The dimensions of the chronic respiratory disease problem.

Abstract

CHIIONIC respiratory disease, with the exception of pulmonary tuberculosis, has until recently been one of the most neglected disease categories in the modern practice of medicine.J To recognize the accuracy of this statement one has only to examine the evolution of our knowledge of bronchogenic carcinoma and other major chronic respiratory diseases. As late as three or four decades ago the physician and pathologist considered bronchogenic carcinoma a rare entity and failed to recognize its primary site or pulmonary origin. Instead, it was described as arising in the adjacent mediastinal structures, or was thought to be metastasized from what was later found to be its own metastases. Another example one might mention to illustrate this point would be pulmonary emphysema. Fifteen to twenty years ago emphysema was known as a clinical entity, but for practical purposes individuals were classified as those in whom the condition was marked by severe disabling symptoms and signs, and those in whom it was not. Various gross classifications were proposed, usually based on the posture of advanced emphysema patients now known to be the effect rather than the cause and certain roentgenographic or gross anatomical manifestations such as the presence of blebs or bullae or the absence of vascular markings, the socalled vanishing lung. It has been only in the past decade that the pathologists and anatomists have focused their attention on the significance of the primary lobule as the anatomical unit of the lung of particular importance in emphysema. and have offered a reasonable scientific classification of the disease. Histopathologic studies, coupled with recent advances in technics for testing pulmonary function, have called attention to the fact that emphysema is truly a chronic progressive disease, but that in many instances it may be arrested or its progression delayed, if detected early and proper measures are taken. Bronchial asthma, on the other hand, represents the one chronic respiratory disease concerning which we have accumulated detailed clinical information. This is largely due to the early discovery of bronchodilating hormones and drugs, such as epinephrine and ephedrine, for the relief of patients, and which have made possible laboratory and clinical investigation. This factor, which also stimulated and paralleled the advances made in the field of allergy during the past few decades, was responsible for our more extensive clinical knowledge of this disorder. However, paradoxical as it may seem, less statistical information is available on bronchospasm and asthma than for many of the other common chronic respiratory diseases. Chronic bronchitis, prior to the diagnostic advances of the past eight or nine years, represented one of the most perplexing diagnostic and clinical classification problems in the entire chronic respiratory disease field. As a surgeon, I can state frankly that for years the thoracic surgeons in this country and