In chronic obstructive lung disease, an evolving dynamic mismatch of capillary bed perfusion with ventilation of airspaces appears possibly symptomatic of a central process of inflammatory injury to small airways early in childhood.  Subsequent development of the chronic obstructive lung disease simply constitutes an endresult of multiple progressive lesions that determine an association between hypoxia and carbon dioxide retention on the one hand and a subsequent evolving consequence of repeated acute attacks of chronic bronchitis.  A complex of acute infections in a patient suffering from chronic bronchitis adds to the progression of emphysematous changes and concurrent small airways disease characteristic of clinical disease that is definable as anatomic parenchymal lung disease.