**2. Evaluating COPD in different contexts**

Perhaps more so than other common respiratory disorders such as bronchial asthma, the construal of COPD varies according to demographic, cultural, socioeconomic, geographical, and even political contexts. Patients' anamnesis and conceptions of the illness not only vary across the world but also according to the chronological period that the disease is diagnosed. Change in nomenclature has contributed somewhat to the latter. Nowadays, terms like "chronic bronchitis" and "emphysema" are less often used in clinical diagnosis, and in their place, the acronym COPD has become widely accepted across the globe by laymen and professionals. The benefit of standard terminology is not solely titular since the definition of the disease can only be agreed upon once everyone has accepted what it should be called, at least in clinical practice. For this, we are heavily indebted to the unifying work developed and continually updated by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) [3] in enabling clinicians and researchers to figuratively speak the same language. Some readers may recall an epoch when COPD was confusingly construed as overlapping conditions of chronic bronchitis, emphysema, and asthma within the confines of chronic airflow limitation. In appreciation of GOLD, standard definitions of COPD have been refined and gained widespread acceptance, thus fostering mutual understanding and expedient communication within the medical community.

Nonetheless, such universality in evaluating COPD tends to mask the particularity of COPD as it presents in various contexts. The term COPD confers varying connotations among diverse individuals and people groups. For instance, diagnosis of COPD will likely evoke more unease among people where the disease is less common than

in populations with shared predisposing factors leading to a high prevalence of the disease. Contrariwise, detecting COPD in younger patients and non-smoking women may prove challenging for a disease oft erroneously thought to be confined to older smoking men. A diagnosis of COPD made a decade or two ago does not conjure up the same notions compared to one recently established, as the rapid rate of advancement in medical knowledge may have a consequent impact on the minds of both the patient and the clinician. Two score and more years ago, diagnosis of the disease was often met with nihilism, as physicians had little to offer and diagnoses were delayed with scant attention paid to the early stages of COPD. Not much was known about the natural progression of the disease, save for a greater rate of decline in lung function among susceptible smokers compared to healthy adults. Currently, we know that that simplistic paradigm requires a reformation to accommodate multifactorial disease progression, with myriad contributory factors that may be present earlier in life, some even in childhood or *in utero* [4]. This paradigm shift goes some way toward answering the age-old question of why some smokers develop COPD but not others. With such advancement in knowledge, the stigma of COPD as a self-afflicted smoker's disease should also be done away with. In today's context, a diagnosis of COPD should no longer convey a sense of shame for the patient nor an attitude of sanctimony among others.
