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
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
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 ...