CHRONIC BRONCHITIS, EMPHYSEMA. AND ASTHMA H. W1illiam Harris, M.D. THIS REPORT will present current con- cepts of certain of the common chronic respiratory diseases with em- phasis on their natural history and diag- nosis. Although there are many impor- tant chronic respiratory diseases, atten- tion will be directed principally to chronic bronchitis, pulmonary emphe- sema, and bronchial asthma, because of their prevalence and particular signifi- cance. Chronic Bronchitis The term "chronic bronchitis" has been used in Great Britain for many years to define the clinical condition of individuals with chronic cough and ex- pectoration with or without shortness of breath. In the United States, however, clinicians less often diagnose "chronic bronchitis." Individuals who have only cKonic cough and expectoration seldom cohsult a physician with these com- plaints; if they have dyspnea as well, pulmonary emphysema, bronchial asthma, or heart disease is more often diagnosed than is chronic bronchitis. This difference between the United States and Britain in the use of diag- nostic terms has resulted in differences in the morbidity and mortality rates of these diseases in the two countries. Be- cause of the high prevalence of chronic bronchitis in England and Wales, in the past it has been considered to be an "English disease." The English phy- sician's willingness to diagnose chronic bronchitis stems largely from tradition, whereas, physicians in the United States have demonstrated reluctance to use this diagnostic term, perhaps with concern that more serious disease, such as bron- chogenic carcinoma, or more remediable pulmonary disease, such as tuberculosis, at times leading to symptoms indis- tinguishable from those of chronic bronchitis might be overlooked. The confusion as to nomenclature has been rectified somewhat by recent at- tempts to define these conditions as pre- cisely as possible. A group of dis- tinguished English chest physicians meeting in a Ciba Symposium' pub- lished their concepts of "chronic bron- chitis" along with other definitions and diagnostic standards for the chronic pul- monary diseases in this general group. More recently,2 the American Thoracic Society Committee on Diagnostic Stand- ards in Non-tuberculous Respiratory Diseases suggested definitions and diag- nostic standards for these disorders. Both groups defined "chronic bronchitis" similarly as a clinical disorder charac- terized by excessive mucous secretion in the bronchial tree. According to the ATS definition, chronic or recurrent cough should be present on most days for a minimum of three months in the year and for not less than two successive years. Many diseases of the lung (e.g., tuberculosis, abscess), of the bronchial tree (e.g., tumors, bronchiectasis), and certain cardiac diseases may cause iden- tical symptoms; furthermore, patients with chronic bronchitis may have other pulmonary or cardiac diseases as well. Thus, the diagnosis of chronic bron- chitis can be made only by excluding these other bronchopulmonary or car- diac disorders as the cause for the symp- MARCH, 19963 7
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