Brief COPD History

Did you know that for most of history, nearly every lung disease, including COPD, was lumped under the umbrella term asthma? It’s true. In fact, it’s only been over the past 100 years that COPD has been plucked from under this asthma umbrella to become a disease entity of its own with its own remedies. That said, here is a brief history of COPD.

2697 B.C.: Nei Ching Su Wen (Classics on Internal Medicine) is the oldest known medical document. In it, Huang Ti, The Yellow Emperor, is involved in dialogue with Ch'i Pai, his physician. The Emperor makes many references to asthma or COPD-like symptoms such as noisy breathing and troubled breathing.

1500 B.C. Asthma and COPD-like symptoms were also described by the ancient Egyptians. The Ebers Papyrus is a medical document that describes over 700 remedies for asthma, including placing herbs on heated rocks and inhaling the smoke.

800 B.C. Homer is the first to use the term asthma to define difficulty breathing after exertion in battle, or from wounds caused by battle.

400 B.C.: Hippocrates defines asthma for the medical community as difficulty breathing.

1679 A.D.: For the first time in history, physicians were allowed to perform autopsies to search for the true causes of diseases. A Swiss physician named Theophile Bonet performed over 3,000 autopsies on patients of his who died and became the first to describe emphysema as a medical condition. He defined it as “voluminous lungs.”

1769: Giovanni Morgagni described 19 cases of “turgis” lungs, and verified the findings of Dr. Bonet.

1784: Dr. Samuel Johnson was a long-time sufferer of “asthma.” However, Dr. James Arthur Wilson, who was only 19-years-old, performed an autopsy on Dr. Johnson. Based on his description of Dr. Johnson’s lungs, later physicians determined that Johnson didn’t die of asthma, he died of emphysema.

1799: Matthew Baillie, who also studied the body of Dr. Johnson, was the first to describe emphysema (“enlarged air spaces”) and publish his description in a book with pictures.

1814. Charles Badham became the first physician to use the term bronchitis when referring to inflammation of the mucous membrane. He referred to a chronic cough and increased mucus secretion as being caused by chronic catarrh. He also described chronic bronchitis as a disabling condition.

1819: Rene Laennec, the inventor of the stethoscope, became the first physician to accurately describe emphysema and chronic bronchitis as related conditions.

1837: Dr. William Stokes became the first to use the term chronic bronchitis.

1846: English Surgeon John Hutchinson invented the spirometer. It was a device used to measure slow vital capacity (SVC) or the amount of air that can be exhaled after a deep inhalation. Later on, forced vital capacity (FVC) was described, or a forced exhalation after a deep inhalation. How fast can you get the air out after a deep inhalation?

1885: Mendelssohn observed an increased incidence of “grinder’s asthma,” or what was often diagnosed as tuberculous among metal grinders. Before him it was believed inhaling coal dust was harmless, but he believed it was the cause of asthma. He was the first to observe a link between inhaled irritants like coal dust and smoke with lung disease. (1)

1947: The ability to measure FEV1 was developed. This is the amount of air exhaled in the first second of FVC. Tiffeneau-Pinelli described inspiratory vital capacity (IVC) and created the formula FEV1/IVC This gave physicians the ability to differentiate between obstructive lung diseases (like asthma and chronic bronchitis) and restrictive diseases like emphysema and kyphosis. The formula used today is FEV1/FVC. Due to airway obstruction, FEV1 is reduced in people with COPD, resulting in a reduced FEV1/FVC. A normal FEV1 value is 80% of predicted. So, a diagnosis of COPD was determined to be a FEV1 less than 80% of predicted, along with a FEV1/FVC less than 70%. This is a good indicator of airflow obstruction and airflow limitation. In a restrictive lung disease, FEV1 and FVC will each equally be diminished to do lots of space for lungs to expand, and so FEV1/FVC may be close to normal or even slightly elevated.

1958. American and British physicians defined the same disease differently up to this time. It was referred to as a chronic obstructive bronchopulmonary disease, chronic airflow obstruction, chronic obstructive lung disease, nonspecific chronic pulmonary disease, and diffuse obstructive pulmonary syndrome. This was confusing as it seemed as though each researcher, or each physician, was referring to something different. In order to unify efforts to learn about this disease, it was decided that a unified name must be created. The CIBA Guest Symposium, a gathering of various medical professionals, convened from Sept. 24-26. They were the first agree to use the term Chronic Obstructive Pulmonary Disease (COPD) in referring to the comorbidity of chronic bronchitis and emphysema. The results of the symposium were published in 1959.

The 1950s: Antibiotics were increasingly used to treat lung infections (pneumonia) caused by increased secretions in airways. Potassium Chloride was used as a mucus thinner and theophylline as a bronchodilator. Epinephrine was used either as an injection or nebulized inhalant in emergency rooms. Epinephrine nebulizer solution was available for home use, and, after 1957, epinephrine inhalers were available. While systemic corticosteroids were available, they were rarely used to treat COPD. Isoprenaline nebulizer solution was also available, although used less regularly than epinephrine due to cost. An isoprenaline inhaler was also available after 1957.

The 1960s: Isoprenaline was increasingly used, and corticosteroid and oxygen use continued to be rarely used to treat COPD.

1960: Fry and Hyatt devised the flow volume loop, which displays the FVC as a graphic. This allowed physicians to physically see the difference between obstructive and restrictive disease. This made it easier to use spirometry as a means of differentiating between restrictive and obstructive diseases.

1962. Now researchers and physicians needed a unified definition of chronic bronchitis and emphysema. The American Thoracic Society Committee on Diagnostic Standards (Committee Diagnostic Standards for NonTuberculosos Respiratory Disease) defined chronic bronchitis as a cough lasting three months for at least three years, and emphysema as enlarged air spaces and loss of alveolar walls. Asthma was defined as airway hyperresponsiveness to a variety of stimuli. Asthmatic bronchitis was defined as a combination of asthma and COPD. For the first time, asthma and COPD were officially defined as unique diseases.

Also, it was well known during the 1950s and 1960s that COPD was caused by cigarette smoke. So, in 1962, Donald O. Anderson and Benjamin Ferris reported in the New England Journal of Medicine the results of a study performed in Berlin clearly linking the effects of cigarette smoke with chronic bronchitis.

1964. In the November issue of American Journal of Public Health, Donald O. Anderson said, “There seems little doubt whatever that cigarette smoking, and to a lesser extent other forms of tobacco smoking, are associated with mortality from lung cancer. This association has been amply demonstrated by both case history and cohort studies in a variety of countries and has been thoroughly summarized at countless symposia and in innumerable review articles. The controversy, instead, is whether this association has the attributes of a cause-effect relationship..”

1965: William Briscoe became the first person to use the term COPD at the 9th Aspen Emphysema Conference.

2001. Pauwels, et al, 2001, defined COPD as chronic airflow obstruction, or airflow limitation, due to airway obstruction that progressively worsens over time and is only partly reversible (compared with asthma, which is considered to be completely reversible with medicine or time). This was the first time COPD was defined based on physiologic criteria, as opposed to clinical or anatomic criteria.

2004: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) went with the definition of COPD as defined by Pauwels, et al, in 2001. Since then COPD has been considered a disease of airflow limitation.

2006: COPD is the 4th most common cause of death in the United States, and, among the top five causes of death, is the only one rising in morbidity and mortality.

2013: According to the CDC, COPD becomes the 3rd leading cause of death in the United States, surpassing accidents and strokes, and close behind heart disease and cancer.

References::

1. Klotz, Oskar, Wm. Charles White, ed., "Papers on the Influence of Smoke on Health," Bulletin #9, 1914, page 36