[Chronic obstructive pulmonary disease (COPD) and its future]

Chronic obstructive pulmonary disease (COPD) is an important health problem in all countries of the world with its high and steadily increasing mortality, morbidity and prevalence. The disease has long been ignored due to the fact that smoking which is known as an important factor in the development of the disease could not be taken under control throughout the world and due to misperceptions that the disease is progressive and irreversible. In recent years with the understanding that COPD is a global health problem and that it creates increasing socioeconomic burden, the disease became the focus of scientific circles and pharmaceutical industry. Together with better understanding of the disease and the significant advances in its treatment, COPD patients are being approached more optimistically, while the disease is being defined and treated more comprehensively. Yet, it is a fact that COPD has not yet been fully understood and discussions regarding how to define and treat the disease are ongoing. Our knowledge about the risk factors other than smoking responsible from development of COPD, the pathogenesis of the disease, its clinical course, phenotypes, comorbidities and treatment is limited. Currently we have important advances in the treatment of COPD such as the use of long acting anticholinergics and beta- 2-agonists, inhaled steroids and non-pharmaceutical treatments like pulmonary rehabilitation that have to be in use throughout the life time of the patient as main components of therapy. However, in response to severe socioeconomic burden of the disease, in addition to using the available treatment options in full scope there needs to be new therapeutic possibilities that could modify the disease course as well as more effective smoking cessation strategies. We also need new and effective paradigms while trying to understand the pathobiology and the clinical course of COPD and evaluating the benefits of treatment approaches. In future, the development of new treatment paradigms that can make comprehensive use of our knowledge about COPD pathophysiology will gain utmost importance. Thus, the disease will be better treated while treatment effects will be better assessed.