The natural history of chronic airflow obstruction.

TLDR

Infective processes and chronic mucus hypersecretion do not accelerate chronic airflow obstruction, indicating that chronic airflow obstruction and hypersecretory disorders are largely unrelated. A prospective epidemiological study of early COPD development was conducted on London working men. FEV1 declines gradually with age, yet most non‑smokers and many smokers never develop clinically significant obstruction; in susceptible individuals smoking induces irreversible changes, but cessation halts further loss rates to normal. Severe or fatal obstructive lung disease could be prevented by screening smokers' lung function in early middle age and encouraging cessation in those with reduced function.

Abstract

A prospective epidemiological study of the early stages of the development of chronic obstructive pulmonary disease was performed on London working men. The findings showed that forced expiratory volume in one second (FEV1) falls gradually over a lifetime, but in most non-smokers and many smokers clinically significant airflow obstruction never develops. In susceptible people, however, smoking causes irreversible obstructive changes. If a susceptible smoker stops smoking he will not recover his lung function, but the average further rates of loss of FEV1 will revert to normal. Therefore, severe or fatal obstructive lung disease could be prevented by screening smokers' lung function in early middle age if those with reduced function could be induced to stop smoking. Infective processes and chronic mucus hypersecretion do not cause chronic airflow obstruction to progress more rapidly. There are thus two largely unrelated disease processes, chronic airflow obstruction and the hypersecretory disorder (including infective processes).