The
development and evolution regarding COPD (emphysema) covers a few centuries.
In
the past, what was understood about
emphysema and the cause of the disease? How has our understanding
towards emphysema developed over the time?
Some of the early discoveries include :
→ In
1814, Charles Badham used the word ‘catarrh’
(disorder of inflammation of the mucous membranes in one of the airways or
cavities of the body) to refer to chronic cough and mucus hypersecretion.
Badham described chronic bronchitis as disabling disorders.
→ René
Laennec, a clinician, pathologist as well as a physician, described emphysema in
A treatise on the diseases of the chest, as below:
“The
disease which I designate by this title is very little known and has not
hitherto been correctly described by any author. I for a long time thought it
very uncommon, because I had observed only a few cases of it: but since I have
made use of the stethoscope, I have verified its existence as well on the
living as the dead subject, and am led to consider it as by no means
infrequent. I consider many cases of asthma, usually deemed nervous, as
depending on this cause. The chief reason of this affection having been so
completely overlooked is, that it is in some sort merely the exaggeration of
the natural condition of the viscus. ”
“In opening the chest, it is not
unusual to find that the lungs do not collapse, but they fill up the cavity
completely on each side of the heart. When experienced, this will appear full
of air . . . . The bronchus of the trachea are often at the same time a good
deal filled with mucous fluid.”
He
dissected patients he studied during his life, and found out that emphysema
lungs were hyperinflated and did not empty well. Laennec was also the inventor
of stethoscope in 1816.
 |
| First drawing of stethoscope in 1819 |
 |
| Rene Laennec |
→ The
invention of spirometer in 1846 by John Hutchinson gave rise to effective means
of identification and assessment of the course of COPD and responses to therapy.
However, it is underused.
 |
| A modern USB-PC based spirometer |
→ William
Osler, who was called the Father of modern medicine, believed that emphysema
was caused by excessive pressure in the alveoli. However, in Osler’s
Principles and practices of medicine (1916), no mention on spirometer was included.
BONUS : The 1973 edition of "Diagnosis and
Treatment" (a standard medical textbook), states that emphysema is a
disease which involves destruction of the alveolar(lung) tissue but the cause
is unknown, although "many doctors" think it is caused by
"cigarette smoking". Some time subsequent to 1973, a genetic cause of
emphysema was discovered.
Similar
to the prediction back in the past, smoking is the leading cause of emphysema
as cigarette contains irritants which will damage the lungs and airways. Other
factors are also associated with long-term exposure to airborne irritants, such
as:
1.
Tobacco smoke
2.
Marijuana smoke
3. Air
pollution
4.
Manufacturing fumes
5. Coal
and silica dust
Inhalation and breathing in of these
irritants over a long period of time inflame and narrow the airways. Elastic
fibres that are responsible for the elasticity of the lungs are destroyed, affecting
its ability to stretch. A person who has had frequent and severe lung
infections, especially during childhood, may have a greater chance of
developing lung damage that can lead to emphysema.
Alpha-1
Antitrypsin deficiency is a rare, inherited cause of emphysema. Alpha-1
Antitrypsin is a protein that protects the elastic structures in the lungs. It
keeps white blood cells from damaging normal tissues. The condition of a smoker
with Alpha-1 Antitrypsin deficiency is much worse than a non-smoker as
emphysema progresses faster. People with Alpha-1 Antitrypsin develop emphysema
at a younger age compared to smokers.
Do
you know?
About 2 out of every 1,000 people have
an alpha-1 antitrypsin deficiency. People who smoke and have Alpha-1
Antitrypsin deficiency are almost certain to develop emphysema.
Frequent use of cooking fire without
proper ventilation is also a risk factor for emphysema.
References
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