21st century perspective on chronic obstructive pulmonary disease

The prediction that chronic obstructive pulmonary disease (COPD) will be the third leading cause of death worldwide by 2020 has enormous economic repercussions. Yet many issues and questions remain unresolved. For example, how can population studies of morbidity and mortality be viewed as comparable, without a worldwide consensus on the definition of COPD? How can the early diagnosis of COPD be improved? Why is it that only a minority of smokers develop COPD, despite tobacco smoking being the primary risk factor for chronic bronchitis and emphysema? How can the efficacy of smoking cessation interventions be improved? To what extent are the pathologic changes in the lungs reversible - and, if so, at what stage? And to what degree is it appropriate to emphasize the similar features of COPD and asthma? It is to be hoped that the emerging post-genomic and proteomic climate will facilitate the unlocking of the genetic substrate for COPD, and thus promote greater therapeutic specificity and efficacy.