A Brief History of COPD: As Told by Some of Its Senior Scientists and Clinicians

Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is highly prevalent worldwide and is the third leading cause of death. While some aspects of the disease were known since the Enlightenment, Laennec's work in the 19th century began the process of our current understanding of this disease. In this narrative review, 13 clinicians and scientists with over three centuries of cumulative experience treating and studying COPD give their perspectives on the science underpinning our modern concept of this disease and its management. These include (1) the challenges of coming up with a name for what is a complex syndrome; (2) the evolution of our thinking on the natural history of the disease; (3) the importance of particulate matter inhalation in its pathogenesis; (4) the often-overlooked but important-and often treatable-systemic effects of the disease that contribute to its morbidity and mortality; (5) the changes in our perspective of not just addressing pathologic or physiologic abnormalities but also measuring outcomes, such as breathlessness or health-related quality of life, that are of considerable importance to the patient; (6) the role of pharmacologic therapy in not only providing symptomatic relief by increasing airway caliber but also in disease modification, especially by reducing exacerbation frequency; (7) lung hyperinflation as an essential feature of COPD pathophysiology, driving symptom burden, exercise limitation, and mortality risk; (8) long-term oxygen therapy, despite being demonstrated to prolong survival in a defined set of hypoxemic patients with COPD, still having unanswered questions regarding its application and delivery; and (9) pulmonary rehabilitation, a major component of the non-pharmacologic treatment of COPD patients and prominently situated in clinical guidelines for this disease. While this, by necessity, must be a brief review of a very complex disease, the perspectives of these esteemed clinicians and scientists should be of use to other clinicians in understanding and managing this disease.