Thurlbeck W M
Chest. 1977 Sep;72(3):341-9. doi: 10.1378/chest.72.3.341.
This report questions several commonly used definitions and commonly accepted concepts. It suggest that the term, "chronic airflow obstructions," should replace the terms, "chronic obstructive pulmonary disease," "chronic obstructive lung disease," or "chronic airway obstruction," because it is flow that is obstructed. It is suggested the term, "chronic mucous hypersecretion," be used, rather than "chronic bronchitis," and that the latter be avoided. Chronic bronchitis should not be equated with narrowing of the airway and emphysema with loss of elastic recoil. Chronic bronchitis, emphysema, and lesions of the small airways probably occur together more frequently than chance will allow because of a common etiologic agent, tobacco smoke. Chronic mucous hypersecretion without other airway or parenchymal lesions seldom produces airflow obstruction and does not impair prognosis significantly. Central airways are important in chronic airflow obstruction. It is time that someone found out what is happening in subjects with abnormal results on tests of the function of small airways. The definition of "destruction" as it occurs in emphysema is deceptive, and loss of recoil and emphysema may be separate conditions. The dysfunction that occurs in emphysematous lungs is due mainly to associated airway lesions and may perhaps be due in part to the site and nature of emphysematous lesions (as opposed to loss of elastic recoil).
本报告对几个常用定义和普遍接受的概念提出了质疑。报告建议用“慢性气流阻塞”一词取代“慢性阻塞性肺疾病”“慢性阻塞性肺病”或“慢性气道阻塞”等术语，因为阻塞的是气流。建议使用“慢性黏液高分泌”一词，而非“慢性支气管炎”，并应避免使用后者。慢性支气管炎不应等同于气道狭窄，肺气肿也不应等同于弹性回缩丧失。由于共同的病因——烟草烟雾，慢性支气管炎、肺气肿和小气道病变同时发生的频率可能高于偶然情况。无其他气道或实质病变的慢性黏液高分泌很少导致气流阻塞，且对预后无明显影响。中央气道在慢性气流阻塞中很重要。是时候有人弄清楚小气道功能测试结果异常的受试者身上发生了什么了。肺气肿中出现的“破坏”定义具有误导性，弹性回缩丧失和肺气肿可能是不同的情况。肺气肿性肺中出现的功能障碍主要归因于相关的气道病变，也许部分归因于肺气肿性病变的部位和性质（与弹性回缩丧失相反）。
