[HTML][HTML] The pathogenesis of chronic obstructive pulmonary disease: advances in the past 100 years

SD Shapiro, EP Ingenito - American journal of respiratory cell and …, 2005 - atsjournals.org
SD Shapiro, EP Ingenito
American journal of respiratory cell and molecular biology, 2005atsjournals.org
In 1826, Laennec said of emphysema that “it consists simply in the dilatation of the air
cells”(1). Osler's 1892 Textbook of Medicine stated that hypertrophic emphysema, also
known as substantive or idiopathic emphysema,“is a well marked clinical affection,
characterized by enlargement of the lungs due to distention of the air cells and atrophy of
their walls, and clinically by imperfect aeration of the blood and more or less marked
dyspnea”(2). The pathologic description of chronic obstructive pulmonary disease (COPD) in …
In 1826, Laennec said of emphysema that “it consists simply in the dilatation of the air cells”(1). Osler’s 1892 Textbook of Medicine stated that hypertrophic emphysema, also known as substantive or idiopathic emphysema,“is a well marked clinical affection, characterized by enlargement of the lungs due to distention of the air cells and atrophy of their walls, and clinically by imperfect aeration of the blood and more or less marked dyspnea”(2). The pathologic description of chronic obstructive pulmonary disease (COPD) in this text was beautiful:“Grossly, the lungs are large, they have lost their elasticity, and to touch they have a peculiar downy, feathery feel, and pit readily against pressure…. In the larger tubes (bronchi) the mucous membrane may be rough and thickened from chronic bronchitis. Microscopically, there is seen atrophy of the alveolar walls, by which is produced the coalescence of neighboring air-cells.” Insights regarding etiology and pathogenesis were not as prescient. The prevailing hypothesis regarding pathogenesis was that air cells received heightened pressure during forced expiratory efforts. Support for this theory came from the contention that there was a high frequency of the condition in “players of wind instruments, in glass blowers, and in occupations necessitating heavy lifting or straining.” While our current understanding of COPD pathogenesis has progressed, this idea is not as dated as it seems. A recent accurate computer model of emphysema was generated by combining initial proteolytic damage of extracellular matrix in a centriacinar heterogeneous manner with subsequent respiratory forces that propagate this injury (Figure 1)(3).
ATS Journals