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A comprehensive search of the medical literature was performed from January 1985 to December 2006. The search, limited to human subjects and English language journals, included UpToDate, Ovid, MEDLINE®, PubMed, and the Cochrane Database of Systematic Reviews.


Chronic obstructive pulmonary disease (COPD) is a chronic disease of the airways characterized by significant morbidity and mortality. It represents a substantial, global economic and societal burden. COPD is the fourth leading cause of death in the United States and Europe and is projected to be the third leading cause of death for both men and women by 2020.1 In contrast to other leading chronic diseases including cardiac disease, cerebrovascular disease, and cancer, COPD is the only major disease with an increasing mortality. In the United States, 122283 patients died from COPD in 2003. It is estimated that 1.4 million Americans had COPD in 2004. The prevalence data is misleading because most patients with COPD do not seek medical attention until later in the disease course when their symptoms have become apparent. Unfortunately, by the time their symptoms arise, the disease is typically advanced. Women and whites have a higher incidence of the disease.2 Since 2002, more women have died from COPD than men. In 2003, more than 63000 women died of COPD compared to 59000 men.


The economic burden of COPD is high. In the United States, there were about 726000 hospitalizations for COPD patients and 1.5 million emergency-department visits in adults in 2000. In 2004, the disease cost the United States a sum of $37.2 billion, of which $20.9 billion were direct expenditures and $16.3 billion were indirect costs.3 Unfortunately, due to increasing cigarette smoking in adolescents, women, and those from developing countries as well as increases in population and life expectancy, further increases in the prevalence, morbidity, mortality, and economic burden of COPD are expected in the years to come.


Traditionally, the term COPD has referred to a number of different obstructive airway diseases including emphysema, chronic bronchitis, bronchiectasis, and cystic fibrosis. Today, the term COPD refers primarily to emphysema and chronic bronchitis or a combination of the two. Asthma is a separate entity with a distinct pathogenesis and pathology different from that of COPD. The pharmacotherapy of asthma has been discussed in Chapter 8.


Updated definitions of COPD have been provided by a number of medical societies and organizations. Of note, the terms emphysema and chronic bronchitis are no longer included in these definitions. The Global Initiative for Obstructive Lung Disease (GOLD) guidelines, a report prepared by a joint expert panel from the National Heart, Lung, and Blood Institute and the World Health Organization, defined COPD as “a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.”4 Another ...

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