Chronic obstructive pulmonary disease past, present and future

Chronic obstructive pulmonary disease (COPD) is a topic of clinical concern and active research that is strongly represented at the meetings of the British Thoracic Society and in Thorax. This has not always been the case and, for rather different reasons, this disease may not be as important in future decades because the impact of COPD—at least in the developing world—should finally diminish over the next 20 years. This reflects the demographics of smoking cessation and the availability of more effective treatments to reduce the impact of this condition. The problems with COPD are not as current as is often stated. Necropsy data from the late 18th century identified the pathological features of emphysema while the clinical associations of this condition were described by René Laennec in his treaties on diseases of the chest in 1819. However, the slow pace of the illness and its lack of dramatic physical signs delayed our appreciation of its importance.

In the 20th century three partly related developments changed this. The first was the impact of warfare, specifically the use of toxic gases in World War I which stimulated research on pulmonary gas exchange. In World War II the need to fly at high altitudes without the pilots blacking out led to a renaissance of respiratory physiology which had its full impact when the relevant research was declassified at the end of hostilities. The ability to make objective measurements has transformed our understanding of COPD and coincided with a time when clinicians became aware of its importance, partly because of the accelerated death rate from respiratory causes including “bronchitis” after the 1952 London smog which linked impaired air quality very clearly with respiratory death. Additionally, Sir Richard Doll began his studies into the causes of death from …