One hundred years of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a new name for an old malady. The ancients included the disease under the rubric of “catarrh.” In modern times, COPD has come to signify a mixture of chronic bronchitis, asthmatic bronchitis, and emphysema (1, 2). Rarification of the lung in emphysema may progress to form bullae (Figure 1). Cigarette smoking has long been recognized as the predominant etiologic agent. Arterial hypoxemia, a frequent complication of COPD, can lead to pulmonary hypertension and cor pulmonale (Figure 2). Michaud, Murray, and Bloom have recently underscored the enormous national and global impact of COPD (3). The disease is the fourth most common cause of death, and the harmful effects of the disease extend beyond the lungs. The disease is prevalent worldwide and in 1993, the cost of health care for COPD was estimated to be of the order of $15 billion. Arterial hypoxemia, a frequent complication of lung disease, can lead to pulmonary hypertension and cor pulmonale. Neither the prevalence of the disease nor the mortality that it causes show signs of slackening.