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Chronic Obstructive Pulmonary Disease and something about its definition.

Posted Sep 16 2008 6:07am
Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, emphysema, or both. Its definition has evolved since a long time ago when it was recognized as a pure consequence of smoking cigarettes.Today, COPD is considered a more complex disease with different features not restricted to the pulmonary ones. Beyond the pulmonary results, it is clearly linked to systemic effects that may include cardiovascular comorbidities, gastrointestinal complications, muscle disfunction and pathological changes, central nervous system changes, as well as mental associated disorders.Unfortunately, its pulmonary features have dominated the definition giving room to confusion and space to doubts.Although cigarette smoking has been identified as its major risk factor, today it is clear that different factors are involved in its pathogenesis.The initial inflammatory process due to the continuous or intermittent exposure to noxious agents  is not completely clear. The start and end of those changes are not specified and this has led to repetitive mistakes in the approach to the disease. Is COPD an inflammatory disease? Is it a consequence of a previous inflammation? The response to this questions is still to be defined. It seems to have some similarities with other diseases where there was a inflammation, strong reaction, and some crisis during the course of the disease.So, what is COPD? COPD is a noxious gases related disease with continuous bronchospasm associated to imbalance in the protective mechanisms at the cellular level of the lungs with evolutionary changes given in airflow reduction, trapping of air in distal air spaces, and potential destruction of the gas exchange surface and showing periods of crisis characterized by different degrees of inflammation. Its progression would eventually lead to affection of other organs and general disability if it not well managed.Although this definition has many pathological features, more work is needed in terms of evolution, phenotypes, and comorbidities to progress in the understanding of a disease that has been considered a simple complication of smoking to become in a complicated condition still been studied.
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