COPD and Declining FEV1— Time to Divide and Conquer?

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Abstract
In 1976, Fletcher et al. published a monograph summarizing the results of an 8-year observational study of the relationship between cigarette smoking, chronic expectoration, and the development of irreversible airflow obstruction.1 At that time, the nomenclature for chronic obstructive pulmonary disease (COPD) was confusing. COPD was understood to include chronic bronchitis and emphysema, but the definitions of these two entities contained no mention of airflow obstruction. The clinical paradigm described patients as either “blue bloaters,” who had chronic airway inflammation and a propensity for resting hypercapnia, and “pink puffers,” who had airspace destruction and preserved resting arterial oxygenation.The study . . .