Evaluation of symptomatic patients without airflow obstruction: back to the future

Abstract

Throughout recent decades, the concept of chronic obstructive pulmonary disease ( COPD ) has been evolving from initial clinical observations of single cardinal symptoms and morphological manifestations in the form of chronic bronchitis and emphysema . The 1959 CIBA Guest Symposium defined chronic bronchitis and emphysema in clinical and anatomic terms respectively. Although neither definition used any physiologic criteria, COPD is now defined in functional terms. According to current criteria, COPD is diagnosed in relation to the appearance of an airflow obstruction that is not fully reversible and the history of tobacco exposure (1). Although symptoms help the clinician to suspect the disease (2), the final individual diagnosis relies on a confirmed risk exposure in the medical record and the presence of this non-reversible airway obstruction (1).