Definition, epidemiology, course, and prognosis of COPD

Chronic obstructive pulmonary disease (COPD) is now recognized as our nation's most rapidly growing health problem. It ranks as the 4th most common killer and is the only disease in the top 10 whose rank is rising. In 2000, more women than men (59,936 vs 59,118) died of COPD (1). The National Heart, Lung, and Blood Institute has calculated that in 2001, COPD was a $34.4 billion burden on society (both direct and indirect costs) (2). Two new initiatives, the National Lung Health Education Program (NLHEP) (3,4) and the Global Initiative for Chronic Obstructive Lung Disease (5), promote the early diagnosis and intervention of COPD. Both initiatives offer guidelines for the care of patients with all stages of COPD. The NLHEP recommends spirometry in all current or former smokers age > or = 45 years and anyone with symptoms of chronic cough, excessive dyspnea on exertion, or wheezing (6). "Test your lungs, know your numbers" is the motto of the NLHEP. Most patients with COPD are first seen by their primary care practitioner well before symptoms or signs of moderate-to-advanced stages of the disease are present. Thus, the primary care practitioner, working on the front line, is in the position to make a difference in the treatment and outcome of this devastating disorder.