Chronic obstructive pulmonary disease: on an exponential curve of progress

The last 50 years have witnessed major progress in our understanding of the underlying nature of chronic obstructive pulmonary disease (COPD) and approaches to care. During the last 10 years, however, there has been an explosive expansion of knowledge related to this disorder. Large-scale epidemiologic studies show that COPD is the fourth leading cause of death in the United States and will be the fifth leading health burden worldwide by the year 2020. We have also learned that COPD is an inflammatory disorder of small airways, which presents new opportunities for therapy involving interfering with the early components of the inflammatory cascade. Unfortunately, most clinicians fail to perform spirometric screening of at-risk individuals, so most patients first present with COPD during a sudden exacerbation of the disease. Worldwide interest is emerging in promoting earlier diagnosis and finding new pharmacologic interventions to halt the progression of airway and parenchymal damage. In this review, evidence is presented that we are on the upward limb of an exponential curve of progress in managing COPD, which will produce major advances in our ability to recognize and treat this disorder in its earliest stages.