Although humans have likely dealt with chronic obstructive pulmonary disease — an incurable and progressive disease that results from damage to the lungs making it progressively more difficult to breathe — for nearly as long as we’ve had lungs, descriptions of the condition didn’t begin showing up in medical literature until medieval times. (That’s probably at least partially because not much “medical literature” existed in the West prior to the Enlightenment, a philosophy of describing the world through science, which began in the late 17th century.)
According to a 2006 history of COPD in the International Journal of COPD written by Thomas L. Petty, a pulmonologist and professor of medicine at the University of Colorado Health Sciences Center in Denver who passed away in 2009, an early reference to emphysema came when Swiss physician Theophile Bonet described a patient’s “voluminous lungs” in 1679.
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The “voluminous lungs” Bonet observed likely referred to the penchant of emphysemous lungs to trap air and prohibit the lungs from expelling spent air. This makes it difficult to draw in fresh air and can lead to big problems for the patient. An article on the Cleveland Clinic website describes how damaged air sacs (alveoli) create this problem: “When emphysema develops, the alveoli and lung tissue are destroyed. With this damage, the alveoli cannot support the bronchial tubes. The tubes collapse and cause an ‘obstruction’ (a blockage) which traps air inside the lungs. Too much air trapped in the lungs can give some patients a barrel-chested appearance.” What’s worse than the change in appearance is the reduction of oxygen that can be extracted from each breath and delivered to other tissues in the body because of the reduction in the number of functioning alveoli.
In 1769, 90 years after Bonet first described emphysemous lungs, Giovanni Battista Morgagni, the Italian anatomist and physician who’s regarded as the father of modern anatomical pathology, described 19 cases “in which the lungs were ‘turgid,’ [swollen and distended] particularly from air,” Petty writes. These were also likely cases of emphysema, even though smoking, the most common cause of emphysema, was not a widespread practice yet. The lung damage in the patients Morgagni encountered likely resulted from exposure to smoke from cooking fires or other airborne irritants.
In 1789, Matthew Baillie, a Scottish-born physician and pathologist, published illustrations of an emphysematous lung thought to belong to the famous English writer Samuel Johnson, Perry writes. Johnson was perhaps best known for “A Dictionary of the English Language,” and had childhood tuberculosis scrofula (an infection in the lymph nodes of the neck caused by a bacterium related to the one that causes tuberculosis of the lungs) and several other severe health problems. He died in 1771, and forensic readings of the autopsy that were published in the mid-1990s indicate he probably had pulmonary fibrosis, a condition that exhibits many of the same symptoms as COPD.
The Mayo Clinic website describes pulmonary fibrosis as a “lung disease that occurs when lung tissue becomes damaged and scarred. This thickened, stiff tissue makes it more difficult for your lungs to work properly.” As with COPD, pulmonary fibrosis is not reversible, and as the disease progresses, shortness of breath, coughing and fatigue increasingly become problematic.
Clinical understanding of chronic bronchitis, the other primary disease that’s classified under the COPD umbrella today, began in 1814 with the work of Charles Badham, a British physician “who used the word catarrh to refer to the chronic cough and mucus hypersecretion that are cardinal symptoms,” Perry writes. Badham is credited with describing “bronchiolitis and chronic bronchitis as disabling disorders.”
Refinement of medicine’s understanding of diseases of the lung came in 1821 from French physician and inventor of the stethoscope, Rene Theophile Hyacinthe Laënnec. Based on the sounds he could now hear inside his pulmonary patients, Laënnec added diagnostically useful descriptions for a range of conditions, including emphysema and chronic bronchitis.
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William Stokes, an Irish physician who furthered our understanding of cardiac and pulmonary disease with his two works, “Treatise on the Diagnosis and Treatment of Diseases of the Chest” (published in 1837) and “The Diseases of the Heart and Aorta” (published in 1854), is credited with coining the term chronic bronchitis. The Lung Institute reports that to Stokes, “chronic bronchitis was the inflammation of the mucus membrane which caused the cells to dilate, making it harder to breathe. Stokes believed that some form of bronchitis was evident in nearly all diseases of the lungs (asthma, pneumonia, etc.).”
In 1846, John Hutchinson, a British physician who emigrated to Australia in 1852, invented the spirometer. “The spirometer is key to the diagnosis and management of COPD, yet its use is still poorly applied to the diagnosis and management of COPD in most locations in the world today,” Perry writes.
Some 100 years later Robert Tiffeneau, a French pharmacologist who’s often noted as being a pioneer in the field of pulmonology, would further refine the instrument to measure airflow in addition to volume, making it the diagnostic tool it is today. A 2006 editorial in the journal Allergy noted that Tiffeneau developed the FEV1 ratio, a designation that may look familiar to today’s COPD patients as it’s commonly used to determine the stage and severity of COPD.
Two “landmark meetings,” in 1959 and 1962, “defined the components of COPD, which are the foundation of our definitions today,” Perry writes. William Briscoe, the London-born physician who became the head of the pulmonary division of the New York Hospital-Cornell Medical Center, “is believed to be the first person to use the term COPD in a discussion at the 9th Aspen Emphysema Conference” in 1965. That term stuck, but if you ever come across the terms chronic obstructive bronchopulmonary disease, chronic airflow obstruction, chronic obstructive lung disease, nonspecific chronic pulmonary disease or diffuse obstructive pulmonary syndrome, these were all earlier descriptions of COPD.
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Since the 1960s, advancement of our knowledge of COPD has focused on the mechanisms that cause it and how to improve treatment. The 1960s also marked the peak in popularity for cigarette smoking, which we now know is the number one cause of COPD. As those smokers have aged, many of them have developed COPD, and this is projected to lead to a COPD epidemic in the near future. The World Health Organization warns that “total deaths from COPD are projected to increase by more than 30 percent in the next 10 years unless urgent action is taken to reduce the underlying risk factors, especially tobacco use. Estimates show that COPD becomes in 2030 the third leading cause of death worldwide.”
The hope is that the more scientists can build on the knowledge gained by past researchers about this disease, they’ll be able to develop new and better treatment options in the future. Although the disease is not currently curable, there are many ways to manage it, so see your doctor for the latest in treatment options and support if you’re dealing with this challenging illness.
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How Long Has COPD Been Around? originally appeared on usnews.com
