[COPD: new insights]

Both morbidity and mortality due to chronic obstructive pulmonary disease (COPD) are increasing. In the Netherlands there are between 500,000 and 1 million patients. It has now been recognized that airway obstruction can be partially reversed and that inflammation and oxidative stress play a part in the pathophysiology. New disease outcome measures in scientific research and in the clinical setting include symptoms, quality of life, exacerbation frequency and changes in exercise tolerance. Bronchus-dilating medication is now the standard pharmacotherapy and at every stage of COPD bronchodilators administered by inhaler are advised. The introduction of long-acting beta2-agonists is an advancement in treatment. The long-term effects of tiotropium are awaited. Acetylcysteine seems to be indicated in frequent exacerbations or hyperinflation. Where non-medicinal treatment is concerned, nutrition, exercise and particularly stopping smoking are important. Company medical officers can give advice concerning work and the work situation. Home care, hospital admissions and medication are the main costs, particularly in more serious COPD.