Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality throughout the world. It is the fourth commonest cause of death in the United States after ischaemic heart disease (IHD), cancer and cerebrovascular disease. Unlike IHD and cancer, however, COPD suffers from an 'image problem'. Surely no other disease of similar impact can have as many different names—chronic obstructive airways disease, chronic obstructive lung disease, chronic bronchitis and emphysema, to name a few. Similarly, personal experience suggests that only a minority of patients know the name of the disease from which they suffer. The precise definitions used to diagnose the condition are open to contention and debate, based on assessment of symptoms and interpretation of spirometry. As the most important aetiological factor is smoking, the disease is often regarded as self- inflicted — and in turn, patients are at times viewed less sympathetically than those with malignancy, for example.

Despite the difficulties that arise from varying nomenclature and definitions, there is no doubt that COPD has a major impact on global health, particularly in the developed world. This chapter seeks to address the following issues:

• Does all COPD result from smoking?

• Other aetiological factors in the pathogenesis of COPD

• The global impact of COPD

• The natural history of COPD

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