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The Definition of COPD Is Changing

The definition of COPD is changing. This is good news, in a way. It kind of forces us to keep up on our COPD research. It keeps us on our toes. And it’s also a sign that researchers are working hard to learn about our disease. And as they learn more they occasionally have to tweak the definition.

Older COPD terms

We’ve already said goodbye to SOME antiquated terms. If you want, you can read my post, "What Are Blue Bloaters And Pink Puffers.” Those old terms are long gone, but sometimes still brought up. So, it sometimes takes time for people to accept changes the experts recommend. It takes time for old terms to fade away. (And sometimes they kind of linger. That’s normal.)

The latest change involves nixing the terms emphysema and chronic bronchitis. Can you believe that? I was kind of shocked the first time I heard it. But, I think it’s true enough now. I’ve seen it more than one place.

The most recent place I’ve heard it is the World Health Organization. They note:

“Chronic bronchitis and emphysema are terms that are no longer used and are now included within the COPD diagnosis.”1

We kind of saw this coming. Doctors hardly ever use these terms, unless they are describing certain physiological processes. When you're explaining what’s happening in COPD lungs, that’s when you pull out these old terms.

COPD as a combination of both emphysema and chronic bronchitis

Rarely do doctors say, “Well, he has emphysema.” Or, “Well, I think he has chronic bronchitis.” Usually, they say, “He has COPD.” And this is mainly because, as the experts note, most people with COPD have a combination of both emphysema and chronic bronchitis.

Now, one or the other may dominate. But, rarely do people have just one or the other. Usually, people with COPD have some degree of both. They both develop alongside one another. And they both may cause airflow limitation.

And, COPD is now defined primarily as persistent airflow limitation and persistent respiratory symptoms. These symptoms include coughing, sputum production, chest tightness, and shortness of breath. You can probably add wheezing in there too.

The new definition of COPD

“Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.”2

This is the new definition. It’s in the 2019 Global Initiative for Chronic Initiative for Obstructive Lung Disease (GOLD) COPD Guidelines.

The authors go on to explain why they left these old terms out. They note that chronic bronchitis, by definition, means cough and sputum production for 3 consecutive months for 3 consecutive years. This definition, they say, is useful clinically. But, it only defines a small number of people diagnosed with COPD. Plus, some people have chronic bronchitis symptoms without having airflow limitation. So, that’s kind of another thing the experts considered.

They note that emphysema, by definition, means “destruction” of gas exchange units (alveoli). They note this term is “often (but incorrectly) used” by doctors. But, “describes only one of several structural abnormalities present in patients with COPD.”2

Do you accept these changes to the COPD definition?

I kind of do. I mean, I think using terms like emphysema and chronic bronchitis are useful in describing what’s happening inside COPD lungs. But, these terms have been around a long time. They are ingrained in our heads. So, I don’t see them fading away overnight. Someday, I see the definition being further advanced. And, I wouldn’t be surprised if the name COPD is changed to something else entirely as well. I’m just saying. What do you think?

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