions of chronic non-specific lung disease (CNSLD), consisting of chronic bronchitis and generalized obstructive lung disease (GOLD). Many papers addressed this theme focusing on the definition and concepts of COPD for a long period after the Ciba Guest Symposium. The ATS and ACCP joint committee on pulmonary nomenclature (1975) reported that the term of COPD refers to diseases of uncertain etiology characterized by persistent slowing of airflow during forced expiration, and the committee recommended that chronic obstructive bronchitis or chronic obstructive emphysema be used, whenever possible. However, in many patients it is still difficult determine what extent the airway obstruction result from emphysema and to what extent it results from an accompanying chronic obstructive bronchitis, as Burrows described. Fishman (1980) and Burrows (1981) suggested that if the patient is thought to have a combination of chronic obstructive bronchitis and pulmonary emphysema, the case should be so diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)