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The pathology of chronic obstructive pulmonary disease

Published on January 31, 2013   43 min

A selection of talks on Respiratory Diseases

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This talk is on the pathology of Chronic Obstructive Lung Disease. My name is Jim Hogg, and I'm from Vancouver in Canada.
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This is from a famous study conducted by Fletcher and his associates on London postmen, where they followed a group of people over the course of six to seven years and followed the progression of their forced expiratory volume (FEV_1) in one second. That refers to the volume of air you can blow out of your lungs in one second, you blow as hard and as fast as you can and it's a measurement of how well you empty your lungs. This indicates the GOLD classification of the severity of chronic obstructive pulmonary disease (COPD). It was named by a committee that had the acronym, GOLD for Global Obstructive Lung Disease and divided into four categories of severity. You can see from the top curves, which are normal people and non-smokers, their FEV_1 declines with age. That happens in everybody and it is a function of getting older. The bottom one of the three represents what happens to most people when they smoke, and the middle curve represents what happens to nonsmokers if they've smoked for a long period of time and then stop for a long period of time, they go back towards the normal decline. Not absolutely the same, but it's close to that. Now, GOLD 1 is the mildest form of the disease, and at this level of the disease, that person doesn't really know that there's anything wrong. But you can see this bottom curve, which is the next step, indicates that importantly, many people don't get to the very maximum they should get to at age 25 when you're supposed to be at your very best because they've either been born prematurely or they've had a childhood infection that has done something to their lungs. Now, they become in this group of what we call the susceptible minority, who are usually smokers but can be people that have been exposed to other things, other aerosols. Most commonly of the others, is in the developing world, where people, mostly women, are exposed to smoke from cooking fires and that is an enormous factor in causing COPD. There is this susceptible minority that have a rapid decline in their FEV_1. The real reason for that is not known. But the pathology is such that we think that they lose their airways at a faster rate than normal and that that causes this rapid decline to occur.

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The pathology of chronic obstructive pulmonary disease

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